Multimodal Acute Pain Management in the Parturient with Opioid Use Disorder: A Review

Figures & data

Table 1 DSM-V Diagnostic Criteria for OUD; Two Out of the 11 Criteria are Needed for Diagnosis

Taking opioids in larger amounts or over a longer period of time than intended

Having a persistent desire or unsuccessful attempts to reduce or control opioid use

Spending excess time obtaining, using or recovering from opioids

Craving opioids

Continued opioid use causing inability to fulfill work, home, or school responsibilities

Continuing opioid use despite having persistent social or interpersonal problems or psychological problems

Lack of involvement in social, occupational, or recreational activities

Using opioids in physically hazardous situations

Continuing opioid use in spite of awareness of persistent physical or psychological problems

Exhibiting tolerance symptoms, as defined by either of the following:

A need for markedly increased amounts of opioids to achieve intoxication or desired effect, or

Markedly diminished effect with continued use of the same amount of an opioid.

Exhibiting withdrawal symptoms, as manifested by either of the following:

The characteristic opioid withdrawal syndrome, or

Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms

Note: Table content is data from the article of CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep 2022;71(No. RR-3):1–95.⁹

Figure 1 Practical approach for managing pain in the parturient with untreated OUD during vaginal delivery (left) and cesarean section (right).

Figure 2 Practical approach for managing pain in the opioid abstinent parturient during vaginal delivery (left) and cesarean section (right).

Figure 3 Practical approach for managing pain in the parturient with on MOUD during vaginal delivery (left) and cesarean section (right).

Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R CDC clinical practice guideline for prescribing opioids for pain—United States, 2022. MMWR Recomm Rep 2022;71(3):1–95. doi: 10.15585/mmwr.rr7103a1

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