Pain Core Curriculum Module 7: Treating Pain in People with Opioid Use Disorder (OUD)-Presentation

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Video Summary

This presentation, led by Dr. Laila Khalid and Dr. Michelle DeNora, focuses on challenges and strategies for treating pain in people with opioid use disorder (OUD). Pain is highly prevalent among individuals with OUD, with acute and chronic pain complicating treatment. Key difficulties include opioid tolerance, opioid-induced hyperalgesia, withdrawal symptoms overlapping with pain, and the pharmacologic impacts of medications for OUD (methadone, buprenorphine, naltrexone) on analgesia.<br /><br />For acute pain, multimodal treatment combining non-opioid medications, adjunct therapies, and higher doses of full agonist opioids as needed is recommended. Managing opioid withdrawal concurrently improves outcomes. Methadone and buprenorphine should generally be continued perioperatively; buprenorphine dosing can be split or temporarily increased to enhance analgesia. Close collaboration among surgical, anesthesia, addiction, and primary care teams is essential. Regional anesthesia and non-opioid adjuncts like NSAIDs, acetaminophen, ketamine, and gabapentinoids support pain control.<br /><br />Chronic pain management emphasizes biopsychosocial assessment, patient education, and individualized multimodal plans prioritizing function over complete pain elimination. Opioids are generally not favored for non-cancer chronic pain due to limited benefit and substantial risks; when used, a risk-benefit approach and frequent reassessment are crucial. Transitioning patients on long-term opioids to buprenorphine can aid in managing OUD and pain.<br /><br />Patient-centered care requires addressing stigma, involving patients in shared decision-making, validating pain experiences, and ensuring ongoing support. Resources from the Providers Clinical Support System facilitate mentorship and guidance.

Keywords

opioid use disorder

pain management

acute pain

chronic pain

opioid tolerance

opioid-induced hyperalgesia

methadone

buprenorphine

multimodal treatment