Pain is a prevalent condition in patients with cancer, particularly in advanced stages of cancer. Although strong opioids are the mainstay of cancer pain management protocols,patients are often undertreated. Transdermal buprenorphine is currently available for the treatment of moderate to severe cancer pain and severe pain which does not respond to nonopioid analgesics; patch doses of 35, 52.5 and 70 μg/h are available (applied for up to 96 h), with no more than 2 transdermal patches at the same time, regardless of the strength.
To date, there are no published reports in the literature of the use of high-dose transdermal buprenorphine (>140 μg/h). Herein, we present 2 cases of palliative cancer patients who received transdermal buprenorphine at doses titrated up to 210 and 175 μg/h, respectively, for the management of pain. Transdermal buprenorphine titrated to doses >140 μg/h provided adequate pain control and was well tolerated. Future studies to confirm these initial
observations are warranted.