Nalbuphine A Safe, Effective Long-Term Therapy for Severe Chronic Pain

NEW YORK JAN 24, 2006 (Reuters Health) - Nalbuphine (Nubain) effectively reduces long-standing debilitating pain from a variety of causes and conditions without inducing any observable withdrawal, according to a report on a series of patients treated at the Veterans Affairs Medical Center Pain Clinic in Fayetteville, North Carolina.

Nalbuphine achieves analgesia almost equivalent to morphine but without the euphoria, sedation, tolerance, or psychotomimetic effects associated with opiates, Dr. James S. Howard, III, explains in his report in the American Journal of Pain Management for January.  Furthermore, it does not stimulate mast cell histamine release or depress respiration.

The diagnoses in the 14 men and 11 women included pain from "degenerative lumbar and/or cervical disc herniation with or without radicular pain, chronic severe migraine, fibromyalgia, and chronic severe pain from traumatic orthopedic crush injuries to the spine, pelvis, or extremities." 

The average duration of pain was 6 years, during which patients had experienced an average of three pain-related hospital admissions for surgery.  All of the patients rated their average pain levels as unbearable (8 to 10 on a visual analog scale).

Nalbuphine was prescribed in doses ranging from 10 to 20 mg three to four times daily.  The drug has to be injected, either subcutaneously, intramuscularly, or intravenously.

After establishment of this regimen, the patients rated their average pain levels as bearable (2 to 3 on a visual analog scale).  Men tended to require larger doses than women for adequate relief.  Many of the patients have been treated with nalbuphin for several years without requiring dose escalation or medication switches.  Many report that they"ve been able to return to work, without experiencing motor impairment, sedation or difficulty concentrating.

In addition to the indications listed above, Dr. Howard notes that nalbuphine has been used at 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:

• Am J Pain Manage 2006;16:29-33.