Pain management in opioid maintenance treatment

Expert Opin Pharmacother. 2019 Nov;20(16):1993-2005. doi: 10.1080/14656566.2019.1652270. Epub 2019 Aug 16.


Introduction: Opioid addiction is a worldwide disease with a significant impact. A multitude of physical and mental comorbidities are associated with opioid addiction, pain being one of the most relevant. Insufficient pain management may lead to a disruption in medical treatment, self-medication, and subsequent harm to patients. Areas covered: In this review, the authors provide a general overview of opioid addiction. A literature search for pain management and opioid maintenance treatment was conducted. Different settings of acute or chronic pain and situations specific to patients addicted to opioids are described. Pain management therapy in addiction is also addressed with an emphasis on treatment strategies such as the optimization of methadone and buprenorphine medication, additional opioid analgesia, and multimodal pain management. Expert opinion: Opioid addiction is a growing global health concern, and maintenance therapy remains an effective and lifesaving treatment option. However, there remains uncertainty on the appropriate pain management for this patient group. The backbone of pain management in opiate-addicted patients remains maintenance therapy while adjunctive treatment such as regional analgesia, non-opioid analgesia, antidepressants, steps to improve sleep, acceptance and commitment therapy, biofeedback, and hypnosis should be considered. Additional opioid medication is possible as well.

Keywords: Methadone; buprenorphine; opioid dependence; opioids; pain; therapy.

Publication types

  • Review

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Chronic Pain / drug therapy*
  • Humans
  • Opiate Substitution Treatment
  • Opioid-Related Disorders / pathology
  • Opioid-Related Disorders / prevention & control
  • Pain Management / methods*


  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Antidepressive Agents