HIV/AIDS Treatment and Care : Clinical protocols for the European ...

HIV/AIDS TREATMENT AND CARE FOR INJECTING DRUG USERS
• Careful monitoring of IDUs on ARVs and continuing pain medication is required, as dose adjustments
or a change of timing may be necessary.
• Clinicians should treat IDUs on methadone for pain the same way they do non-methadone patients.
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4.6.2. Pain management in patients receiving buprenorphine
Further clinical studies are needed of patients treated for pain while on buprenorphine. Like methadone,
buprenorphine has strong analgesic properties; however, the once-daily dosage for treatment
of substance use is not sufficient to sustain pain relief. Therefore:
• Patients on buprenorphine needing pain relief should first be treated with a non-opioid analgesic
when appropriate; a temporary increase in buprenorphine dosage may be sufficient.
• If acute pain is not relieved by non-opioid medications or an increase of buprenorphine,
more aggressive pain management should be undertaken, including short-acting opioid pain
relievers.
• When patients on buprenorphine require other opioid treatment for pain, the following should
be borne in mind:
° Morphine should not be prescribed.
° Buprenorphine should be discontinued while other opioid pain medication is being taken.
° Higher doses of short-acting opioid pain medication may be needed to achieve analgesia
until the buprenorphine clears the body, when they should be decreased.
° Buprenorphine should not be restarted until an appropriate period after the last dose of the
opioid analgesic, given its half-life.
° Non-combination opioid analgesics are preferable to avoid toxicity and other side-effects,
° Patients with chronic pain who do not respond to increased buprenorphine and continually
and for easier dosage.
require additional analgesia may need to be transferred to methadone treatment (131, 132).
For further information on pain management, refer to Protocol 3, Palliative care for people living
with HIV.
26 For example, a woman on methadone who is in labour will require pain relief in exactly the same way as any other preg-
nant woman.
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