VA, DoD guidelines recommend buprenorphine for chronic pain, not full agonist opioids

Buprenorphine may be used for patients taking daily opioid analgesics for chronic pain, according to new guidelines from the Department of Veterans Affairs (VA) and the Department of Defense (DoD).

Buprenorphine’s lower risk of misuse or overdose compared with full agonist opioids make it a safe option, according to the guidelines.

“The benefits that opioids can provide are small and are outweighed by the risks to the patient,” wrote authors of guidelines in the Annals of Internal Medicine. “If the decision is made to use long-term opioid therapy for a patient, then buprenorphine should be considered because of its lower risk profile.”

Authors of the updated guidelines also suggest that all chronic pain patients undergo behavioral health evaluations and receive preoperative education on opioids and pain management.

The research team also developed three 1-page algorithms to help guide clinical decision-making.

“The guideline development group identified that more studies are needed examining the comparative effectiveness of different analgesic agents, the effectiveness of different tapering strategies, and the effectiveness of different risk mitigation strategies on the management of patients receiving long-term opioid therapy,” the authors wrote.

Officials at VA and DoD approved the joint clinical practice guidelines in May 2022. A guideline development group relied on data from a systematic evidence review and evaluated the evidence and recommendations as strong or weak before coming to this conclusion.