Acute pain therapy in opiate-substituted patients

Treatment of acute pain is an essential part of emergency and rescue medicine. In Germany, there has been an increasing number of patients undergoing opiate substitution therapy. Managing acute pain in these patients is a great challenge. Knowledge of current substitution therapies, the effects of opioid-induced hyperalgesia, and opioid tolerance is helpful for the treating staff. The stigma (need for pain medication as an expression of addiction) of this patient group and fears of induced relapse often make adequate analgesia difficult. The importance of handovers at the interfaces between prehospital, emergency department, and in-hospital is high, as they pave the way for adequate pain control and the establishment of an early multimodal pain concept. This study aimed to enhance the knowledge about current opiate substitution therapies, including opiate-induced hyperalgesia and opiate tolerance, within the context of pain management. To facilitate this, a list of potentially available pain medications will be provided as a working tool to physicians who are inexperienced in pain management for an early multimodal therapy concept.

We reviewed and analyzed the currently available data on opioid-based substitution therapy and pain management in patients receiving long-term opioid therapy by searching relevant databases, including PubMed, UptoDate, TripPro, and the Cochrane Library. A classic patient casuistry was presented and discussed.

Knowledge of substitution therapies and their impact on pain management help in the care of this special patient population

With the increasing number of patients receiving opiate substitution therapy, the knowledge of substitution therapy and possible treatment strategies would facilitate the provision of acute care for these patients and enable the initiation of adequate pain management in preclinical settings.