Safety of Buprenorphine for Cancer Related Pain in Pregnancy: A Case Series

Document Type

Conference Proceeding

Publication Date

5-1-2025

Publication Title

J Pain Symptom Manage

Abstract

Outcomes: 1. Recognize buprenorphine as a safe option to treat cancer related pain in pregnancy for both mother and fetus. 2. Consider the utilization of different analgesics in treating cancer related pain in pregnancy. Key Message: Current evidence supports the safety and efficacy of buprenorphine for maternal opioid use disorder; however, there are no established guidelines for its use to manage cancer-related pain in pregnancy. We present three cases demonstrating the safe use of buprenorphine achieving varying levels of analgesia for cancer related pain in pregnant women. Opioids are often the mainstay of treatment for cancer related pain; however, managing cancer related pain in pregnancy can present challenges due to associated risk to the fetus in utero. Evidence supports the use of buprenorphine for opioid use disorder (OUD) treatment during pregnancy; however, there are no best practices or guidance established in this population for cancer pain management. Here we present three cases where buprenorphine products were utilized to manage cancer related pain in pregnancy. Patient A, a 36-year-old G3P2 female with a metastatic neoplasm of the pancreas, achieved pain control at 27 weeks gestation on buprenorphine films. Her baby did not experience any neonatal abstinence syndrome (NAS) at birth. Patient B, a 32-year-old female with pancreatic cancer, started on full agonist opioid therapy at 25 weeks gestation, received a celiac plexus block and eventually buprenorphine, but switched back to full agonist opioid therapy before delivery at 32 weeks. Her baby required morphine for NAS after birth. Patient C, a 26-year-old female with stage IV lung cancer with metastasis to liver and adrenals, was started on a buprenorphine transdermal patch at 24 weeks gestation and then transitioned to hydromorphone PCA at 31 weeks before delivering at 32 weeks. Baby C required treatment for NAS after birth. In our experience, buprenorphine is safe to use in pregnancy for both mother and fetus but may not always be tolerated or provide appropriate and timely analgesia. Our recommendation is a tailored approach to each pregnant patient with cancer related pain. Given buprenorphine's safety to both mother and fetus and ACOG's stance on OUD in pregnancy supporting use of buprenorphine, we recommend considering its use as first line treatment for cancer related pain during pregnancy. References: Suarez, E. A., Huybrechts, K. F., Straub, L., Hernández-Díaz, S., Jones, H. E., Connery, H. S., Davis, J. M., Gray, K. J., Lester, B., Terplan, M., Mogun, H., & Bateman, B. T. (2022). Buprenorphine versus methadone for opioid use disorder in pregnancy. New England Journal of Medicine, 387(22), 2033–2044. https://doi.org/10.1056/nejmoa2203318 Opioid use and opioid use disorder in pregnancy. Committee Opinion No. 711. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e81–94.

Volume

69

Issue

5

First Page

e565

Last Page

e566

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