Managing Acute and Chronic Pain in Patients on Medication Assisted Treatment



Daniel P. Alford, MD, MPH, FACP, FASAM
Associate Professor of Medicine
Assistant Dean, Continuing Medical Education
Director, Clinical Addiction Research and Education (CARE) Unit
Director, Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program
Boston University School of Medicine
Boston Medical Center

August 12, 2014

The webinar will address the challenges of treating acute and chronic pain in patients with opioid use disorders maintained on MAT, including methadone, buprenorphine and naltrexone.

Patients with a history of opioid use disorders often have increased pain sensitivity.  Opioid agonists taken once per day to treat opioid addiction (methadone, buprenorphine) do not provide analgesia beyond 8 hours and may interfere with co-administered opioid analgesics.  

 
The appropriate treatment of acute pain in patients on methadone and buprenorphine includes continuing the patient's baseline opioid requirements to avoid increased pain sensitivity associated with opioid withdrawal. These patients are also at risk of cross-tolerance to opioid analgesics and therefore adequate pain control will often necessitate higher opioid doses at shorter dosing intervals. Various treatment options will be discussed for both outpatient and inpatient acute pain management.  

 
For patients on MAT and suffering from chronic pain, nonopioid analgesics and nonpharmacological approaches should be tried. Strategies for managing chronic pain requiring opioids will be discussed.

Webinar Slides