From the Research
For patients with opioid use disorder requiring intravenous pain management, a multimodal approach prioritizing non-opioid medications is recommended, as supported by the most recent study 1. This approach is crucial in managing pain effectively while minimizing the risks associated with opioid use. The key components of this approach include:
- Non-opioid medications such as IV acetaminophen and IV ketorolac
- Consideration of regional anesthesia techniques like nerve blocks
- Close monitoring for potential complications
When opioids are necessary, options like IV hydromorphone, fentanyl, or methadone may be considered, with careful dose titration based on pain response, as noted in 2. For patients on maintenance therapy, continuing their baseline methadone or buprenorphine while adding short-acting opioids for breakthrough pain can be effective, as discussed in 3.
The rationale for this approach acknowledges that patients with opioid use disorder often have altered pain perception and opioid tolerance, requiring thoughtful pain management that addresses both their acute pain needs and underlying substance use disorder, as highlighted in 4.
Key considerations in the management of pain for patients with opioid use disorder include:
- The importance of a multimodal approach to pain management
- The need for careful dose titration when using opioids
- The potential benefits of regional anesthesia techniques
- The importance of close monitoring for potential complications, including respiratory depression, sedation, and withdrawal symptoms, as emphasized in 5.
By prioritizing a multimodal approach and carefully considering the individual needs of each patient, healthcare providers can effectively manage pain in patients with opioid use disorder while minimizing the risks associated with opioid use.