For patients with opioid use disorder (OUD), evidence supports continuation of buprenorphine during episodes of acute pain, but overall evidence for pain outcomes in these patients is low, according to a review published online March 18 in the Annals of Internal Medicine.

Michele J. Buonora, M.D., from the Yale School of Medicine in New Haven, Connecticut, and colleagues conducted a systematic review to examine the benefits and harms of acute pain interventions among patients with OUD. A total of 17 trials, 20 controlled observational studies, and 78 uncontrolled observational studies met the criteria for eligibility.

The researchers found that based on cohort studies conducted primarily in perioperative settings, there may be an association between continuing use of buprenorphine during acute pain episodes with similar or improved pain-related outcomes compared with discontinuation.

In adults not prescribed medications for OUD, oral clonidine, intramuscular haloperidol and midazolam with intravenous morphine, and intraoperative intravenous lidocaine may improve pain outcomes based on single well-conducted randomized controlled trials in emergency department or perioperative settings; these findings warrant further study in diverse patient populations. Methadone and the effect of interventions on OUD outcomes were only assessed in a small percentage of studies.

“The effects of acute pain management interventions on OUD outcomes have not been well-characterized and merit urgent study in light of the ongoing crisis of opioid-related overdoses and other harms,” the authors write.

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