Chronic pain is the most common condition alongside opioid use disorder (OUD). When it is poorly managed, it drives relapse. In a Journal of Pain survey, two-thirds of people in OUD treatment said their pain was not managed well. Those treated with methadone or buprenorphine reported better pain relief and better results.
Summary: Chronic pain is one of the most common conditions in people being treated for opioid use disorder (OUD). But a new study found that, in most cases, doctors treating OUD do not pay enough attention to chronic pain. That leads to more opioid relapse. The study also found that people treated with medicines like methadone or buprenorphine had better pain relief and so better results. So researchers urge doctors to manage these other conditions when treating OUD.
When we think of people with OUD, we forget that many of them live with severe chronic pain, such as neck pain, complex regional pain syndrome and more. This poorly managed pain may be linked to poor treatment results in many of them. Studies show chronic pain is the most common other condition in people with OUD.
The Journal of Pain recently published a patient survey. It found that two-thirds of those treated for OUD said their chronic pain was not managed well. Worse, 47% said their pain got worse over time. That raises the risk of opioid relapse.
The opioid crisis is still a major health problem, and it shows no sign of slowing down. The coronavirus pandemic only increased opioid use disorder (OUD) and overdose deaths. That makes it even more important to focus on effective opioid addiction treatment.
Health experts say the problem with the opioid crisis is not just poor access to opioid treatment. Other factors also make treatment harder and lead to high relapse rates. Most people treated for OUD have other conditions too. Many live with mental health problems and chronic pain.
It is no secret that chronic pain and OUD are linked. But no one knows how poorly managed pain affects OUD treatment results. Health experts say one problem is that doctors focus heavily on OUD and less on other conditions, above all chronic pain.
In the new survey, researchers studied data from 14,449 patients treated at 225 OUD treatment centers. One-third of all patients had significant chronic pain. Of these, just one-third said their pain was well managed with medicines. And almost half of all patients said pain was the primary reason for opioid relapse.
Researchers say this is a huge sample. They were stunned to see how many patients do not get proper care for their chronic pain. Many of these patients have even used street drugs like heroin to manage their pain.
When researchers talked with doctors treating OUD, they often heard that treating pain was not their priority or not part of their practice.
Researchers say we must understand that pain is one of the biggest causes of opioid relapse. So effective OUD treatment must include real pain relief.
The study had another surprising finding about relapse. In the survey, 20% of those treated for OUD said they would go back to opioid use once they beat their addiction. So treatment is not preparing them well for life after treatment. Many of them still see opioid use as an option.
The study also found that people treated for OUD with medicines did better. Those treated with buprenorphine and methadone were more satisfied with treatment. One reason these medicines work better seems to be that they also help treat chronic pain.
So health experts say addiction treatment will only improve if different specialists work together. The coronavirus pandemic has also shown that teamwork across fields, using tools like telemedicine, is not that hard.
Of course, researchers say the study also raises questions, like what role opioids should play in pain care. So the researchers suggest limiting the use of opioids for chronic pain.
Researchers also say doctors often do not see chronic pain as a major problem. They forget that the pain may come from other conditions, like depression and mood disorders, that need treatment. If these are left alone, relapse is more likely.
So researchers concluded that OUD should be treated by teams of many specialists. That includes pain management, psychiatry, psychology, integrative medicine and physical therapy. We should treat the whole patient, not just try to lower the number on a pain scale.
Frequently asked questions
How are chronic pain and opioid use disorder related?
Chronic pain is the most common condition that people with opioid use disorder (OUD) live with, from neck pain to complex regional pain syndrome. In a survey of 14,449 patients at 225 OUD treatment centers, one-third had significant chronic pain. Many had even used street drugs such as heroin to manage that pain when it went untreated.
Does chronic pain cause opioid relapse?
It is one of the biggest causes. Almost half of the patients surveyed said pain was the main reason they went back to opioids. And 47% said their pain got worse over time. Many doctors treating OUD told researchers that pain was not their priority or not part of their practice. Treatment for OUD works only when it includes real pain relief.
Do methadone and buprenorphine help with chronic pain?
Yes. People treated for OUD with medicine did better. Those on buprenorphine or methadone were more satisfied with their treatment. One reason these medicines work better is that they also ease chronic pain. That removes one of the main triggers for relapse.
Who should treat opioid use disorder when chronic pain is present?
A team. Researchers concluded that OUD should be treated by several specialties working together: pain management, psychiatry, psychology, integrative medicine and physical therapy. Pain can come with depression and mood disorders that also need treatment. The goal is to treat the whole person, not just lower a pain score.
Related reading
Mindfulness Cuts Opioid Treatment Dropout and Relapse · Barely 25% With Opioid Use Disorder Get Their Meds · Self-Care Training for Chronic Pain Outcomes · How Chronic Pain and Opioid Addiction Are Related