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|Issue 160||October 2019|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Evidence Brief: Managing Acute Pain in Patients Taking Medications for Opioid Use Disorder
Acute pain management in patients with opioid use disorder (OUD) can be challenging due to several factors including increased pain sensitivity and higher opioid tolerance. Use of medications for OUD (MOUD) including methadone, buprenorphine/naloxone, or naltrexone adds to the complexity of acute pain management because of the unique pharmacologic properties of these medications and implications for use of additional opioid analgesics. Current guidelines addressing acute pain management in patients taking MOUD are primarily based on expert consensus and do not provide clinicians with detailed recommendations. Given the scope of the opioid crisis and public health response, it is likely that more patients will be treated with MOUD over time. Therefore, determining best practices to manage acute pain in patients on MOUD is a timely and relevant issue to frontline clinicians in multiple settings.
This rapid review examined the benefits and harms of different acute pain management strategies for patients taking OUD medications, and whether these benefits and harms vary by the type of OUD medication or type of acute pain (i.e., emergent condition vs planned surgery). Investigators with VA’s Evidence Synthesis Program (ESP) Center in Portland, OR reviewed the literature identified from searches of MEDLINE®, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL). From nearly 300 articles, 8 retrospective studies addressed the review’s questions: 2 studies examining patients with OUD taking buprenorphine/naloxone, 4 studies examining those taking methadone, and 2 examining a mixed group of patients. No studies examined the use of naltrexone or examined Veterans specifically. Other study characteristics include:
Summary of Findings
Related HSR&D Research Topics:
Please feel free to forward this information to others!
ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers –; and to disseminate these reports throughout VA.
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