• Bridin Patricia Murnion, Consuelo Rivas, Apo Demirkol, Vicky Hayes, Nicholas Lintzeris, and Suzanne Nielsen.
• Drug and Alcohol Services, Central Coast Local Health District, Hamlyn Terrace, Australia.
• Pain Med. 2020 Jun 1; 21 (6): 1188-1198.

ObjectiveThe study objective was to identify the analgesic efficacy of three different pharmacological strategies in patients receiving methadone or buprenorphine as opioid agonist treatment (OAT). The three pharmacological approaches, a) increasing maintenance methadone/buprenorphine dose by 30%, b) adding oxycodone, or c) adding a single dose of gabapentin, were compared with a control condition of the participant's usual OAT dose.DesignA randomized, controlled, double-blinded, double-dummy, within-subject crossover study.SubjectsNine participants on stable doses of methadone and eight participants on stable doses of buprenorphine were recruited.SettingAn outpatient opioid treatment clinic in inner city Sydney, Australia.MethodsThe cold pressor tolerance test was used to examine experimental pain threshold and tolerance. Ratings of subjective drug effects and safety measures (physiological and cognitive) were assessed.ResultsThere was no difference in the primary outcome measures of pain thresholds or tolerance between the conditions examined. Interindividual variability was evident. Differences in some subjective measures were identified, including lower pain recall, lower "bad effects," and higher global satisfaction in the additional methadone condition. In the buprenorphine arm, increased drug liking and "bad effects" were detected with oxycodone administration, while increased subjective intoxication was identified with gabapentin.ConclusionsThere was no evidence of an objective improvement in analgesia with any condition compared with control. Further research is required to optimize pain management strategies in this population.© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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