What about opioids for managing severe pain from shoulder dislocation?

From the Guidelines

Opioids should be used with caution and for the shortest duration possible for managing severe pain from shoulder dislocation, prioritizing non-opioid therapies first, as recommended by the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1. When considering opioids for acute severe pain, such as from a shoulder dislocation, it's essential to weigh the benefits against the risks, including the potential for opioid use disorder, respiratory depression, and other adverse effects.

• Non-opioid therapies, including NSAIDs, acetaminophen, ice, heat, elevation, rest, immobilization, or exercise, should be maximized as appropriate for the specific condition 1.
• Opioid therapy has a role in acute pain related to severe traumatic injuries, invasive surgeries, and other severe acute pain when non-opioid therapies are contraindicated or likely to be ineffective.
• If opioids are prescribed, immediate-release opioids should be used at the lowest effective dose and for no longer than the expected duration of pain severe enough to require opioids, with a plan for tapering off opioids as soon as pain becomes manageable with non-opioid alternatives 1.
• Patients should be educated on the expected benefits, common risks, serious risks, and alternatives to opioids, and involved in decisions about starting opioid therapy, with discussions on safe storage, disposal, and the importance of not sharing opioids with others 1.
• The goal is to reduce pain to a manageable level, rather than eliminating it, and to minimize the development of tolerance and withdrawal symptoms by limiting opioid use to the minimum needed to manage pain 1.

From the FDA Drug Label

Oxycodone hydrochloride tablets are an opioid agonist indicated for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate Hydrocodone bitartrate and acetaminophen tablets are indicated for the management of, pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate

Opioids such as oxycodone 2 and hydrocodone 3 can be used for managing severe pain from shoulder dislocation, but only if:

• Alternative non-opioid analgesics have not been tolerated or are not expected to be tolerated
• Alternative treatments have not provided adequate analgesia or are not expected to provide adequate analgesia It is essential to weigh the risks of addiction, abuse, and misuse associated with opioids against the potential benefits of using them for pain management.

From the Research

Opioids for Managing Severe Pain from Shoulder Dislocation

• Opioids may be considered for managing severe pain from shoulder dislocation, but their use should be tailored to each patient and minimized to reduce the risk of harm 4.
• For severe or refractory acute pain, treatment can be briefly escalated with the use of medications that work on opioid and monoamine receptors, such as tramadol or tapentadol, or with the use of acetaminophen/opioid or NSAID/opioid combinations 4.
• However, there is evidence to suggest that alternative methods of analgesia, such as intra-articular lidocaine, may be effective in managing pain from shoulder dislocation and may reduce the need for opioids 5.
• In cases where opioids are necessary, it is essential to carefully select the appropriate medication and dosage, and to monitor patients closely for signs of adverse effects or addiction 6.
• Other options for managing pain from shoulder dislocation include nonopioid analgesics, such as acetaminophen or NSAIDs, and adjunctive agents, such as muscle relaxants or tricyclic antidepressants 7.
• Remifentanil has been shown to be effective in painless reduction of anterior shoulder dislocation, with lower procedural time, lower failure rate, and higher patient satisfaction compared to fentanyl/midazolam combination 8.