Managing Chronic Pain in Patients With Opioid Dependence

Liebschutz, Jane M.; Beers, Donna; Lange, Allison

doi:10.1007/s40501-014-0015-4

Cited by 12 publications

(4 citation statements)

References 80 publications

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“…Chronic pain can be difficult to treat in people with OUD. Comprehensive multimodal approaches should be used, including OUD treatment; nonopioid analgesics; nonpharmacologic treatments, such as physical therapy and acupuncture; and other psychosocial treatments directed at pain and comorbid mental health conditions ( 85 ). Multidisciplinary treatment teams with pain, addiction, and mental health specialists are likely best equipped to care for patients with OUD and chronic pain ( 86 ).…”

Section: Comorbid Conditions Due To the Direct Effects Of Opioidsmentioning

confidence: 99%

Caring for Patients With Opioid Use Disorder: What Clinicians Should Know About Comorbid Medical Conditions

Slawek

Hayes

et al. 2019

PRCP

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Opioid use disorder (OUD) is a growing problem, with opioid‐involved overdose deaths quadrupling since 1999 in the United States. This article reviews comorbid medical conditions related to OUD, starting with complications of behaviors associated with opioid use (e.g., injection drug use), followed by conditions stemming from the direct effects of opioids (e.g., hypogonadism). HIV and hepatitis C virus (HCV) are common infections in people with OUD, and treatment for these conditions can be safely provided regardless of ongoing substance use. Complications of drug injection, such as HIV, HCV, skin and soft tissue infections, and infective endocarditis, may be prevented through provision of sterile syringes and supervised injection facilities. Rare, life‐threatening bacterial infections may present with signs and symptoms that mimic intoxication, such as malaise or stupor, and should be assessed in patients with fever or positive blood cultures. In addition, chronic opioid exposure can lead to hypogonadism, opioid‐induced hyperalgesia, sleep‐disordered breathing, and potentially increased risk of cardiovascular disease and neurocognitive impairment. Pharmacotherapies for OUD (buprenorphine, methadone, and naltrexone) are safe and effective and their adverse opioid effects can be managed in clinical practice. Awareness of OUD‐associated medical conditions and their treatments is an important step in improving the health and wellness of people with OUD.

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Section: Comorbid Conditions Due To the Direct Effects Of Opioidsmentioning

confidence: 99%

Caring for Patients With Opioid Use Disorder: What Clinicians Should Know About Comorbid Medical Conditions

Slawek

Hayes

et al. 2019

PRCP

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“…The promotion of exercise in MMT programs may be particularly timely because a recent study of methadone‐maintained participants found that the majority did not meet recommended weekly levels of physical activity . While exercise has been proposed as an intervention for enhacing the psychological functioning of patients in MMT and for managing pain in those with co‐occurring chronic pain and opioid use disorder, few studies have examined the feasibility, acceptability, or efficacy of these approaches . Among patients with chronic musculoskeletal pain, the avoidance of physical activity is common and may result in deconditioning and pain exacerbation .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…Draft items were developed in two steps. First, items were proposed based on a review of the literature and evidencebased recommendations (Barry, 2016;Liebschutz et al, 2014). We reviewed studies, reviews, and consensus-based guidelines that focused on the treatment of co-occurring chronic pain and OUD.…”

Section: Item Developmentmentioning

confidence: 99%

“…First, chronic pain is most commonly treated in primary care, accounting for ~10% to 15% of patients (Levy et al, 2015; Mills et al, 2016). If a patient transitions from appropriate opioid use to inappropriate or problematic opioid use, a change in treatment plan typically originates with their prescribing clinician (Dowell et al, 2016; Liebschutz et al, 2014). Moreover, given the dynamic interaction of pain and opioid use, it is important to explore factors that might influence the treatment of pain and OUD together (McGovern et al, 2014; Speed et al, 2018; St Marie & Broglio, 2020; Wilson-Poe & Moron, 2018).…”

Section: Introductionmentioning

confidence: 99%

Development and validation of the Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire

Varley

Goodin

Copes

et al. 2020

Implementation Research and Practice

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Background: Patients with co-occurring chronic pain and opioid use disorder (OUD) have unique needs that may present challenges for clinicians and health care systems. Primary care providers’ (PCPs) capacity to deliver high quality, research-informed care for this population is unknown. The objective of this study was to develop and test a questionnaire of factors influencing PCP capacity to treat co-occurring chronic pain and OUD. Methods: Capacity to Treat Co-Occurring Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire items were developed over a 2-year process including literature review, semi-structured interviews, and expert panel review. In 2018, a national sample of 509 PCPs was recruited through email to complete a questionnaire including the initial 44-item draft CAP-POD questionnaire. CAP-POD items were analyzed for dimensionality, inter-item reliability, and construct validity. Results: Principal component analysis resulted in a 22-item questionnaire. Twelve more items were removed for parsimony, resulting in a final 10-item questionnaire with the following 4 scales: (1) Motivation to Treat patients with chronic pain and OUD (α = .87), (2) Trust in Evidence (α = .87), (3) Assessing Risk (α = .82), and (4) Patient Access to therapies (α = .79). These scales were associated with evidence-based practice attitudes, knowledge of pain management, and self-reported behavioral adherence to best practice recommendations. Conclusion: We developed a brief, 10-item questionnaire that assesses factors influencing the capacity of PCPs to implement best practice recommendations for the treatment of co-occurring chronic pain and OUD. The questionnaire demonstrated good reliability and initial evidence of validity, and may prove useful in future research as well as clinical settings. Plain language abstract Patients with co-occurring chronic pain and opioid use disorder (OUD) have unique needs that may present challenges for clinicians and health care systems. Primary care providers’ (PCPs) ability to deliver high quality, research-informed care for this population is unknown. There are no validated instruments to assess factors influencing PCP capacity to implement best practices for treating these patients. The objective of this study was to develop and test a questionnaire of factors influencing PCP capacity to treat co-occurring chronic pain and OUD. We recruited 509 PCPs to participate in an online questionnaire that included 44 potential items that assess PCP capacity. Analyses resulted in a 10-item questionnaire that assesses factors influencing capacity to implement best practice recommendations for the treatment of co-occurring chronic pain and OUD. PCPs reported moderately high confidence in the strength and quality of evidence for best practices, and in their ability to identify patients at risk. However, PCPs reported low motivation to treat co-occurring chronic pain and OUD, and perceived patients’ access to relevant services as suboptimal, highlighting two areas that should be targeted with tailored implementation strategies. The 10-item Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire can be used for two purposes: (1) to assess factors influencing PCP capacity before implementation and identify areas that may require improvement for implementation and (2) to evaluate implementation interventions aimed at increasing PCP capacity to treat this population.

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Managing Chronic Pain in Patients With Opioid Dependence

Cited by 12 publications

References 80 publications

Caring for Patients With Opioid Use Disorder: What Clinicians Should Know About Comorbid Medical Conditions

Caring for Patients With Opioid Use Disorder: What Clinicians Should Know About Comorbid Medical Conditions

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

Development and validation of the Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire

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