Transdermal Buprenorphine for Pain in Pediatric Palliative Care: A 23-Patient Retrospective Study.

BACKGROUND

Pain management in pediatric palliative care is challenging, particularly in children with neurological impairments, feeding difficulties, or low opioid requirements. Transdermal buprenorphine offers pharmacological advantages, including stable plasma concentrations and a reduced risk of sedation; however, its use in children remains off-label and insufficiently studied.

AIM: To evaluate the use, effectiveness, and safety of transdermal buprenorphine in pediatric palliative care and assess its feasibility in everyday clinical practice.

DESIGN

Retrospective observational study. Data were extracted from structured electronic medical records, including patient characteristics, analgesic indications, buprenorphine dosing and titration, clinical outcomes, and adverse effects.

SETTING/

PARTICIPANTS

The study included 23 pediatric patients aged 8 months to 17 years treated between April 2023 and April 2025. Participants received care either from a specialized outpatient pediatric palliative care service (SOPPC; German: Spezialisierte Ambulante Palliativversorgung für Kinder und Jugendliche, SAPV-KJ; 74%) or an inpatient pediatric palliative care unit. All patients received transdermal buprenorphine for chronic pain. Those treated with other forms of buprenorphine or alternative opioids were excluded.

RESULTS

All patients initiated treatment with a 5 µg/h patch; 43% required dose escalation. Pain control was rated as good in 87% (95% CI: 66-96%). Improved alertness was observed in 74% (95% CI: 52-88%). Mild local skin reactions occurred in 13%, and no serious adverse events were reported. Sublingual buprenorphine was used effectively for breakthrough pain in 26% of cases. Four patients were managed with transdermal buprenorphine monotherapy.

CONCLUSIONS

Transdermal buprenorphine appears to be an effective and well-tolerated analgesic option for pediatric palliative care patients with low opioid needs. Its ease of use and favorable side effect profile support its potential clinical utility. Prospective studies are warranted to confirm safety and guide dosing strategies.