Mild to moderate acute pain can usually be effectively managed with simple analgesics (including mild opioid medications) and/or other appropriate medications.
Opioid maintenance patients with acute severe pain usually require higher doses of opioid agonists than non-opioid tolerant patients in order to achieve adequate pain relief. (Many receive inadequate analgesia for acute severe pain).
In the event an OST patient is hospitalised their GP prescriber will need to liaise with the hospital staff to ensure continuation of methadone or buprenorphine/naloxone in hospital, cancellation of the prescription at the community pharmacy and the resumption of prescribing at the community pharmacy on discharge. BOPAS can assist as required.
Chronic pain in Opioid maintenance patients should be managed in the same way as it is for other patients.
Methadone or buprenorphine/naloxone as prescribed for maintenance treatment may provide partial relief for some chronic pain.
BOPAS advises consultation with a specialist pain management service or BOPAS medical officer before considering the regular prescribing of opioid medication for the management of chronic pain.
Long term methadone treatment can saturate and dull opioid receptors leading to increased patient pain levels as the body tries to compensate for inhibited pain recognition (hyper-analgesia; increased sensitivity to pain secondary to long-term blockade of opiate based pain receptors)
*See Section 6.6; 6.6.1; 6.6.2 Management of Acute and Chronic Pain page 49 of " New Zealand Practice Guidelines for Opioid Substitution Treatment 2014"
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