Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy

Alford, Daniel P.; Compton, Peggy; Samet, Jeffrey H.

doi:10.7326/0003-4819-144-2-200601170-00010

Cited by 411 publications

(320 citation statements)

References 83 publications

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“…In fact, there is evidence supporting increased sensitivity to experimental pain in patients receiving opioid agonist therapy (Alford et al, 2006a;Compton et al, 2000;Doverty et al, 2001a). In Experiment 5, rats arbitrarily assigned to groups and tested after being on a high dose of methadone or vehicle for 5 days, showed no differences in latencies of responding to painful thermal stimulation.…”

Section: Discussionmentioning

confidence: 96%

“…Most of these studies, however, examined individuals with a history of dependence on illicit opioids, and there are reasons to believe that some may have been hyperresponsive to pain before methadone treatment (Pud et al, 2006). Furthermore, although it is well established that methadone-maintained individuals require higher doses of acute opioid agonists for pain control (Alford et al, 2006b;Scimeca et al, 2000), it has never been established whether high methadone maintenance produces cross-tolerance or enhances the analgesic effect of cocaine (Lin et al, 1989;Waddell and Holtzman, 1999).…”

Section: Introductionmentioning

confidence: 99%

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High-Dose Methadone Maintenance in Rats: Effects on Cocaine Self-Administration and Behavioral Side Effects

Leri

Sorge

Cummins

et al. 2007

Neuropsychopharmacol

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It has been demonstrated that high-dose methadone maintenance is efficacious in reducing cocaine abuse in opioid-dependent individuals, but it is not clear whether this is caused by an action of methadone on the direct reinforcing properties of cocaine or on cocaine seeking. Also, it is not clear whether high-dose methadone maintenance may induce behavioral side effects, which could limit its clinical use. Here, we report that high-dose methadone maintenance (20-40 mg/kg/day) does not reduce, and even enhances cocaine (10-30 mg/kg, i.p.)-induced elevation in dopamine concentration in the ventral striatum measured by in vivo microdialysis. In parallel, however, rats maintained on high-dose methadone (30 mg/kg/day) seek and consume significantly less cocaine than controls when tested for intravenous cocaine (0.5 mg/kg/infusion) self-administration on a progressive ratio schedule of reinforcement. This reduction in cocaine self-administration does not result from impaired sensory-motor functioning as rats maintained on high-dose methadone show normal locomotor activity. Furthermore, the reduction in responding for cocaine does not seem to result from general behavioral deficits as male rats maintained on high methadone doses respond normally to palatable food and thermal pain, although their sexual responses to receptive females are greatly suppressed. Taken together, these results from studies in rats support the usefulness of larger doses of methadone to reduce severe cocaine abuse in opioid-dependent individuals and possibly in the management of pure-cocaine addiction.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

High-Dose Methadone Maintenance in Rats: Effects on Cocaine Self-Administration and Behavioral Side Effects

Leri

Sorge

Cummins

et al. 2007

Neuropsychopharmacol

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“…Pain is the cognitive and emotional response to nociception [7,13,36]. The intensity of pain for a given noxious stimulus is strongly related to psychologic distress (depression/anxiety), heightened illness concern, and ineffective coping strategies (eg, greater catastrophic thinking and more self-doubts [lower self-efficacy] regarding the ability to control pain and function despite it) [1,7,13,34,36].…”

Section: Introductionmentioning

confidence: 99%

Opioid Use After Fracture Surgery Correlates With Pain Intensity and Satisfaction With Pain Relief

Bot

Bekkers

Arnstein

et al. 2014

Clinical Orthopaedics &Amp; Related Research

158

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Background In 2012, Medicare began to tie reimbursements to inpatient complications, unplanned readmissions, and patient satisfaction, including satisfaction with pain management. Questions/purposes We aimed to identify factors that correlate with (1) pain intensity during a 24-hour period after surgery; (2) less than complete satisfaction with pain control; (3) less than complete satisfaction with staff attention to pain relief while in the hospital; and we also wished (4) to compare inpatient and discharge satisfaction scores. Methods Ninety-seven inpatients completed measures of pain intensity (numeric rating scale), satisfaction with pain relief, self-efficacy when in pain, and symptoms of depression days after operative fracture repair. The amount of opioid used in oral morphine equivalents taken during the prior 24 hours was calculated. Through initial bivariate One of the authors (AGJB) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period from ''AnnaFonds Travel grant'' (Dutch Orthopaedic travel grant), Leiden, the Netherlands (less than USD 10,000); ''VSBfonds'', Utrecht, the Netherlands, a nonmedical study grant (less than USD 10,000); and ''Prins Bernhard Cultuurfonds, Banning-de Jong fonds'', Amsterdam, the Netherlands, a nonmedical study grant (less than USD 10,000). One of the authors (SB) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than 10,000 USD from a VU University ''Faculty Fund'', Amsterdam, the Netherlands. One of the authors (PMA) has received funding from Connell Nursing Research Scholarship (less than USD 10,000); the Nurse Practitioner Healthcare Foundation (less than USD 10,000); the American Pain Society and the American Association of Nurse Practitioners (less than USD 10,000); the Nurse Practitioner Healthcare Foundation (less than USD 10,000); and F.D. Davis Publishers (less than USD 10,000). One of the authors (DR) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period from a study-specific grant from Skeletal Dynamics (USD 10,000-100,000) (Miami, FL, USA); is a consultant for Wright Medical (Memphis, TN, USA), Skeletal Dynamics, and Biomet (Warsaw, IN, USA) (less than USD 10,000); received honoraria from AO North America (Paoli, PA, USA), and AO International (less than USD 10,000); and received royalties from Wright Medical (less than USD 10,000). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. and then multivariate analysis, we identified factors that we...

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“…Maintenance treatment with OAT does not provide sufficient analgesia to treat episodes of acute pain. 39 In patients on methadone maintenance, the maintenance dose should be continued and adjunctive analgesia should be provided with nonopioid analgesics or short-acting opioids. 39 The management of acute pain in individuals on buprenorphine maintenance is more complicated since buprenorphine is a partial opioid agonist with high affinity to the opioid receptor, which limits the impact of adjunctive opioids.…”

Section: Special Populationsmentioning

confidence: 99%

Inpatient Management of Opioid Use Disorder: A Review for Hospitalists

Theisen‐Toupal

Ronan

Moore

et al. 2017

Journal of Hospital Medicine

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The United States is experiencing an epidemic of nonmedical opioid use and opioid overdose-related deaths. As a result, there have been a number of public health interventions aimed at addressing this epidemic. However, these interventions fail to address care of individuals with opioid use disorder during hospitalizations and, therefore, miss a key opportunity for intervention. The role of hospitalists in managing hospitalized patients with opioid use disorder is not established. In this review, we discuss the inpatient management of individuals with opioid use disorder, including the treatment of withdrawal, benefits of medication-assisted treatment, and application of harm-reduction strategies.

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Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy

Cited by 411 publications

References 83 publications

High-Dose Methadone Maintenance in Rats: Effects on Cocaine Self-Administration and Behavioral Side Effects

High-Dose Methadone Maintenance in Rats: Effects on Cocaine Self-Administration and Behavioral Side Effects

Opioid Use After Fracture Surgery Correlates With Pain Intensity and Satisfaction With Pain Relief

Inpatient Management of Opioid Use Disorder: A Review for Hospitalists

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