Management of chronic pain patients presents a unique challenge to critical care providers. These patients may have significant opioid tolerance and exhibit signs of opioid-induced hyperalgesia. Mechanical ventilation, hemodynamic instability and cognitive impairment further complicate the accurate assessment of pain and efficacy of treatment. This review will examine core topics such as management of opioid-tolerant patients, drug interactions, and implantable therapies that pose problems to critical care providers.
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