Balancing Pain Management and OUD in the Hospital, with Shoshana Herzig, MD

Managing acute pain in patients with opioid use disorder (OUD) remains one of the most complex challenges in hospital medicine. These patients often face under-treatment of pain, contributing to high rates of premature discharge and incomplete medical care. Clinicians also need to consider factors like medications for OUD, such as buprenorphine, in their pain management regimens.

Shoshana Herzig, MD, MPH, Associate Professor of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, gave a talk at the American College of Physicians (ACP) Internal Medicine (IM) Meeting 2025, held April 3-5, in New Orleans, Louisiana, reviewing current best practices and the most updated data supporting strategies for effective and safe acute inpatient pain management. One special population of consideration in pain management is patients with opioid use disorder (OUD), which Herzig also touched on in her talk.

HCPLive sat down with Herzig during the conference to learn more about the latest strategies for managing pain, especially in patients with OUD. She noted that management is generally similar but includes considerations like balancing medications for treating OUD with analgesics. She also mentioned new emerging strategies for pain management in this population, including dose-splitting of pain medications and microdosing of buprenorphine.

“You don't want to send them out of the hospital without managing their OUD, but you also don't want to precipitate withdrawal. And so microdosing of buprenorphine is becoming more [common]. Patients across the country are becoming more familiar with that, although that still usually requires involvement of Addiction Medicine consult.

Herzig has no disclosures to report.

REFERENCE

Herzig S. Acute Pain Management in the Inpatient Setting. Presented at: ACP IM Meeting 2025; April 3-5; New Orleans, Louisiana.