title: Management of acute postpartum pain in patients maintained on methadone or buprenorphine during pregnancy.
abstract: BACKGROUND
  Empirical evidence is needed to guide adequate postpartum pain relief of methadone and buprenorphine stabilized patients.
  
  
  OBJECTIVE
  To first determine the adequacy of pain control using non-opioid and opioid medication in participants stabilized on buprenorphine or methadone before a vaginal delivery. Second, to compare the amount of non-opioid and opioid medication needed for adequate pain control for buprenorphine-and methadone-maintained patients during the immediate postpartum period.
  
  
  METHODS
  Pain control adequacy and amount of non-opioid and opioid medication needed in buprenorphine- (n = 8) and methadone-maintained (n = 10) patients over the first five days postpartum were examined.
  
  
  RESULTS
  Pain ratings and number of opioid medication doses decreased over time in both medication groups. While the buprenorphine and methadone groups began with similar mean daily ibuprofen (IB) doses, the buprenorphine group decreased its IB use, while the methadone group increased its IB use.
  
  
  CONCLUSIONS
  Patients treated daily with either buprenorphine or methadone can have adequate pain control postpartum with opioid medication and IB. Pain control is dependent on the opioid-agonist medication in use at delivery, and must be individualized.
authors.affiliation: Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Hendree E
authors.initials: HE
authors.lastname: Jones
authors.forename: Kevin
authors.initials: K
authors.lastname: O'Grady
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dahne
authors.forename: Rolley
authors.initials: R
authors.lastname: Johnson
authors.forename: Laetitia
authors.initials: L
authors.lastname: Lemoine
authors.forename: Lorriane
authors.initials: L
authors.lastname: Milio
authors.forename: Alice
authors.initials: A
authors.lastname: Ordean
authors.forename: Peter
authors.initials: P
authors.lastname: Selby
mesh_terms: D000208:Acute Disease; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D008691:Methadone / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone; D007052:Ibuprofen