Beyond the Basics: How Should We Manage Acute Pain in Hospitalized Patients with OUD?

Case A 23-year-old male with opioid use disorder (OUD) with intravenous use is hospitalized with a fever and several weeks of back pain. He is diagnosed with methicillin-resistant Staphylococcus aureus bacteremia and osteomyelitis of the cervical spine. He desires medication treatment for OUD (MOUD) but is afraid of inadequate pain management while hospitalized. During previous admissions, untreated pain and withdrawal led to in-hospital substance use.  Brief overview of issue The opioid epidemic is increasing hospitalizations and inpatient mortality related to OUD.1 Patients with injection use can experience painful, life- or limb-threatening, infectious complications. They may delay seeking medical attention due to fear of undertreated pain and withdrawal.2 Pain management in patients with untreated OUD can be challenging given their opioid tolerance. They may need opioids many times daily to avoid withdrawal and therefore can experience significant withdrawal while waiting several hours in an emergency department (ED). Simply treating withdrawal may not meet the opioid deficit to adequately address pain. Approaches to pain management need adjustments for patients with OUD. Inadequately treated pain can increase the risk of return to use and patient-directed discharge. Opioid tolerance can decrease quickly due to the under-dosing of opioids during hospitalization, and coupled with the increasing prevalence of nonpharmaceutical synthetic fentanyl in the illicit opioid suppl...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Clinical Guidelines Key Clinical Questions Pain Source Type: research