Nalbuphine safe, effective for severe chronic pain

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Nalbuphine (Nubain) effectively reduces long-standing debilitating pain from a variety of causes and conditions without inducing any observable withdrawal symptoms, according to a report on a series of patients treated at the Veterans Affairs Medical Center Pain Clinic in Fayetteville, North Carolina.

Nalbuphine relieves pain almost as well as morphine does, but without the euphoria, sedation, tolerance, or psychological effects associated with opiates, Dr. James S. Howard, III, explains in his report in the American Journal of Pain Management. Furthermore, it does not stimulate the immune system or depress respiration.

The diagnoses in the 14 men and 11 women included in the study were pain from degenerative disease or herniation of the lower back or neck, chronic severe migraine, fibromyalgia, and chronic severe pain from traumatic crush injuries to the spine, pelvis, arms or legs.

The average duration of pain was six years, during which time patients experienced an average of three pain-related hospital admissions for surgery. All of the patients rated their average pain levels as unbearable, scoring 8 to 10 on a pain scale.

Nalbuphine was prescribed in doses ranging from 10 to 20 mg three to four times daily. The drug has to be injected under the skin, into the muscle or intravenously.

After the treatment regimen was established, the patients rated their average pain levels as bearable, with scores of 2 to 3. Men tended to require larger doses than women for adequate relief.

Many of the patients have now been treated with nalbuphin for several years without requiring an increase in dosage or medication switches. Many report that they’ve been able to return to work, without experiencing mobility problems, sedation or difficulty concentrating.

Howard also notes that nalbuphine has been used in his clinic to treat patients with rheumatoid arthritis and osteoarthritis, cancer-related pain, and pain from traumatic bone, nerve and deep-tissue injuries.

He concludes: “It appears that the daily use of injectable nalbuphine may offer a new and worthwhile alternative in the long-term management of severe chronic pain.”

SOURCE: American Journal of Pain Management, January 2006.

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