Pain Core Curriculum Module 14: Care at the Crossroads: Opioid Prescribing in Individuals with Serious Illness and Opioid Use Disorder-Presentation

Video Transcription

Video Summary

Dr. Julie Childers, a professor of medicine and palliative care/ addiction medicine specialist, discusses managing pain in patients with serious illness and opioid use disorder (OUD). She emphasizes a three-dimensional approach considering pain etiology, substance use history, and prognosis to guide opioid prescribing. Challenges include longer survival with advanced illness due to medical advances, the high prevalence of chronic pain (including in OUD populations), and heightened pain sensitivity due to OUD and mental health comorbidities. Dr. Childers presents three cases illustrating tailored approaches: transitioning patients from methadone or buprenorphine to optimize pain control and addiction management, balancing opioid and non-opioid treatments, and continuing or tapering buprenorphine at end of life based on shared decision-making and prognosis. She stresses opioids are most effective for cancer-related pain, less so for chronic non-cancer pain, which often requires multimodal therapy. Buprenorphine is recommended to treat OUD and can be combined with full agonist opioids for cancer pain. Careful assessment of substance use stability and prognosis informs treatment plans, ensuring quality of life and addiction control even near end of life. She advocates open communication, ongoing monitoring with urine drug screens, and individualized, compassionate care. Resources like the PCSS mentoring program support clinicians managing these complex patients.

Keywords

pain management

opioid use disorder

palliative care

buprenorphine

methadone

chronic pain

cancer pain

addiction medicine