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Systematic Review and Meta-Analysis of the Prevalence of Chronic Pain Among Patients With Opioid use Disorder and Receiving Opioid Substitution Therapy

  • Jessica Delorme
    Affiliations
    Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Clermont-Ferrand, France

    Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
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  • Nicolas Kerckhove
    Correspondence
    Address reprint requests to Nicolas Kerckhove, Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Clermont-Ferrand, 63000, France.
    Affiliations
    Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Clermont-Ferrand, France

    Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France

    Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
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  • Nicolas Authier
    Affiliations
    Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Clermont-Ferrand, France

    Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France

    Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
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  • Bruno Pereira
    Affiliations
    CHU Clermont-Ferrand, Secteur Biométrie et Médico-économie, Clermont-Ferrand, France
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  • Célian Bertin
    Affiliations
    Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Clermont-Ferrand, France

    Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France

    Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
    Search for articles by this author
  • Chouki Chenaf
    Affiliations
    Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Clermont-Ferrand, France

    Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France

    Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
    Search for articles by this author
Published:October 07, 2022DOI:https://doi.org/10.1016/j.jpain.2022.08.008

      Highlights

      • 23 studies on chronic pain (CP) prevalence in patients treated with OST were assessed.
      • 78.3% of the studies had a low risk of bias.
      • The prevalence of CP in patients treated with OST is high (45.3 %).
      • Prevalence did not vary according to gender, OST, and CP duration.
      • Primary care sites were associated with a lower CP prevalence than medical clinics.

      Abstract

      To assess studies examining the prevalence of chronic pain (CP) in patients treated with Opioid Substitution Treatment (OST - buprenorphine or methadone) for Opioid Used Disorder (OUD), we conducted a systematic review and meta-analysis of the literature between the years 2000 and 2020. We searched EMBASE, PsycINFO, Cochrane, and MEDLINE databases and included studies assessing the prevalence of CP in OUD adults treated with OST. The studies were assessed for risk of bias and overall quality and the results were pooled using a random-effects model. Subgroup analyses and meta-regressions were used to identify possible factors associated with CP. Twenty-three studies reported data on the prevalence of CP in patients treated with OST were evaluated. The prevalence obtained was 45.3% (CI95% [38.7; 52.1]). Overall, 78.3% of the studies had a low risk of bias. Subgroup analysis estimates did not vary according to gender, OST, and CP duration. However, it appeared that the clinical settings was associated with a lower CP prevalence when assessed in primary care sites. Our study provided an estimate regarding the prevalence of CP among OST patients. These patients deserve specific attention from health professionals and health authorities. Thus, the real challenge in OST patients is the implementation of a multidisciplinary approach to manage CP.

      Perspective

      Our meta-analysis provided an estimate of CP prevalence, reaching almost 50% of OUD patients with OST. Thus, the urgent challenge in OST patients is to pay systematic attention to chronic pain diagnosis, along with the implementation of a multidisciplinary patient-focused approach for an appropriate management of CP.

      Registration

      PROSPERO (CRD42021284790)

      Key words

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