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Download Sample letter to specialist: Managing acute pain in patients
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<<CLNIC NAME>> <<CLINIC ADDRESS>> <<DATE>> Re: <<PATIENT NAME >> Dear Dr. <<NAME>>, This patient is currently receiving methadone daily, prescribed by myself. People on methadone tend to be more pain sensitive than those not on long-term opioid agonist maintenance, due to a down-regulation of their endogenous opioid receptors. Acetaminophen and NSAIDs are compatible with methadone if these drugs are not contraindicated for this patient. Patients on methadone generally respond well to the same analgesics used for other patients. NSAIDs are generally best for dental pain. In cases of acute pain that cannot be sufficiently managed using non-opioids, opioids may be used. Codeine would be a reasonable first choice; if it fails, oxycodone-acetaminophen combinations can be used. Patients on methadone tend to need higher and more frequent opioid doses than opioid-naive patients. Use of opioids should be of short duration (less than two weeks). There is always a risk of relapse to problematic drug use when opioids are prescribed, however, the under-treating of acute pain is even more likely to lead to relapse. Opioid agonist/antagonists such as Stadol, Talwin, Tramadol or Suboxone (buprenorphine) should not be used, as they will precipitate acute withdrawal in a methadone-maintained patient. Benzodiazepines and OxyContin should also be avoided. Sincerely, ______________________ <<PHYSICIAN NAME >> © 2008 Centre for Addiction and Mental Health, Toronto, Canada. Permission is granted for this document to be adapted as appropriate, copied and distributed for use by health professionals in the treatment of opioid dependence. All other rights are reserved. This document is available for download as part of the OpiATE Project Toolkit: please visit methadonesaveslives.ca.
