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

Kathryn Smith, Michelle Wang, Ruslan Abdukalikov, Amy McAullife, Dena Whitesell, Janelle Richard, William Sauer, Aurora Quaye

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)449-462
Number of pages14
JournalJournal of Clinical Pharmacology
Volume62
Issue number4
DOIs
StatePublished - Apr 2022
Externally publishedYes

Keywords

  • acute pain management
  • buprenorphine
  • methadone
  • naltrexone
  • opioid use disorder
  • opioid withdrawal treatment

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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