Acute pain management in opioid-tolerant patients

Acute pain management in opioid-tolerant patients: a growing challenge. – PubMed – NCBI – Anaesth Intensive Care. 2011 Sep –  – Free full-text article

In Australia and New Zealand the … burden of chronic pain is more widely recognized and there has been an increase in the use of opioids for both cancer and non-cancer indications.

As a result, the proportion of opioid-tolerant patients requiring acute pain management has increased, often presenting clinicians with greater challenges than those faced when treating the opioid-naïve

Treatment aims include

  • effective relief of acute pain,
  • prevention of drug withdrawal, 
  • assistance with any related social, psychiatric and behavioral issues, and
  • ensuring continuity of long-term care

Pharmacological approaches incorporate 

  • the continuation of usual medications (or equivalent)
  • short-term use of sometimes much higher than average doses of additional opioid, and 
  • prescription of non-opioid and adjuvant drugs, aiming to improve pain relief and attenuate opioid tolerance and/or opioid-induced hyperalgesia.

Discharge planning should commence at an early stage and may involve the use of a ‘Reverse Pain Ladder’ aiming to limit the duration of additional opioid use.

Legislative requirements may restrict which drugs can be prescribed at the time of hospital discharge.

Healthcare by legislation is the practice of medicine without a license.

At all stages, there should be appropriate and regular consultation and liaison with the patient, other treating teams and specialist services.

Proper care from medical professionals can mitigate the harms of healthcare by legislation

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