Title: Treatment of Acute Pain in Patients on Buprenorphine<br/>Author: Wesley Oliver<br/><a href='mailto:1911'>[Click to email author]</a><hr/><p>
        Buprenorphine is a partial opioid receptor agonist that has a higher binding affinity than pure opioid agonists. There can be unease in managing acute pain in patients sustained on buprenorphine for opioid use disorder due to many factors.</p>
<p>
        The main barriers to effective pain management in these patients are:</p>
<ol>
        <li>
                Opioid-Induced Hyperalgesia
                <ol start="1" style="list-style-type: lower-alpha;">
                        <li>
                                Patients maintained on buprenorphine can have an increased sensitivity to pain.</li>
                        <li>
                                Consider using a multimodal approach that optimizes non-opioid analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs.</li>
                </ol>
        </li>
        <li>
                Opioid Tolerance
                <ol start="1" style="list-style-type: lower-alpha;">
                        <li>
                                Patients maintained on buprenorphine require higher doses of opioids to treat acute pain due to the decreased effectiveness of opioids over time.</li>
                        <li>
                                As in hyperalgesia, a multimodal approach can be beneficial.</li>
                        <li>
                                Higher doses of supplemental opioids will be required in these patients compared with opioid-naïve patients.</li>
                        <li>
                                Titrate supplemental opioids to effect and monitor for toxicity.</li>
                </ol>
        </li>
        <li>
                Opioid Withdrawal
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                        <li>
                                Opioid withdrawal symptoms can contribute to stress and anxiety, increasing pain sensitivity.</li>
                        <li>
                                To prevent withdrawal symptoms it is appropriate to continue buprenorphine throughout the episode of acute pain.</li>
                        <li>
                                The patient's typical home dose of buprenorphine can be utilized.</li>
                </ol>
        </li>
</ol>
<p>
         </p>
<p>
        <u><strong>Take Home Points</strong></u><br />
        In general, the treatment strategy for acute pain in patients on buprenorphine should be:</p>
<ul>
        <li>
                Optimize non-opioid analgesia.</li>
        <li>
                Use supplemental opioids when needed.
                <ul>
                        <li>
                                Will likely require higher doses.</li>
                        <li>
                                Titrate to effect.</li>
                        <li>
                                Monitor for toxicity.</li>
                </ul>
        </li>
        <li>
                Continue buprenorphine therapy at home dose throughout the acute pain episode.</li>
</ul>
<fieldset><legend>References</legend>

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        <li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">
                <span id="docs-internal-guid-1672b793-7fff-e9fd-fd33-b1698ba03954"><span style="font-size: 11pt; font-family: Calibri, sans-serif; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">Coffa D, Carr D. Management of acute pain in adults with opioid use disorder. In: Crowley M, ed. UpToDate. Waltham, MA: UptoDate Inc. </span><a href="https://www.uptodate.com/contents/management-of-acute-pain-in-adults-with-opioid-use-disorder" style="text-decoration-line: none;"><span style="font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(5, 99, 193); font-variant-numeric: normal; font-variant-east-asian: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">https://www.uptodate.com/contents/management-of-acute-pain-in-adults-with-opioid-use-disorder</span></a><span style="font-size: 11pt; font-family: Calibri, sans-serif; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">. Accessed February 5, 2021.</span></span></li>
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                <span style="font-family: Calibri, sans-serif; font-size: 11pt; white-space: pre-wrap;">Quinlan J, Cox F. Acute pain management in patients with drug dependence syndrome. Pain Rep. 2017;2:e611.</span></li>
</ol>
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