Pain management in opioid maintenance treatment

ABSTRACT

Introduction: Opioid addiction is a worldwide disease with a significant impact. A multitude of physical and mental comorbidities are associated with opioid addiction, pain being one of the most relevant. Insufficient pain management may lead to a disruption in medical treatment, self-medication, and subsequent harm to patients.

Areas covered: In this review, the authors provide a general overview of opioid addiction. A literature search for pain management and opioid maintenance treatment was conducted. Different settings of acute or chronic pain and situations specific to patients addicted to opioids are described. Pain management therapy in addiction is also addressed with an emphasis on treatment strategies such as the optimization of methadone and buprenorphine medication, additional opioid analgesia, and multimodal pain management.

Expert opinion: Opioid addiction is a growing global health concern, and maintenance therapy remains an effective and lifesaving treatment option. However, there remains uncertainty on the appropriate pain management for this patient group. The backbone of pain management in opiate-addicted patients remains maintenance therapy while adjunctive treatment such as regional analgesia, non-opioid analgesia, antidepressants, steps to improve sleep, acceptance and commitment therapy, biofeedback, and hypnosis should be considered. Additional opioid medication is possible as well.

KEYWORDS:

• Methadone
• buprenorphine
• pain
• opioids
• opioid dependence
• therapy

Article highlights

● pain is an important problem for patients with opioid maintenance treatment leading to significant morbidity and mortality

● to continue maintenance therapy, increase or split dose or switch to a substitute compound is essential

● guidelines for non-addicted patients should be checked and transferred

● regional analgesia and non-opioid analgesia may be a good option. In the case of chronic pain apply acceptance and commitment therapy, biofeedback, and hypnosis.

● If another opioid is necessary to use caution when administering any opioid analgesia combined with naloxone and attempt to curb misuse.

This box summarizes the key points contained in the article.

Acknowledgments

The authors thank Kristina Adorjan for her assistance in the preparation of this manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.