Management of Acute Pain Due to Traumatic Injury in Patients with Chronic Pain and Pre-injury Opioid Use
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PAIN MANAGEMENT IN TRAUMA (MR HOFFMAN, SECTION EDITOR)
Management of Acute Pain Due to Traumatic Injury in Patients with Chronic Pain and Pre-injury Opioid Use Danielle Fontaine 1
&
Melissa Red Hoffman 2
Accepted: 3 November 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review This review seeks to provide a summary of recent literature to help guide practitioners in the management of acute pain due to traumatic injury in patients with chronic pain as well as with pre-injury opioid use. It also seeks to illuminate areas in need of further investigation. Recent Findings There is a paucity of professional guidelines and clinical trials on this topic, despite the disproportionate rates of preexisting opioid use and chronic pain in trauma patients, and the contributions of these issues to inferior outcomes. The management of these patients is complex, requiring knowledge of opioid conversions, medication-assisted treatment (MAT), and non-opioid analgesic options. Summary Provider education, standardized assessments and screening tools, evolving multidisciplinary approach, careful management of pre-injury therapy, use of non-opioid adjuvant therapies, early discharge planning, and close follow-up are essential to achieving adequate acute pain control in these patients, which can contribute to better short- and long-term outcomes. Keywords Chronic pain . Pain management . Opioid use . Opioid use disorder . Trauma . Traumatic injury
Introduction Guidelines from both professional and governmental organizations for the treatment of chronic pain exist, but guidance for the treatment of acute pain due to trauma in patients with chronic pain as well as those with pre-injury opioid use— whether prescribed or secondary to opioid use disorder (OUD)—are limited, despite the fact that trauma patients have disproportionately high rates of preexisting substance use and chronic pain when compared to the general population [1, 2]. Up to 16–20% of trauma patients are using opioids at the time of injury, and approximately 40% of these patients also have This article is part of the Topical Collection on Pain Management in Trauma * Danielle Fontaine [email protected] Melissa Red Hoffman [email protected] 1
Mountain Area Health Education Center General Surgery Residency Program, 121 Hendersonville Rd, Asheville, NC 28803, USA
2
Acute Care Surgeon, Mission Hospital, University of North Carolina, 509 Biltmore Avenue, Asheville, NC 28801, USA
issues with chronic pain [2–4]. Not only does pre-injury opioid use and chronic pain complicate the treatment of acute pain from a pharmacologic standpoint, but pre-injury opioid use is also associated with negative clinical outcomes, including increased number of days in the intensive care unit (ICU), increased hospital length of stay, and need for mechanical ventilation [1, 4]. Pre-injury opioid dependency was also found to be associated with a higher number of readmissions and of discharge to facilities [3]. Negative clinical outcomes have also separately b
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