To Dream the Impossible Dream: Acute Pain Management for Patients on Buprenorphine

With our current climate of opioid overuse and increasing opioid related deaths, alternatives to pure mu opioids are necessary. Buprenorphine, an important weapon in the arsenal for management of substance use disorder, is now rising in popularity as an opioid option for chronic pain. Evidence has demonstrated efficacy for various chronic pain conditions with less risk of adverse effects, such as the development of tolerance and respiratory depression. With increasing utilization, patients on chronic buprenorphine therapy are now more frequently being admitted to hospitals with severe acute pain due to surgery or trauma. A partial opioid agonist, buprenorphine has unique pharmacokinetic properties that differ from pure mu opioid agonists. Challenges with pain control can occur when acute pain treatment with a pure opioid is used in patients receiving buprenorphine due to its strong affinity to the mu receptor. This session will review the unique characteristics of buprenorphine and offer options for treatment of severe acute pain in patients receiving buprenorphine therapy.