Strategies for Treating Acute Pain in Patients with Opioid Dependence, Opioid Use Disorder, or Long-Term Opioid...

Treating acute pain in individuals who use opioids is complex due to tolerance, physiological and psychological dependence, opioid-induced hyperalgesia, and withdrawal risk. Evidence guiding management remains heterogenous and variably robust.

To map and synthesize available evidence on strategies for treating acute pain in individuals with opioid dependence, opioid use disorder, or opioid tolerance from long term therapy.

Scoping review.

MEDLINE, Embase, Cochrane Central, Web of Science, and Google Scholar were searched. Forward and backward citation tracking were conducted. Two independent reviewers screened titles and abstracts and extracted relevant data from included full text sources.

Of 4030 records screened, 55 works met inclusion criteria, including randomized trials, case reports, cohort studies, and reviews. Evidence spanned five patient categories: illicit opioid use, medications for opioid use disorder (MOUD), chronic opioid therapy, mixed populations, and unspecified opioid exposure. Study design was heterogeneous, with a substantial proportion of lower-level evidence. Multimodal analgesia and continuation or adjustment of baseline opioid therapies were commonly associated with improved pain control. Non-opioid adjuncts, including ketamine, non-steroidal anti-inflammatory drugs (NSAIDs), and regional analgesia were frequently reported as beneficial. However, findings were inconsistent across studies, and several interventions demonstrated limited or context-dependent benefits.

Available evidence suggests that individualized, multimodal approaches and continuation of baseline medications for opioid use disorder may improve acute pain management in patients who use opioids. However, conclusions are limited by substantial heterogeneity, variable methodological quality, and reliance on small or non-comparative studies. These findings should be considered hypothesis-generating and highlight the need for higher-quality, patient-centered, comparative research.