Acute Pain Management for Patients Receiving Maintenance [PDF]

Ann Intern Med. Author manuscript; available in PMC 2007 Jun 19. Published in final edited form as:

PMCID: PMC1892816 NIHMSID: NIHMS17732

Ann Intern Med. 2006 Jan 17; 144(2): 127–134.

Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy Daniel P. Alford, MD, MPH, Peggy Compton, RN, PhD, and Jeffrey H. Samet, MD, MA, MPH From Boston University Medical Center, Boston, Massachusetts, and University of California, Los Angeles, School of Nursing, Los Angeles, California. Requests for Single Reprints: Daniel P. Alford, MD, MPH, Clinical Addiction Research and Education (CARE) Unit, Boston Medical Center, 91 East Concord Street, Suite 200, Boston, MA 02118. Current author addresses are available at www.annals.org. Current Author Addresses: Drs. Alford and Samet: Boston Medical Center, 91 East Concord Street, Suite 200, Boston, MA 02118. Copyright notice and Disclaimer The publisher's final edited version of this article is available at Ann Intern Med This article has been corrected. See the correction in volume 144 on page 460. See other articles in PMC that cite the published article.

Abstract

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Pain and Opioid Dependence

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Common Misconceptions

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Misconception 1: The Maintenance Opioid Agonist (Methadone or Buprenorphine) Provides Analgesia

Analgesic Properties of Maintenance Opioids

Opioid Tolerance

Opioid-Induced Hyperalgesia

Misconception 2: Use of Opioids for Analgesia May Result in Addiction Relapse

Misconception 3: The Additive Effects of Opioid Analgesics and OAT May Cause Respiratory and CNS Depression

Misconception 4: Reporting Pain May Be a Manipulation To Obtain Opioid Medications, or Drug-Seeking, because of Opioid Addiction

Recommendations for Treating Acute Pain

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General Recommendations

Recommendations for Patients Receiving Maintenance Methadone Therapy

Recommendations for Patients Receiving Maintenance Buprenorphine Therapy

Conclusion

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Acknowledgments

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Footnotes

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Potential Financial Conflicts of Interest: None disclosed. See also: Web-Only. CME quiz, Conversion of tables into slides Dr. Compton: University of California, Los Angeles, School of Nursing, Factor Building 4-246, Box 956918, Los Angeles, CA 90095-6918. Grant Support: Drs. Alford and Samet were supported by a grant from the National Institute on Drug Abuse (R25-DA-13582).

References

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