Pain Management in OUD

A patient with opioid use disorder has the same right to effective acute pain control as anyone else. Continue buprenorphine during acute pain, use multimodal analgesia, and add full-agonist opioids when clinically indicated—often with higher doses needed because of opioid tolerance. For patients on buprenorphine, fentanyl or hydromorphone are preferred because of their higher μ-receptor affinity. Appropriate opioid treatment for acute pain has not been shown to destabilize OUD and undertreated pain may itself contribute to worse outcomes.