Managing acute pain in opioid-tolerant patients with chronic pain

When a patient with chronic pain presents with pain, assess whether this is an exacerbation of chronic pain (ie a flare) or acute pain resulting from new pathology (eg acute myocardial infarction, bowel obstruction, trauma); see Assessing a patient with pain.

Discuss with the patient that the focus of treatment will be on their new pain. Any additional opioids prescribed for acute pain management will be weaned over time. Altering their long-term opioid regimen should be avoided; see Overview of managing acute pain in opioid-tolerant patients for further advice.