SHM's Clinical Quick Talks-Acute Pain Management in Patients with Opioid Use Disorder (OUD)

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Managing acute pain in patients with Opioid Use Disorder (OUD) is challenging due to their increased pain sensitivity and opioid tolerance. These patients are often under-treated for pain because of concerns about continuous substance use or drug-seeking behavior. Effective pain management should involve coordinated care with the patient's OUD-treating clinicians and may involve Medication-Assisted Treatment (MAT), which includes the use of medications like Buprenorphine, Methadone, and Naltrexone along with counseling and therapy.<br /><br />Acute pain scenarios in OUD patients can be categorized into unplanned pain, often requiring emergency department intervention, and planned pain during elective procedures. In emergency situations, there is potential for stigma, with physicians possibly viewing the patient as drug-seeking. Planned procedures, however, allow for preemptive pain management planning and MAT adjustments.<br /><br />Physicians should accept patient-reported pain levels and recognize that seeking pain relief is not necessarily indicative of drug-seeking behavior. It is important to note that current opioid agonist therapies do not address acute pain and there's no evidence suggesting that inpatient opioid analgesics for acute pain increase addiction or relapse risks. Conversely, undertreating pain may provoke cravings and stress, potentially triggering relapse.<br /><br />For optimal pain management, start titrating opioids at 50-100% of the patient's baseline and adjust for higher tolerance levels. Employ oral long-acting opioids on a fixed schedule and short-acting opioids for breakthrough pain. Non-opioid pain relief strategies and local anesthetics should also be considered.<br /><br />Overall, clinicians should balance the need for effective pain relief with the risk of relapse, ensuring that acute pain management is meticulously coordinated with other ongoing treatments for OUD.

Asset Subtitle

Charles Googe, Nicole Terrigno

Meta Tag

Concept Acute Pain Management

Concept Opioid Use Disorder

Concept Opioid Tolerance

Concept Opioid-Induced Hyperalgesia

Concept Medication-Assisted Treatment

Keywords

Opioid Use Disorder

acute pain management

opioid tolerance

Medication-Assisted Treatment

Buprenorphine

Methadone

Naltrexone

emergency department

pain relief strategies

relapse prevention

Acute Pain Management

Opioid Use Disorder

Opioid Tolerance

Opioid-Induced Hyperalgesia

Medication-Assisted Treatment