# Buprenorphine Facilitates Rapid Weaning From Very-High-Dose Intrathecal Hydromorphone

## TL;DR

Two patients with severe chronic pain were successfully weaned off high-dose intrathecal hydromorphone using low-dose buprenorphine, improving their pain and function.

## Contribution

Demonstrates the potential of low-dose buprenorphine for rapid weaning from high-dose intrathecal opioids.

## Key findings

- Patients were weaned off 20 mg/day intrathecal hydromorphone using buprenorphine.
- Buprenorphine led to significant pain and functional improvement without opioid dependence.
- This approach offers a novel strategy for managing chronic opioid use in clinical practice.

## Abstract

Pain management in patients on chronic opioid therapy is a common clinical challenge. The phenomena of opioid-induced hyperalgesia and tolerance are important contributors to that challenge. There are multiple strategies described to wean opioid doses and/or transition patients off opioids altogether. However, there is very little data to guide transitions off chronic intrathecal opioids. Here, we report on two patients with intractable post-laminectomy pain syndrome, resulting in severe functional limitation in the setting of opioid escalation culminating in the intrathecal delivery of hydromorphone to daily doses as high as 20 mg/day. We describe their rapid successful weaning off opioids using low-dose buprenorphine, which resulted in a dramatic improvement in pain and function.