How to Manage Acute Pain in a Patient With Opioid Dependence

We're typically starting with phalagonist opioid, long-acting opioids to treat the dependence of opioids and then concurrent short-acting opioids intolerant doses to manage pain. The standard buprenorphine initiation is tough because it requires a withdrawal period before you can give them a big dose of bu prenorphine. And so now there's this low dose initiation and one of the other options we just talked about is giving them just full agonist opioids that will keep them from withdrawing. That will also help control their pain. So do you have any preference or how do you decide between these pathways? It's oftentimes patient preference that we start there and then work back.