VOICE
Trial question
What is the role of switching to buprenorphine strategy in patients with chronic pain prescribed long-term opioid therapy?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
11.0% female
89.0% male
N = 207
207 patients (22 female, 185 male).
Inclusion criteria: patients with chronic pain prescribed long-term opioid therapy.
Key exclusion criteria: dementia diagnosis; unstable or severe untreated psychiatric disorder; unstable or end-stage medical disease that would interfere with participation; documentation of suspected controlled substance diversion; inability to communicate by telephone.
Interventions
N=104 buprenorphine switch (option to switch to buprenorphine for chronic pain).
N=103 no buprenorphine option (no option to switch to buprenorphine for chronic pain).
Primary outcome
Mean reduction in Brief Pain Inventory total score at 12 months
0.59 points
0.5 points
0.6 points
0.4 points
0.3 points
0.1 points
0.0 points
Buprenorphine
switch
No buprenorphine
option
No significant
difference ↔
No significant difference in mean reduction in BPI total score at 12 months (0.59 points vs. 0.5 points; MD 0.09, 95% CI -0.34 to 0.52).
Secondary outcomes
No significant difference in mean opioid daily dose at 12 months (-61 mg/day vs. -58.5 mg/day; MD -2.5, 95% CI -21.1 to 16).
No significant difference in mean Prescribed Opioids Difficulty Scale concerns score at 12 months (-0.8 points vs. -1.1 points; MD 1.19, 95% CI -0.11 to 2.49).
No significant difference in mean Patient Reported Outcomes Measurement Information System fatigue T score at 12 months (-2.7 points vs. -2.6 points; MD -0.28, 95% CI -3.4 to 2.56).
Conclusion
In patients with chronic pain prescribed long-term opioid therapy, buprenorphine switch was not superior to no buprenorphine option with respect to mean reduction in BPI total score at 12 months.
Reference
William C Becker, Karen H Seal, David B Nelson et al. Buprenorphine, Pain, and Opioid Use in Patients Taking High-Dose Long-Term Opioids: A Randomized Clinical Trial. JAMA Intern Med. 2025 Apr 1;185(4):372-381.
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