Managing acute pain in people recovering from opioid-use disorder

Management of patients recovering from an opioid-use disorder who are no longer taking opioids (or any other substances of abuse) is similar to that of opioid-naive patients; see General principles of acute pain management.

Additional consideration is required if patients are taking medication to assist with recovery, for further advice see:

• Patients taking methadone for opioid substitution
• Patients taking buprenorphine for opioid substitution
• Managing acute pain in patients taking naltrexone.

People recovering from opioid-use disorder may be concerned about relapse if opioids are administered for acute pain. Effective communication and planning are essential. Reassure the patient that the risk of relapse is small if opioids are used appropriately, and the risk could be higher if inadequate doses are used. Where possible, use alternative methods of analgesia and explore nonpharmacological alternatives. Management must include regular reassessment and dose adjustment.

For hospitalised patients, careful discharge planning is important to ensure appropriate tapering of analgesics. Close communication with usual care providers is essential.