Acute pain management for patients receiving maintenance methadone or buprenorphine therapy.
More patients with opioid addiction are receiving opioid agonist therapy (OAT) with methadone and buprenorphine. As a result, physicians will more frequently encounter patients receiving OAT who develop acutely painful conditions, requiring effective treatment strategies. Undertreatment of acute pain is suboptimal medical treatment, and patients receiving long-term OAT are at particular risk. This paper acknowledges the complex interplay among addictive disease, OAT, and acute pain management and describes 4 common misconceptions resulting in suboptimal treatment of acute pain. Clinical recommendations for providing analgesia for patients with acute pain who are receiving OAT are presented. Although challenging, acute pain in patients receiving this type of therapy can effectively be managed.
Alford
Daniel P
DP
Clinical Addiction Research and Education (CARE) Unit, Boston University Medical Center, Boston, Massachusetts 02118, USA.
Compton
Peggy
P
Samet
Jeffrey H
JH
D000208:Acute Disease; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D002047:Buprenorphine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006556:Heroin Dependence / Q000150:complications / Q000534:rehabilitation*; D006801:Humans; D008691:Methadone / Q000009:adverse effects / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D010146:Pain / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D012008:Recurrence; D014458:Ulna Fractures / Q000150:complications
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone