title: Acute Pain Management in Opioid Dependent Patients.
abstract: Acute pain management remains a challenge in opioid dependent patients, and it has been recognised that these patients are commonly under-treated.Chronic opioid exposure leads to widespread adaptations both at cellular and synaptic level.Physical dependence is a neuropharmacological phenomenon as a result of neuroadaptation and neuroplasticity, in contrast to addiction that is both neuropharmacological and behavioural.While providing the patient's pre-existing opioid requirement, the acute pain episode should be managed using additional multimodal analgesia: non-opioid medications in combination with local anaesthetic techniques and as required, short-acting opioid titrated to effect.Patients on long term buprenorphine and methadone with acute pain episode should be continued with their maintenance therapy and an additional short-acting opioid analgesic titrated to achieve therapeutic effect.
authors.affiliation: Consultants in Pain Medicine and Anaesthesia, Pain and Anaesthesia Research Centre, St Bartholomew's Hospital. Barts and The London NHS Trust, London, UK.
authors.forename: Vivek
authors.initials: V
authors.lastname: Mehta
authors.affiliation: Consultants in Pain Medicine and Anaesthesia, Pain and Anaesthesia Research Centre, St Bartholomew's Hospital. Barts and The London NHS Trust, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Langford