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What if I need pain medication for surgery?

You will still be able to be treated for pain with elective dental or surgical procedures. Your doctors should speak with each other about the plan. They might stop your Buprenorphine medication, and provide opioid pain killers, and then when you are ready to go back on Buprenorphine you will need to be re-induced, which means stopping your pain medicine, experiencing mild withdrawal (for a very short time) and restarting your Buprenorphine.

 

Your doctor can contact The SAMHSA-funded  Physician Clinical Support System (PCSS) and consult one of the buprenorphine mentors. Sample information available about pain by from PCSS

 

note: Buprenorphine was first marketed for pain as Buprenex®. Buprenorphine is effective for mild to moderate pain but not severe pain. The same ceiling effect that limits euphoria also limits analgesia.

 

 

Recommendations for Patients Receiving Maintenance Buprenorphine Therapy (Ann Intern Med. 2006;144:127-134. www.annals.org )


Treatment options are as follows.

1. Continue buprenorphine maintenance therapy and titrate a short-acting opioid analgesic to effect. Higher doses of full opioid agonist analgesics may be required to compete with buprenorphine. 


2. Divide the daily dose of buprenorphine and administer it every 6 to 8 hours to take advantage of its analgesic properties. However, these low doses may not provide effective analgesia in patients with opioid tolerance who are receiving OAT. Therefore, in addition to divided dosing of buprenorphine, effective analgesia may require the use of additional opioid agonist analgesics (for example, morphine).


3. Discontinue buprenorphine therapy and treat the patient with full scheduled opioid agonist analgesics by titrating to effect to avoid withdrawal. With resolution of the acute pain, discontinue the full opioid agonist analgesic and resume maintenance therapy with buprenorphine, using an induction protocol.


4. Convert patient from buprenorphine to methadone at 30 to 40 mg/d. At this dose, methadone will prevent acute withdrawal in most patients.

 

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