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Stem Case and Key Questions Stem Case and Key Questions
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(1) What is opioid addiction/opioid use disorder? (1) What is opioid addiction/opioid use disorder?
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(2) What is opioid tolerance? (2) What is opioid tolerance?
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(3) What are other options to manage pain in patients with a history of opioid use or an opioid use disorder? (3) What are other options to manage pain in patients with a history of opioid use or an opioid use disorder?
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(4) How do opioid requirements in patients with acute pain differ in patients with opioid tolerance compared to those without? (4) How do opioid requirements in patients with acute pain differ in patients with opioid tolerance compared to those without?
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(5) When should an addictionologist be consulted in patients with a history of opioid use disorder who are admitted with acute pain? (5) When should an addictionologist be consulted in patients with a history of opioid use disorder who are admitted with acute pain?
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(6) What is buprenorphine and how is it used in patients with a history of an opioid use disorder? (6) What is buprenorphine and how is it used in patients with a history of an opioid use disorder?
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(7) Should this patient have his buprenorphine held before this elective procedure? (7) Should this patient have his buprenorphine held before this elective procedure?
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(8) What is a comprehensive perioperative pain management plan for this patient? (8) What is a comprehensive perioperative pain management plan for this patient?
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Discussion Discussion
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Conclusion Conclusion
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References References
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Review Questions Review Questions
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Answers Answers
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Reference Reference
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41 C41Surgery in the Presence of Active Addiction or Medication Assisted Addiction Treatment
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Published:April 2023
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Abstract
The opioid epidemic has proved challenging for pain physicians and the entire healthcare industry. Opioid therapy has been a cornerstone of a multimodal approach to the management of chronic and acute pain. The number of individuals using—and misusing—opioids has also risen in the United States. It is estimated that 5–8 million Americans take daily opioids to treat chronic pain. In 2015 an estimated 20.5 million Americans older than 12 years of age had a substance use disorder, including 2 million to prescription analgesics and heroin. These individuals present to the hospital, for both surgical and non-surgical care, with acute pain that may be very difficult to treat due to opioid tolerance and opioid-induced hyperalgesia. Buprenorphine adds another layer of complexity as it intrinsically blocks full opioid agonists from exerting an effect. Some patients may be on buprenorphine/naloxone and related medications that decrease the effectiveness of opioids in pain management. Other patients on maintenance therapy may wish to avoid exposure to opioids for fear of relapse. Ultimately, poor pain management may result in increased suffering, delayed discharge, decreased patient satisfaction, and increased risk of developing persistent post-surgical pain.
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