title: Acute pain management for patients under opioid maintenance treatment: what physicians do in emergency departments?
abstract: The aim of this study was to analyze the current practices on acute pain management of patients under opioid maintenance treatment (OMT), that is, buprenorphine or methadone. A total of 706 physicians were solicited through a national network to answer a survey about pain perception and analgesic strategies. Among the prescribers, 323 (46%) answered the survey: 131 (40%) physicians estimated that patients under OMT when exposed to an acute painful event feel more pain than other patients and 170 (53%) estimated that the patients felt the same amount of pain. Use of WHO step 1 analgesics was reported by 283 (88%) prescribers [264 (82%) prescribers reported use of paracetamol and 178 (55%) reported use of NSAIDs]. Among the second-line analgesic drugs, the WHO step 3 analgesics (mainly morphine) were the most commonly reported [221 physicians (68%)]. Overall, the results demonstrate the misconceptions of physicians on the pain tolerance of patients under OMT. Clinical studies and evidence-based guidelines are necessary to improve the therapeutic strategies for such patients in an emergency setting.
authors.affiliation: aPharmacoépidémiology, UMR1027, INSERM, Toulouse University III bDepartment of Clinical Pharmacology, Pharmacodependence-Evaluation and Information Center (CEIP-A) cEmergency Department, University Hospital of Toulouse, Toulouse, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bounes
authors.forename: Emilie
authors.initials: E
authors.lastname: Jouanjus
authors.forename: Anne
authors.initials: A
authors.lastname: Roussin
authors.forename: Maryse
authors.initials: M
authors.lastname: Lapeyre-Mestre
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D004636:Emergency Service, Hospital; D019538:Health Care Surveys; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D058850:Opiate Substitution Treatment; D059408:Pain Management; D017288:Pain Threshold; D010818:Practice Patterns, Physicians'
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D002047:Buprenorphine; D008691:Methadone