Shoshana Herzig, MD, MPH

Herzig discussed special considerations for treating pain in people with OUD.

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.

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

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Herzig outlined a talk she gave at the ACP Internal Medicine 2025 meeting reviewing the latest data in acute inpatient pain management.

Opioids or NSAIDS? Current Pain Management Best Practices, with Shoshana Herzig, MD, MPH

Effective pain management remains a cornerstone of inpatient care, yet practice patterns often vary widely—and not always in ways that reflect current evidence. Despite the availability of multiple pharmacologic options, many clinicians default to familiar regimens rather than tailoring treatment based on safety, efficacy, and patient-specific factors.

, 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 of the main messages in my talk… is to remind people that NSAIDs are over the counter for a reason and opioids are not over the counter for a reason, and I think we need to kind of recalibrate our perceptions of risks and benefits as they relate to NSAIDs versus opioids,” Herzig told 

during the meeting. “There's been some emerging data that does support the assertion that we should use NSAIDs more often.”

sat down with Herzig during the conference to learn more about the latest strategies for managing pain, as validated by the literature. She stressed the importance of ensuring consistent pain management strategies between centers and clinicians and also noted widespread, unnecessary NSAID-avoidance by many practitioners, although its use is supported by data. She outlined some recent findings of opioid compared with non-opioid pain management strategies, although she also said that more studies would be beneficial to strengthen the currently available data.

Shoshana Herzig, MD, MPH

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