OUD: chronic pain not influenced by switch to opioid antagonist or agonist

  • Latif ZE & al.
  • Am J Addict
  • 31 Jan 2019

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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  • Patients with chronic pain and opioid-use disorder (OUD) did not experience any increase in pain after switching from daily opioid use to either extended-release naltrexone (XR-NTX) or buprenorphine-naloxone (BP-NLX).
  • In a longer follow-up, patients who switched from maintenance therapy with daily BP-NLX to maintenance with XR-NTX also reported no increase in pain.

Why this matters

  • This is the first study to compare the effects of XR-NTX and BP-NLX on chronic mild to moderate pain in opioid-dependent patients and challenges the perception that XR-NTX and other opioid antagonists may aggravate pain in opioid-dependent patients with chronic pain.

Study design

  • 143 participants (age, 18-60 years) with chronic pain and opioid dependencies evaluated.
  • After opioid detoxification, patients were randomly allocated to either intramuscular XR-NTX (380 mg every fourth week) or sublingual BP-NLX (4-24 mg daily) for 12 weeks, followed by 36 weeks of follow-up, in which participants chose treatment with either drug.
  • Funding: Research Council of Norway.

Key results

  • Between weeks 4 and 12, no significant difference in mean present pain intensity, visual analogue scale, or sensory and affective pain scores was observed within treatment groups.
  • After week 12, participants who switched from BP-NLX to XR-NTX treatment reported no increase in pain intensity during longer-term treatment.


  • Open-label study.

Coauthored with Antara Ghosh, PhD

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