Inpatient Pain Management

  • Biral PatelEmail author
  • Ahmed Embabi
  • Shannon Garitty


Inpatient pain medicine has become of interest within the past few years especially with the current opioid epidemic we are facing in the United States. Unfortunately not every hospital in the United States is able to designate a team to manage patients that have a preexisting condition of chronic pain that may come into the hospital for a variety of issues that may not even be related to their pain. When chronic pain patients do get admitted into a hospital setting, it does pose a challenge for providers that may be inexperienced in treating these patients along with their “high doses” of opioid-based medications to control their pain. With the current healthcare environment and recent CDC guidelines posted for opioid management, it has created a significant frenzy among providers and how to best serve this patient population. While keeping opioid medications as part of the toolbox, we must be able to integrate a full multimodal pain treatment regimen to obtain the best outcome possible for the patient not only during their hospitalization but also as they are discharged and transition back into their normal way of life.

Throughout this chapter, we will highlight the various techniques that we implement on a regular basis for our patient population within the hospital setting. While the first step of any chronic pain patient that is admitted is to resume home medications, we value the addition of adjuvant medications along with interventional techniques when appropriate to ultimately reduce a significant opioid escalation throughout and after their hospitalization.

Inpatient pain services manage patients with acute, chronic, or cancer pain by working with primary treatment teams as well as case managers and physical therapists to address pain problems, coordinate secondary consultations, and promote continuity of care.


Multimodal pain management Opioid escalation Neuropathic pain management Acute-on-chronic pain Behavior modification Non-opioid analgesics 


  1. 1.
    Holth HS, Werpen HK, Zwart JA, Hagen K. Physical inactivity is associated with chronic musculoskeletal complaints 11 years later: results from the Nord-Trøndelag Health Study. BMC Musculoskelet Disord. 2008;9:159.CrossRefGoogle Scholar
  2. 2.
    CDC Guideline for prescribing opioids for chronic pain — United States, 2016, March 15, 18, 2016.Google Scholar
  3. 3.
    World Health Organization. Cancer pain relief and palliative care. Technical report series 804. Geneva: World Health Organization; 1990.Google Scholar
  4. 4.
    Pergolizzi J, Böger RH, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008;8(4):287–313.CrossRefGoogle Scholar
  5. 5.
    Lester P, Remolana R, Sandhu S, Scott J. Road map for opioid management in the inpatient setting: a structured approach to opioid selection and titration. MedEdPORTAL. 2016;12:10470.CrossRefGoogle Scholar
  6. 6.
    Lin RJ, Reid MC, et al. The barriers to high-quality inpatient pain management: a qualitative study. Am J Hosp Palliat Care. 2015;32(6):594–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain ManagementUniversity of Texas Southwestern Medical CenterDallasUSA

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