The Curbsiders Internal Medicine Podcast #299 Acute Pain Management for the Hospitalist
Oct 11, 2021
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Prefer Immediate‑Release Oral Dosing
- Use immediate‑release oral opioids for acute severe pain and dose every 3–4 hours as needed.
- Avoid extended‑release formulations for acute pain management.
Start Multimodal Analgesia Early
- Build a multimodal analgesia plan from the start: standing acetaminophen, antiemetics, nonopioid adjuncts, and nonpharmacologic measures.
- Discuss an opioid exit strategy early and reassess frequently to avoid unnecessary prolonged opioid exposure.
Separate Dependence From Disorder
- Differentiate opioid dependence (physiologic withdrawal) from opioid use disorder (loss of control, cravings, consequences).
- Recognize dependence can develop within about a week at sufficient doses.