Case discussion

As you have seen over the last four steps, the perioperative pain management of patients with opioid tolerance and opioid use disorder (OUD) poses a number of challenges. In this step, you will observe a multidisciplinary discussion which takes place in order to formulate a perioperative pain management plan for a patient with OUD. Read the case summary below before watching the video, then join the discussion at the end of this step.

The UCLH Complex Pain Team is an interdisciplinary team with experience in the management of complex pain (pain associated with multiple physical and mental health comorbidities, significant polypharmacy, complex psychosocial circumstances or substance misuse) in an inpatient and outpatient setting. In this video, you will see how psychological and social support can be provided practically, in order to complement pharmacological pain management.

Case summary

Medication

• MR morphine tablets 60 mg BD
• IR liquid morphine (Oramorph) 20 mg PRN (‘when pain bad at night’)
• Amitriptyline 150 mg ON
• Diclofenac suppositories 50 mg BD
• Lidocaine 5% medicated patches applied directly to the back
• Thiamine
• Vit B Compound tablets

Social circumstances

Your turn now

Use the comments section below to discuss this case.
What features of this patient’s background do you think are particularly relevant to his perioperative pain management?
What do you think would make this particularly challenging?
What do you think are the most important risks factors that should be considered in this case?
Are there any important points you can think of which were not discussed in the video?

Please do not share any details that could be patient-identifiable. You can ‘like’ and comment on other learners’ comments, as well as ‘follow’ other learners so you don’t miss their comments.