{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T03:31:03Z","timestamp":1780630263917,"version":"3.54.1"},"reference-count":13,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2023,2,8]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Medications for opioid use disorder (MOUD) are a life-saving intervention; thus, it is important to address barriers to successful initiation. Spasticity affects many patients with spinal cord injury and can be painful and physically debilitating. Chronic painful conditions can lead to the illicit use of non-prescribed opioids, but fear of pain is a barrier to the initiation of MOUD. In this case report, we describe the novel use of botulinum toxin A injections to treat abdominal spasticity and facilitate Acute Pain Service-led buprenorphine\/naloxone initiation in a patient with opioid use disorder and severe abdominal spasticity due to spinal cord injury.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>A patient with C4 incomplete tetraplegia and opioid use disorder complicated by abdominal spasticity refractory to oral antispasmodics and self-treating with intravenous heroin was referred to the Acute Pain Service for inpatient buprenorphine\/naloxone initiation. The patient began to fail initiation of buprenorphine\/naloxone secondary to increased pain from abdominal spasms. The patient was offered ultrasound-guided abdominal muscle chemodenervation with botulinum toxin A, which resulted in the resolution of abdominal spasticity and facilitated successful buprenorphine\/naloxone initiation. At 6 months post-initiation, the patient remained abstinent from non-prescribed opioids and compliant with buprenorphine\/naloxone 8\u2009mg\/2\u2009mg three times a day.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This case report demonstrates that inpatient buprenorphine\/naloxone initiation by an Acute Pain Service can improve the success of treatment by addressing barriers to initiation. Acute Pain Service clinicians possess unique skills and knowledge, including ultrasound-guided interventions, that enable them to provide innovative and personalized approaches to care in the complex opioid use disorder population.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2022-104317","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T11:20:15Z","timestamp":1676460015000},"page":"425-427","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Acute pain service reduces barriers to buprenorphine\/naloxone initiation by using regional anesthesia techniques"],"prefix":"10.1136","volume":"48","author":[{"given":"Alice","family":"Seol","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittni","family":"Micham","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, Stanford, California, USA"},{"name":"Physical Medicine and Rehabilitation Service, VA Palo Alto Health Care System, Palo Alto, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Ye","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2735-248X","authenticated-orcid":false,"given":"Edward R","family":"Mariano","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA"},{"name":"Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T Kyle","family":"Harrison","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA"},{"name":"Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1502-9522","authenticated-orcid":false,"given":"Oluwatobi O","family":"Hunter","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,2,15]]},"reference":[{"key":"2025101110152330000_48.8.425.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2016.09.124"},{"key":"2025101110152330000_48.8.425.2","first-page":"566","article-title":"Epidemiology of spasticity following traumatic spinal cord injury","volume":"71","author":"Maynard","year":"1990","journal-title":"Arch Phys Med 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