Summary: Chronic pain is among the most common comorbidities in those being treated for opioid use disorder (OUD). But a new study found that most doctors treating OUD pay too little attention to the pain. That leads to more opioid relapse. The study also found that people treated with drugs like methadone or buprenorphine had better pain relief. So they did better overall. The researchers want doctors to treat these other conditions along with 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 badly treated pain may be linked to poor treatment results for many. Studies show chronic pain is the most common comorbid (co-occurring) condition in people with OUD. The Journal of Pain recently published a patient survey. Two-thirds of those treated for OUD said their chronic pain was not well managed. 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 pushed up opioid use disorder (OUD) and overdose deaths. All of this shows we need better opioid addiction treatment.
Health experts say the opioid crisis is not just about too little access to treatment, though that problem is real. Other factors make treatment harder and drive high relapse rates. Most people treated for OUD also have other health problems. Many live with mental health issues and chronic pain. It is no secret that chronic pain and OUD are linked. But it is unknown how badly treated pain may affect OUD recovery. Health experts say part of the problem is focus. Doctors zero in on OUD and pay less heed to other conditions, chronic pain most of all.
In the new survey, researchers analyzed the data of 14,449 patients getting treated in 225 OUD treatment centers. One-third of all the patients had significant chronic pain. Of those, just one-third said their pain was well managed with prescription drugs. Almost half of all the patients said pain was the main reason they went back to opioids. The researchers called this a huge sample. They were shocked that so many patients were not getting proper care for their chronic pain. Many had even used street drugs like heroin to manage their pain.
When researchers spoke with doctors treating OUD, they often heard that pain was not a priority. Some said it was outside their practice. Researchers say doctors need to see that pain is one of the biggest causes of opioid relapse. So good OUD treatment must include real pain relief. The study had another surprise about relapse. In the survey, 20% of those treated for OUD said they would go back to opioids once they beat their addiction. That means treatment is not preparing them for life afterward. Many still see opioid use as an option.
The study also found that people treated for OUD with medications did better. Those treated with buprenorphine and methadone were happier with their care. One reason these drugs work better may be that they also help treat chronic pain. So health experts say addiction care will only improve if different specialists work together. The coronavirus pandemic showed that teamwork across fields, using tools like telemedicine is not that hard.
The researchers say the study also raises questions, such as what role opioids should play in pain care. So they suggest limiting the use of opioids for chronic pain. They also say doctors often do not see chronic pain as a major issue. They forget that the pain may come from other conditions, like depression and mood disorders, that need treatment. If those conditions go untreated, relapse is more likely.
So the researchers concluded that OUD should be treated by multi-specialist teams. These include pain management, psychiatry, psychology, integrative medicine, and physical therapy. We should treat the whole patient, not just chase lower pain numbers on a scale.
Frequently asked questions
What is the relationship between chronic pain and opioid use disorder?
Chronic pain is the most common other condition in people living with opioid use disorder (OUD). It includes neck pain and complex regional pain syndrome. Yet doctors treating OUD often focus on the addiction and leave the pain poorly managed. When the pain is not treated, recovery is harder. Many patients in the study had even used street drugs like heroin to manage their pain.
Can untreated pain cause an opioid relapse?
Yes. In a survey of 14,449 patients at 225 OUD treatment centers, almost half said pain was the main reason they went back to opioids. In the same survey, published in the Journal of Pain, 47% said their pain got worse over time. That raises the risk of relapse. So researchers say good OUD treatment must include real pain relief, not just a plan to stop opioid use.
Do methadone and buprenorphine help with chronic pain?
The study found that people treated for OUD with medications did better. Those on buprenorphine or methadone were happier with their care. One likely reason is that these medications also help treat chronic pain. So for a person living with both conditions, medication for OUD can work on the addiction and the pain at the same time.
Who should treat chronic pain in someone with opioid use disorder?
A team, not one doctor. Researchers concluded that OUD should be treated by multi-specialist teams. These include pain management, psychiatry, psychology, integrative medicine and physical therapy. Depression and mood disorders can drive the pain too, and if they go untreated, relapse is more likely. Telemedicine has shown that this kind of teamwork is not hard to arrange.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
