Pain medicine : the official journal of the American Academy of Pain Medicine
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Observational Study
Dose patterns among patients using low-dose buprenorphine patches.
The objective of this study was to investigate the dose pattern of low-dose buprenorphine patches among patients in Swedish clinical practice. The clinical experts among the coauthors interpreted the results in relation to possible indications of development of tolerance and/or dependence/addiction. ⋯ The average dose increased by 4 μg/h during the patients' treatment course, which lasted on an average of 260 days. From a clinical perspective, the dose increase of 4 μg/h is low and does not suggest dependence/addiction, as also supported by the low proportion of patients remaining on continuous treatment.
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The discovery of neuroplastic phenomena such as central sensitization of nociception has challenged pain theory to evolve, to encompass unpredictable and unlikely chronic pain states, and to cope with the emerging complexity of the brain. Recently, the proposition that chronic pain is a disease in its own right has gained currency, based upon functional and structural changes in the brain constituting a distinctive pathology. Proponents have expanded the theory to identify "eudynia" ("good" pain) and "maldynia" ("bad" pain). ⋯ The proposition that chronic pain is a disease cannot be supported on clinical and pathological grounds, as well as in terms of ways of knowing. The promulgation of "good" and "bad" pain has the potential to obstruct necessary dialogue for advancing the science and treatment of pain. We suggest a way forward to resolve this impasse.