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Renovation St. Sava, Belgrade - photo by JoAnn Sturman
Scott Sturman, M.D.
Since nalbuphine (Nubain) is not available, there is no effective treatment for intractable itching due to intrathecal narcotics. Benadryl has been used as a substitute, but it is ineffective and in some cases causes confusion and excessive sedation. Beginning in August 2013 a limited cohort of patients experiencing severe itching from spinal narcotics has been treated with buprenorphine (Buprenex), an agonist-antagonist narcotic. The dose is 150 ug given every six hours, but it is rare for a patient to require more than one dose.
Through Jan 15, 2014, a total of 99 patients have received the medication, and all but 9 experienced reduction of symptoms. There have been no documented untoward side effects. It is of interest to note that since Nov 2013 the rate of treatment has increased and the reported efficacy, as well. During this period 64 patients have been treated and only 2 have not benefited. The lower rates of treatment and noted benefit from August - September may reflect the staff’s unfamiliarity with the drug. In fact initial resistance from the nursing staff was common, and many were loathe to administer an unfamiliar medication, despite distraught patients with good pain control but miserable from persistent pruritis.
Kalocsa, Hungary - photo by JoAnn Sturman
