Pain Management in Patients on Buprenorphine Maintenance



Tuesday, March 12, 2013

Pain Management in Patients on Buprenorphine Maintenance

Daniel P. Alford, MD, MPH, FACP, FASAM
Associate Professor of Medicine
Assistant Dean, Continuing Medical Education
Boston University School of Medicine
Program Director, Addiction Medicine Fellowship
Medical Director, Office-Based Opioid Treatment Program
Boston Medical Center

This webinar will address the challenges of treating acute and chronic pain in patients maintained on buprenorphine. The main complexities are that patients with history of opioid dependence often have increased pain sensitivity and buprenorphine taken once per day does not provide analgesia beyond 8 hours and may interfere with co-administered opioid analgesics. 
 
The appropriate treatment of acute pain in patients on buprenorphine maintenance 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 buprenorphine maintained patients suffering from chronic pain, non-opioid analgesics and non-pharmacological approaches should be tried. Strategies for managing chronic pain requiring opioids will be discussed.

View the presentation slides from this webinar.