Acute Pain in Patients with Opioid Use Disorder: Leveling Up Analgesia While Dialing Down Risk-Slides

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This presentation by Dr. Eric R. Goodlev addresses the complex clinical challenge of managing acute pain in hospitalized patients with opioid use disorder (OUD), emphasizing evidence-based strategies that balance effective analgesia with minimizing risk.<br /><br />Key points include the high prevalence of OUD among hospitalized patients, including those with cancer, making hospital stays critical opportunities to initiate or optimize medications for opioid use disorder (MOUD). MOUD, including methadone and buprenorphine, does not exclude effective pain control and can be dosed to manage both conditions—often needing lower doses given more frequently.<br /><br />Buprenorphine is highlighted as a unique partial opioid agonist with anti-hyperalgesia effects and a ceiling on respiratory depression risk, making it safer than full agonists like methadone. Full opioid agonists can be safely used alongside MOUD but often require higher dosing to overcome tolerance and the opioid deficit associated with OUD.<br /><br />Clinical strategies focus on individualized care using case-based learning approaches for patients on methadone, buprenorphine, or not on MOUD, including dose splitting and titration. For example, patients on methadone may need higher dose, divided dosing with added short-acting opioids, while patients on buprenorphine can benefit from split dosing and possibly additional full agonists.<br /><br />Communication skills, drawn from palliative care, are essential—recommending presence, recognition of clinician bias, person-centered language, clear dialogue about risks and benefits, and emotional validation to build trust.<br /><br />Finally, the talk underscores that managing pain in OUD requires balancing analgesia and addiction risks, preserving therapeutic relationships, coordinating care post-discharge, and utilizing interdisciplinary support when needed.<br /><br />In summary, hospital providers must integrate pharmacologic knowledge of MOUD and opioids with compassionate communication to effectively manage coexisting pain and OUD, turning hospitalization into a lifesaving intervention.

Keywords

opioid use disorder

acute pain management

hospitalized patients

medications for opioid use disorder

methadone

buprenorphine

partial opioid agonist

pain control strategies

clinician communication

interdisciplinary care