Treating Acute Pain in the Opiate-Dependent Patient

Opioid drugs, including prescription as well as heroin, have come to the national spotlight due to the unprecedented rate of overdose and addiction. The Centers for Disease Control and Prevention (CDC) has termed this problem as an "epidemic" that has reached record numbers of deaths in 2014. Approximately half of these deaths are the result from prescribed opioids. Also on the rise are the numbers of individuals who are diagnosed with chronic pain and are treated with opioids, methadone and buprenorphine. Individuals currently taking opioids for chronic pain confound the treatment of acute pain after traumatic injury. Goals of treatment include effective pain relief, prevention of opioid withdrawal, and managing the associated behavioral and psychological factors with drug addiction and dependence. The CDC has put forth guidelines on how to treat chronic pain but has yet to provide recommendations on how to treat acute pain in this unique population. The purpose of this literature review is to provide resources to treat pain, given a tolerant opioid-dependent patient.