title: Acute pain management in patients with persistent pain.
abstract: OBJECTIVE
  Over the past 20 years, prescriptions of opioids for chronic pain have increased dramatically. This review addresses the difficulties in managing acute pain in this growing group of patients and discusses evidence relating to opioid tolerance and hyperalgesia and new avenues of research in specific painful conditions.
  
  
  RESULTS
  There is accumulating evidence surrounding the dangers of high-dose opioids and the risk of overdose and death. Employing nonopioid analgesics and disease-modifying drugs to cover an acute exacerbation of pain will thus limit escalating opioid doses. In specific diseases, the role of oxidative stress and the disruption of calcium homeostasis may provide treatment targets in acute pancreatitis; the identification of psychological stressors may decrease the frequency of acute exacerbations of abdominal pain; modifying the adhesion of sickle cells to inflamed endothelium may reduce vaso-occlusive crises; while vertebroplasty and calcitonin appear to improve pain and functioning after osteoporotic vertebral fractures.
  
  
  CONCLUSIONS
  Much of the evidence regarding the acute pain management of chronic pain patients is extrapolated from studies of opioid-naïve patients undergoing surgery. More focused research is needed to ascertain whether this model is an appropriate one to follow for such a complex group of patients.
authors.affiliation: Nuffield Division of Anaesthetics, Oxford University Hospitals NHS Trust, Oxford, UK. jane.quinlan@ouh.nhs.uk
authors.forename: Jane
authors.initials: J
authors.lastname: Quinlan
authors.forename: Kim
authors.initials: K
authors.lastname: Carter
mesh_terms: D000208:Acute Disease; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000755:Anemia, Sickle Cell / Q000150:complications; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance; D006801:Humans; D058866:Osteoporotic Fractures / Q000150:complications; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010195:Pancreatitis / Q000150:complications; D046628:Sphincter of Oddi Dysfunction / Q000150:complications
chemical_list: D000701:Analgesics, Opioid