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Methadone & buprenorphine maintenance therapy (MMT &
BMT) are the most common forms of opioid agonist therapy
approved by all major medical and professional organizations
concerned with addiction treatment. Patients on MMT & BMT
are also susceptible to any acute or chronic medical & surgical
problems. There are some misconceptions regarding the pain
management in patients with opioid maintenance therapy
including: maintenance of an opioid agonist (methadone or
buprenorphine) provides analgesia; use of opioids for analgesia
can result in addiction relapse; the additive effects of opioid
analgesics and the opioid agonist therapy can cause respiratory
and central nervous system (CNS) depression; the pain complaint
may be a manipulation of opioid drugs or drug-seeking because
of opioid addiction. And there are some barriers to effective
pain management in patients with opioid maintenance therapy
including: deficiencies in clinician practice; inadequacies
knowledge and skills; systems-related problems; misinformation
about opioid analgesia & tolerance; labeling of aberrant behaviors
(pain relief seeking) as abusive drug seeking. We discussed the
various aspects of acute pain management in patients with opioid
maintenance therapy in this lecture.