Intersection of chronic pain treatment and opioid analgesic misuse: causes, treatments, and policy strategies

Abstract

Treating chronic pain in the context of opioid misuse can be very challenging. This paper explores the epidemiology and potential treatments for chronic pain and opioid misuse and identifies educational and regulation changes that may reduce diversion of opioid analgesics. We cover the epidemiology of chronic pain and aberrant opioid behaviors, psychosocial influences on pain, pharmacological treatments, psychological treatments, and social treatments, as well as educational and regulatory efforts being made to reduce the diversion of prescription opioids. There are a number of ongoing challenges in treating chronic pain and opioid misuse, and more research is needed to provide strong, integrated, and empirically validated treatments to reduce opioid misuse in the context of chronic pain.

Physical activity, psychiatric distress, and interest in exercise group participation among individuals seeking methadone maintenance treatment with and without chronic pain

“…Interdisciplinary approaches, which adopt a biopsychosocial model, are efficacious and cost‐effective in managing chronic pain . Currently, there is an absence of evidence‐based integrated treatments for co‐occurring chronic pain and opioid use disorder, and novel interventions for managing pain in MMT are needed . Exercise, a biological factor in the biopsychosocial pain model, is one promising approach; it is effective in treating chronic pain, including back pain, the most common location of chronic pain in individuals seeking MMT .…”

Co-morbid pain and opioid addiction: Long term effect of opioid maintenance on acute pain

“…However, despite the increased interest in this topic, there is little known about the psycho-physiological links between opioid addiction and pain and extremely few empirically validated treatments (Wachholtz et al, 2011a, 2011b). …”

“…Even environmental effects creating associative hyperalgesia, thought to be partially moderated by NMDA receptors, have received recognition as influencing hyperalgesia (Angst and Clark, 2006). Because of concerns that patients will resume addiction behaviors if opioid analgesics are administered in response to acute pain, there is a great debate in the literature about treating acute pain with opioid analgesics for individuals with an opioid addiction history (Wachholtz et al, 2011a). There is also little recognition of how hyperalgesia affects the treatment of acute pain among patients with a history of addiction to opioids (Collins and Streltzer, 2003; Lee et al, 2011).…”

The Feasibility and Acceptability of Groups for Pain Management in Methadone Maintenance Treatment

“…Studies to date that have examined pain management in methadone maintenance treatment have generally focused on pharmacologic interventions (Wachholtz et al 2011; Alford et al 2013). The current study extends possible treatment options by examining the feasibility and acceptability of providing CBT-informed drop-in groups for pain management in a busy opioid treatment program with minimal counseling attendance requirements.…”

“…Proposed strategies for managing chronic pain in MMT patients have focused on pharmacologic interventions (Wachholtz et al 2011; Alford et al 2013); less attention has centered on psychological treatments that may have several potential advantages. First, there is substantial evidence that psychosocial treatments are effective in treating chronic pain (Hoffman et al 2007), substance-related disorders (McHugh, Hearon, & Otto, 2010), and associated psychiatric conditions such as anxiety and depression (Hofmann et al 2012).…”