Acute Pain Management in Patients With Opioid Tolerance

Adebola Adesoye, PharmD, BCPS; Nakia Duncan, PharmD, BCGP, BCPS


US Pharmacist. 2017;42(3):28-33. 

In This Article

Consequences of Unrelieved Pain

Pain is subjective, which makes it difficult to assess the degree of severity. Generally, acute pain is a multidimensional experience, usually resulting from trauma, that lasts no longer than 3 to 6 months, but it has the potential to become more complex, both physiologically and psychologically.[10,11] Literature suggests that undertreatment of acute pain may lead to decreased responsiveness to opioid analgesics, thereby making subsequent pain control more difficult.

Uncontrolled pain affects various systems, including the CNS and the cardiovascular, pulmonary, gastrointestinal, renal, immunologic, and muscular systems. Additionally, overall recovery is significantly affected, and progression to chronic pain (pain that is persistent in nature, lasting longer than 6 months) may result.[12] The presence of two or more comorbid conditions further complicates pain, and parallels can be drawn between chronic pain and other chronic conditions, such as insomnia, cognitive decline, and depression.

Pain and depression are two of today's most critical public-health issues. This comorbidity is associated with a greater burden to the patient than for either condition alone.[13] Approximately 50% of patients with depression report experiencing pain symptoms.[14] In fact, patients with comorbid depression have greater pain, a worse prognosis, and more functional disability.[15] When pain is not appropriately treated, postanesthesia care-unit stays are prolonged, hospital discharges are delayed, and unanticipated admissions following ambulatory surgery or readmissions occur.[12]