Acute Pain Management in Hospitalized Adult Patients with Opioid Dependence: A Narrative Review and Guide for Clinicians

Proper management of severe pain represents one of the most challenging clinical dilemmas. Two equally important goals must be attained: the humanitarian/medical goal to relieve suffering and the societal/legal goal to not contribute to the drug abuse problem. This is an age-old problem, and the prevailing emphasis placed on one or the other goal has resulted in pendulum swings that have resulted in either undertreatment of pain or the current epidemic of misuse and abuse. In an effort to provide efficacious strong pain relievers (opioids) that are more difficult to abuse by the most dangerous routes of administration, pharmaceutical companies are developing products in which the opioid is manufactured in a formulation that is designed to be tamper resistant. Such a product is known as an abuse-deterrent formulation (ADF). ADF opioid products are designed to deter or resist abuse by making it difficult to tamper with the product and extracting the opioid for inhalation or injection. To date, less than a dozen opioid formulations have been approved by the US Food and Drug Administration to carry specific ADF labeling, but this number will likely increase in the coming years. Most of these products are extended-release formulations.

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“…In such cases, the medication-assisted therapy should be continued with short-acting opioids prescribed to provide acute pain control. 71 …”

Section: Methodsmentioning

confidence: 99%

Managing severe pain and abuse potential: the potential impact of a new abuse-deterrent formulation oxycodone/naltrexone extended-release product

Pergolizzi

Taylor

LeQuang

et al. 2018

JPR

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“…The initial dose of methadone in tolerant individuals should be 10 to 15 mg once to twice a day to ensure tolerability based on a patient's history of opioid misuse and withdrawal symptoms 76 . This dose can then be further increased to 40 mg daily if needed to manage withdrawal symptoms 75,77 . The dose of methadone should not exceed 40 mg to facilitate ease of tapering and to decrease the severity of withdrawal if the patient is discharged without outpatient access to methadone treatment 76 .…”

Section: Pain Management In Patients Actively Misusing Opioidsmentioning

confidence: 99%

Pain Management Considerations in Patients With Opioid Use Disorder Requiring Critical Care

Smith

Wang

Abdukalikov

et al. 2022

The Journal of Clinical Pharma

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The opioid epidemic has resulted in increased opioid‐related critical care admissions, presenting challenges in acute pain management. Limited guidance exists in the management of critically ill patients with opioid use disorder (OUD). This narrative review provides the intensive care unit clinician with guidance and treatment options, including nonopioid analgesia, for patients receiving medications for OUD and for patients actively misusing opioids. Verification and continuation of the patient's outpatient medications for OUD regimen, specifically buprenorphine and methadone formulations; assessment of pain and opioid withdrawal; and treatment of acute pain with nonopioid analgesia, nonpharmacologic strategies, and short‐acting opioids as needed, are all essential to adequate management of acute pain in patients with OUD. A multidisciplinary approach to treatment and discharge planning in patients with OUD may be beneficial to engage patients with OUD early in their hospital stay to prevent withdrawal, stabilize their OUD, and reduce the risk of unplanned discharge and other associated morbidity.

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“…Pain is a symptom of most of chronic clinic pathological processes, being opioids widely used in the last decade for its management (Cooper et al, 2017;Raub & Vettese, 2017). The term opioid refers to compounds with a structural relation with products found in opium, to date, more than eighty alkaloids of this type have been described, most of them with therapeutic properties.…”

Section: Introductionmentioning

confidence: 99%

“…El dolor es un síntoma de la mayoría de los procesos patológicos clínico crónico, siendo los opioides ampliamente utilizados en la última década para su tratamiento (Cooper et al, 2017;Raub & Vettese, 2017).…”

Section: Introductionunclassified

Farmacología y Epidemiología de Opioides

Cardoso‐Ortiz

López-Luna

Lor

et al. 2020

rbio

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Los opioides desde hace muchos años son los analgésicos más utilizados y efectivos para el tratamiento del dolor. Este trabajo da a conocer la clasificación farmacológica, usos terapéuticos, riesgos a la salud y reacciones adversas de los opioides como fármacos, planteando el paradigma del usar este tipo de fármacos para el control del dolor, sin embargo se han convertido en un problema de salud en distintos países ya que en ciertas circunstancias tienen un alto potencial de causar adicción. Además de su uso contra el dolor, los opioides son utilizados como antidiarreicos, antitusivos y para el tratamiento de diversas sintomatologías. A pesar de los efectos adversos, el mal uso y abuso de los opioides; se consideran imprescindibles en la terapia contra el dolor. Actualmente las investigaciones farmacéuticas trabajan en la búsqueda constante de nuevos fármacos con efectos menos severos y con potencia analgésica

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Acute Pain Management in Hospitalized Adult Patients with Opioid Dependence: A Narrative Review and Guide for Clinicians

Cited by 16 publications

References 27 publications

Managing severe pain and abuse potential: the potential impact of a new abuse-deterrent formulation oxycodone/naltrexone extended-release product

Managing severe pain and abuse potential: the potential impact of a new abuse-deterrent formulation oxycodone/naltrexone extended-release product

Pain Management Considerations in Patients With Opioid Use Disorder Requiring Critical Care

Farmacología y Epidemiología de Opioides

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