Strong opioid preparations have become the mainstay in pain management of cancer and many chronic non cancer related pain problems. But often their use is limited by a lack of efficacy in specific pain areas or tolerability problems.
Therefore an important principle in every pain management scheme is to individualise therapy, a goal, which is difficult to achieve in clinical practice as various factors have to be taken into account. Patient selection and evaluation criteria, follow up strategy and the management of side effects and complications are important steps towards an optimised and individualised pain therapy. Of equal importance in this concern are therapeutics or therapeutic schemes which allow for an individual titration and dose adjustment.

Three exemplified case studies are presented to demonstrate the efficacy and safety of transdermal buprenorphine in the management of several challenging problems in chronic pain treatment.
Overall, more than 120 patients with buprenorphine TDS have been treated at the pain clinic at the Brighton and Sussex University Hospitals Trust up to now. No tolerance development or any traces of addiction or withdrawal effects have been observed so far. We conclude that in our daily clinical practice and including patients with complex chronic pain indications as well as elderly patients with a high comorbidity, buprenorphine TDS is a well tolerated therapeutic option.