Continuing buprenorphine during acute pain episodes for people with opioid use disorder (OUD) may lead to lower or similar pain severity compared to discontinuation.

RT’s Three Key Takeaways:

  1. Buprenorphine Continuation: Evidence from controlled studies supports continuing buprenorphine during acute pain episodes for people with opioid use disorder (OUD), as it may lead to lower or similar pain severity compared to discontinuation.
  2. Evidence Gaps: There is limited and inconsistent evidence on pain outcomes and OUD-related outcomes for other medications like methadone or for individuals not on medication for OUD, revealing major research gaps.
  3. Urgent Research Need: Future studies should prioritize evaluating both pain relief and OUD-related outcomes, such as withdrawal and relapse, to better guide acute pain management during the opioid crisis.


A systematic review on the benefits and harms of acute pain interventions among people with opioid use disorder (OUD) supports the current best practice of continuing buprenorphine during episodes of acute pain. According to the review is published in Annals of Internal Medicine, the overall evidence for pain outcomes in people with OUD is low and researchers suggest there is an important evidence gap on the effect of pain interventions on OUD outcomes.

Researchers from Yale School of Medicine, Albert Einstein College of Medicine and colleagues analyzed data from 115 studies evaluating acute pain interventions among adults with OUD. All studies were conducted in hospital or emergency department (ED) settings.

The researchers aimed to address three questions:

  1. Among adults with OUD, including those prescribed medications for OUD (MOUD), what are the benefits and harms of opioid and nonopioid interventions for acute pain?
  2. Among adults with OUD, including those prescribed MOUD, are opioid and nonopioid interventions for acute pain associated with OUD-related outcomes, including withdrawal, return to nonprescribed opioid use (for those in remission), or treatment initiation or retention?
  3. Do the benefits and harms of acute pain interventions vary by use of MOUD before or during the acute pain episode?

Not all of the included studies reported the number of participants with OUD or the method of OUD diagnosis. Pain outcomes were assessed in 15 studies of participants taking buprenorphine, two studies of participants taking methadone, two studies of participants prescribed both buprenorphine and methadone, and 16 studies of participants not prescribed a MOUD. Outcomes related to OUD were assessed in only seven studies. No studies assessed pain or OUD outcomes in participants prescribed naltrexone.

Researchers concluded from 10 controlled cohort studies, continuing buprenorphine in patients already prescribed may be associated with lower or similar pain severity when experiencing acute pain episodes.

The researchers found very little evidence for acute pain management with methadone, highlighting a significant research gap as over 400,000 people in the US receive methadone to treat OUD.

For people with OUD not prescribed MOUD, acute pain interventions studied included oral clonidine, IM haloperidol and midazolam with concurrent IV morphine, and intraoperative IV lidocaine and resulted in improved pain outcomes, but these studies were conducted on mostly men and almost exclusively in Iran. Most studies of interventions have not included OUD outcomes or extended study periods long enough to observe overall trajectories of patients.

The researchers recommend future studies of pain interventions among those with OUD include outcomes related to opioid withdrawal and cravings, return to nonprescribed opioid use, treatment retention. The researchers suggest further research to close this evidence gap is urgently needed in light of the ongoing opioid crisis.