title: [Management of opioid maintenance treatments when analgesic treatments are required].
abstract: Opioid maintenance treatments (OMT) reduce illicit opiate use and its associated risks. They are often prescribed on a long-term basis. Physiological changes induced by long-term OMT may cause hyperalgesia and cross-tolerance to opioid agonists, which suggests that the dosage of analgesic treatment should be modified in cases of acute pain, especially when an opioid-based analgesia is required. When treatment with analgesics is necessary, OMT must be maintained, except in exceptional cases. If a split-dosing schedule is temporarily employed during OMT, the daily dosage should not be increased for analgesic purposes. Analgesic treatment must be managed differently in case of treatment with buprenorphine or methadone. With buprenorphine, non-opioid analgesics should be introduced first, if possible. If this strategy is inefficient or contraindicated, a temporary or definitive switch to methadone should be considered. In the case of methadone-based OMT, opioid analgesics should be added directly and the dosage should be adapted according to the level of pain reported by the patient.
authors.affiliation: CHU de Nancy, centre de soins, d'accompagnement et de prévention en addictologie, 54000 Nancy, France. v.laprevote@chu-nancy.fr
authors.forename: Vincent
authors.initials: V
authors.lastname: Laprevote
authors.forename: Pierre A
authors.initials: PA
authors.lastname: Geoffroy
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rolland
authors.forename: Benoît F
authors.initials: BF
authors.lastname: Leheup
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Patrizio
authors.forename: Olivier
authors.initials: O
authors.lastname: Cottencin
authors.forename: Raymund
authors.initials: R
authors.lastname: Schwan
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D002047:Buprenorphine / Q000008:administration & dosage* / Q000627:therapeutic use; D019468:Disease Management; D006801:Humans; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010146:Pain / Q000188:drug therapy*
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D002047:Buprenorphine