Highlights
- •Two-thirds reported chronic pain was not managed in their opioid treatment program.
- •Pain management was noted as a secondary effect of medication-assisted treatment.
- •Experiences of pain were the primary factor reportedly leading to opioid relapse.
Abstract
Chronic pain is a significant comorbid condition among individuals with opioid use
disorder (OUD). However, due to conflicting perceptions of responsibility, structural
barriers, and a lack of widely applied standards of care, it is unclear what the landscape
of chronic pain management looks like in addiction medicine. Using a national opioid
surveillance system, we analyzed survey data from new entrants (n = 14,449) to 225
OUD treatment centers from 2013 to 2018, as well as an online survey among a subset
of respondents (n = 309). While chronic pain was reported by 33.4% of the sample,
two-thirds of the chronic pain group (66.0%) reported their pain was not managed through
their OUD treatment program, with 47% reporting worsening pain. Pain that was managed
was primarily done so through pharmaceuticals (75.2%), notably as a secondary effect
of medication-assisted treatment. In addition, 43.2% reported chronic pain as a primary
factor in their opioid relapse. These data suggest that chronic pain is commonly reported,
yet not managed by many OUD treatment programs, increasing the likelihood of opioid
relapse. In order to improve poor outcomes among OUD patients, interdisciplinary collaboration/care,
along with evidence-based policies or processes for quality pain management in addiction
care need to be prioritized.
Perspective
This article suggests chronic pain is commonly reported, yet not managed by many OUD
treatment programs, increasing the likelihood of opioid relapse. In order to improve
low retention and success rates among OUD patients, interdisciplinary collaboration,
evidence-based policies or processes (eg, referral) for quality pain management in
addiction care need to be prioritized.
Key words
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Article info
Publication history
Published online: November 13, 2020
Accepted:
October 13,
2020
Received in revised form:
September 24,
2020
Received:
August 18,
2020
Footnotes
Disclosure: This work was sponsored by the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System, an independent nonprofit post-marketing surveillance system that is supported by subscription fees from pharmaceutical manufacturers who use these data for pharmacovigilance activities and to meet regulatory obligations. RADARS System is the property of Denver Health and Hospital Authority, a political subdivision of the State of Colorado. Denver Health retains exclusive ownership of all data, databases, and systems. Subscribers do not participate in data collection nor do they have access to the raw data. All authors are employees of Washington University in St. Louis, which receives research funding from Denver Health and Hospital Authority. Dr. Cicero serves as a paid consultant on the Scientific Advisory Board of the RADARS System. None of the authors have a direct financial, commercial, or other relationship with any of the subscribers of the RADARS System.
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© 2020 by United States Association for the Study of Pain, Inc.
