Ann Intern Med

Continuing buprenorphine may improve pain outcomes in patients with OUD

April 2, 2025

Study details: This systematic review synthesized evidence from 17 trials, 20 controlled observational studies, and 78 uncontrolled observational studies evaluating acute pain interventions in adults with OUD. The review included data from various databases up to July 2024, with independent dual screening and quality assessment of the studies.

Results: Continuing buprenorphine during acute pain episodes may result in similar or improved pain outcomes compared with discontinuation, based on cohort studies primarily in perioperative settings. Single randomized trials in ED or perioperative settings suggested that oral clonidine, IM haloperidol and midazolam with IV morphine, and intraoperative IV lidocaine may improve pain outcomes. However, few studies evaluated methadone or the impact of interventions on OUD outcomes.

Clinical impact: Evidence for pain outcomes in people with OUD is limited and primarily observational, indicating a need for further research. Consider continuing buprenorphine during acute pain episodes and explore the use of adjunctive therapies like clonidine, haloperidol, midazolam, and lidocaine.

Source:

Buonora MJ, et al. (2025, March 18). Ann Intern Med. Acute Pain Management in People With Opioid Use Disorder : A Systematic Review. https://pubmed.ncbi.nlm.nih.gov/40096692/