QID Dosing (4 times a day) is sometimes beneficial for patients with chronic pain. I had a patient with neuropathic pain and chronic headaches. Had her on 8 mg TID but we switched her to 4 QID she had an improved benefit. The total daily dose was lower but the dosing schedule change seemed to provide additional analgesic benefit.
In our practice all of our patients have some history of addiction. My view is that those co-occurring problems are so intertwined that you’re always treating both problems. Any decrease in pain or distress decreases the chance for relapse so you’re still treating the addiction. So any time you’re adjusting the buprenorphine dose for analgesic benefit you should consider the benefit or risk to the relapse prevention as well.
