Pain management in hospitalized patients with long term opioid use

Document Type: Review Article


1 Department of Pharmacotherapy, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran



This study aims to provide a discussion on pain management challenges in opium addict patients. Pain and addiction are complicated with each other, and their managing requires more clinical consideration. The number of opioid abusers has grown rapidly through the Iranian population, and it seems that opium is the drug of choice in addicted patients. Due to illegal sources of procurement, the purity of substances is suspicious, and it makes pain management more challenging in the field of medication choosing. Although hospitalized patients should receive their daily opioid dose in morphine equivalent, there is no equal value for such substances using in Iran. This concern is not limited to the selection of the treatment, but withdrawal symptoms, relapse causes, drug interactions, and comorbidities are also essential and various in patients. Therefore, pain control should individually be started and proceed based on each one's response. As most guideline recommendations from which the Consensus Statement was derived were based on expert opinion alone, this review identified key issues for evidence-based practice in this area.