title: Analgesic management of acute pain in the opioid-tolerant patient.
abstract: OBJECTIVE
  The management of acute pain in the opioid-tolerant patient is an area in perioperative medicine that is growing, as the use of opioids for chronic noncancer pain has been tolerated in the USA. Adding to this population is an increase in opioid abusers, addicts and those in recovery and maintenance programmes. These patients will continue to present for surgery and with acute pain that anaesthesiologists and other members of the healthcare team must become more adept at managing.
  
  
  RESULTS
  This review covers some of the strategies that may be used by practitioners in the management of acute pain in the opioid-tolerant patient. It is important to collect a detailed history of opioid and drugs of abuse, including the timing of the last dose in order to avoid precipitation of withdrawal. The use of multimodal anaesthetic and analgesic strategies is important for both patient safety and satisfaction and can enhance recovery and discharge home.
  
  
  CONCLUSIONS
  There is a need for more high-level evidence-based guidelines to help practitioners achieve the best care of this growing high-risk population of patients.
authors.affiliation: Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Shah
authors.forename: Shruti
authors.initials: S
authors.lastname: Kapoor
authors.forename: Brian
authors.initials: B
authors.lastname: Durkin
mesh_terms: D059787:Acute Pain / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004361:Drug Tolerance / Q000502:physiology*; D006801:Humans; D016202:N-Methylaspartate / Q000037:antagonists & inhibitors; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents; D016202:N-Methylaspartate