Buprenorphine—The Unique Opioid Analgesic. K. Budd and R. B. Raffa (editors). Published by Thieme Medical Publishers, Berlin. Pp. 134; indexed; illustrated. Price $49.95/
39.95. ISBN 3-13-134211-0
This is a small book, dedicated totally to the pharmacology of buprenorphine and, as such, is unusual in its focus. It does give a narrow view of advantages and clinical use of buprenorphine alone, with relatively little discussion of other opioids for comparison. The chapters are short and concise. The information is well presented and very easy to read. The book was well illustrated with helpful and clear drawings and tables. There is a mix of background basic science, evidence from animal models and clinical application. All chapters are well referenced. The book has been put together with a strong editorial hand and there is a lot of consistency within the book in each chapter as regards presentation, layout and content. There are some outstanding chapters; the chapter on transdermal buprenorphine in clinical practice was particularly informing. I enjoyed reading this book and found it informative. It is fair to say that buprenorphine has made a revival in recent years on two counts; first of all, the introduction of the transdermal buprenorphine patch and, particularly more recently, the matrix patch, has given this drug a new life. Secondly, the drug is increasingly used for treatment of maintenance and withdrawal of opioid addiction and therefore used outside the anaesthetic and chronic pain fields. Buprenorphine has therefore become a useful and topical drug again and indeed has many advantages. Similar to many, who grew up with this drug in the early days, I was under the impression that this drug was a partial agonist with its own unique, bell-shaped dose–response curve. It turns out this is indeed true in some, but not all, of the animal models, but human studies would indicate that buprenorphine is a full opioid agonist and does not have a bell-shaped dose–response curve as far as its analgesic actions go in humans.
It may, however, have a bell-shaped dose–response curve for some of its side-effects, including respiratory depression. This was news to me, and certainly would encourage me to increase my use of buprenorphine in the management of chronic malignant and non-malignant pain.
My only criticism of the book is that it is focused on a single drug; I came away, having read the book, with a sense that buprenorphine may be the all-singing, all-dancing drug that was going to answer all my patients' pain relief requirements. Whilst I would be prepared to consider more extensive use of buprenorphine patch technology, I fear that the optimism this book engenders may not be fulfilled to its full extent.
My only other concern is about the financial or other interests of the editors and contributors with buprenorphine. When contributing to major journals, one is required to disclose any interest one has in the product or drug that is the subject of the intended publication. The same ought to be true of a book such as this. I did not, however, feel this was a company book as such, as it were, and I do not want to impugn any of the editors or contributors here, who I am sure are without reproach, but nonetheless a declaration of interests would have been useful.
It is a bit hard to pick the market for this book; it is specialized. I am not sure it has a place in an anaesthetic department library, but it is a book I would recommend to the nurses and pharmacists, who work on our chronic pain medication review clinic. It would also be useful for chronic pain trainees. I think there is enough new information in this to be of value to these groups; it is certainly well put together and an easy book to read.
Sussex, UK
E-mail: Simondolin{at}aol.com
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