Friday, January 20, 2006
Pain management and methadone maintenance
Annals of Internal Medicine has published a "Perspective" on pain management for those receiving methadone or buprenorphine maintenance therapy for opioid addiction. The bulk of the article is dedicated to dispelling the myths surrounding pain treatment for those with substance abuse problems, including:
1. The maintenance opioid agonist provided analgesia,
2. Use of opioids for analgesia may result in addiction relapse,
3. The additive effcts of opioid analgesics and maintenance therapy may cause respiratory and CNS depression, and
4. Reporting pain may be a manipulation to obtain opioid medications, or drug-seeking, because of opioid addiction.
Additionally, it has very focused and practical advice on the treatment of acute pain for those on buprenorphine maintenance (which is complicated due to buprenorphine's very high affinity for the mu-opioid receptor as well as its potential to cause acute opioid withdrawal). This is an area in which I personally have very little experience, and so I learned a lot, and would recommend the article as a primer on the topic.
