2026 Southeastern Residency Conference

Title: Acute Pain Management in Patients with Opioid Use Disorder: Evaluating Practice and Outcomes Within a Tertiary Care Facility

Authors: Breanna Wright, Mary Beth Brinkman, Justin Gruca
TriStar Centennial Medical Center – Nashville, TN

Background: Chronic pain is reported by 20.5% of Americans within the United States. Chronic pain is defined as pain that lasts beyond three months and extends past normal tissue healing time. Although hospitalized patients are treated for chronic pain, they may also require acute pain management in instances such as moderate to severe fractures or post-surgical pain. These instances may lead to undertreated pain by physicians due to fear of cognitive, respiratory, and psychomotor side effects which may be exaggerated with short-term opioid use. It is important to maintain adequate pain management, especially in patients with opioid use disorder (OUD) because undertreated pain has been shown to result in poor health outcomes, including early discharges, negative stigma, and overall mistrust of the healthcare system. Opioid use disorder is defined as a pattern of opioid use associated with a range of consequences, and with increased mortality leading to significant impairment or distress. The American Society of Addiction Medicine (ASAM) have published guidelines for the treatment of OUD, but there is still a lack of consensus among providers as it relates to acute pain management. In this study, we aimed to describe characteristics of acute pain management in patients on chronic opioid therapy within our institution.

Methods: This is a single-center, retrospective cohort study conducted through chart review from January 1, 2025 through July 1, 2025. Patients were identified via a computerized report using a clinical surveillance platform, generated by searching for buprenorphine medication orders. Patients admitted to our facility with acute pain and identified as being on chronic opioid therapy or receiving buprenorphine for opioid use disorder were included. Exclusion criteria consisted of oncology patients, nonverbal patients, patients admitted to the intensive care unit (ICU), patients receiving methadone inpatient or outpatient, and patients undergoing surgery during their admission. The primary endpoint was the average number of as needed (PRN) pain medication orders. Secondary endpoints included pain scale reduction, psychiatric provider consultations, naloxone administrations, methylnaltrexone administrations, and number of unplanned readmissions or emergency department (ED) visits.

Results: A total of 65 patients were screened; 27 patients met inclusion criteria and 38 patients were excluded. Less than half of the patients included within the study were male, and 85% of patients had a prior history of substance use disorder. Twenty-two of 27 patients had a medication-assisted treatment (MAT) regimen prior to index admission to our facility. The average number of PRN pain medication orders was 1.9, with an average of 0.5 PRN opioid orders and 1.4 PRN non-opioid orders. On average, pain scores decreased from admission to discharge by 0.5. Naloxone and methylnaltrexone were not administered to patients included in this study during the index admissions. 4 patients (14.8%) were readmitted within 30 days, while 8 patients (29.6%) visited the emergency department following their index admission.

Conclusion: Pain is a complex condition that can be challenging to manage, both acutely and chronically. This study’s assessment of acute pain control in patients with chronic pain demonstrated outcomes comparable to those reported in prior studies and highlighted the importance of effective acute pain management within this population. Patients had a similar average of PRN analgesic orders to those in prior studies and experienced modest reductions in pain scores from admission to discharge. Increasing the availability of PRN pain medications may further improve pain control in patients with chronic pain.
This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.