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Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy

Daniel P. Alford, MD, MPH; Peggy Compton, RN, PhD; and Jeffrey H. Samet, MD, MA, MPH
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From Boston University Medical Center, Boston, Massachusetts, and University of California, Los Angeles, School of Nursing, Los Angeles, California.

Acknowledgments: The authors thank Jessica Richardson for editorial assistance.

Grant Support: Drs. Alford and Samet were supported by a grant from the National Institute on Drug Abuse (R25-DA-13582).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Daniel P. Alford, MD, MPH, Clinical Addiction Research and Education (CARE) Unit, Boston Medical Center, 91 East Concord Street, Suite 200, Boston, MA 02118.

Current Author Addresses: Drs. Alford and Samet: Boston Medical Center, 91 East Concord Street, Suite 200, Boston, MA 02118.

Dr. Compton: University of California, Los Angeles, School of Nursing, Factor Building 4-246, Box 956918, Los Angeles, CA 90095-6918.

Ann Intern Med. 2006;144(2):127-134. doi:10.7326/0003-4819-144-2-200601170-00010
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More patients with opioid addiction are receiving opioid agonist therapy (OAT) with methadone and buprenorphine. As a result, physicians will more frequently encounter patients receiving OAT who develop acutely painful conditions, requiring effective treatment strategies. Undertreatment of acute pain is suboptimal medical treatment, and patients receiving long-term OAT are at particular risk. This paper acknowledges the complex interplay among addictive disease, OAT, and acute pain management and describes 4 common misconceptions resulting in suboptimal treatment of acute pain. Clinical recommendations for providing analgesia for patients with acute pain who are receiving OAT are presented. Although challenging, acute pain in patients receiving this type of therapy can effectively be managed.





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