The current state of knowledge on care for co-occurring chronic pain and opioid use disorder: A scoping review.
Study Goal
The researchers aimed to identify current treatments and delivery models for co-occurring chronic pain and opioid use disorder (OUD), including the effectiveness of Mindfulness-Oriented Recovery Enhancement.
Results Summary
The study found that combining opioid agonist treatments (OAT) with Mindfulness-Oriented Recovery Enhancement or cognitive behavioral therapy showed effectiveness in managing co-occurring chronic pain and OUD. Authors generally recommended a combination of strategies to address patient needs.
Population
Individuals with co-occurring chronic pain and opioid use disorder (OUD).
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
opioid agonist treatments (OAT) such as methadone or buprenorphine/naloxone | increase | co-occurring chronic pain and opioid use disorder (OUD) management | - | - | provide evidence for the effectiveness | #1 |
combining OAT with Mindfulness-Oriented Recovery Enhancement | increase | co-occurring chronic pain and opioid use disorder (OUD) management | - | - | provide evidence for the effectiveness | #2 |
combining OAT with cognitive behavioural therapy | increase | co-occurring chronic pain and opioid use disorder (OUD) management | - | - | provide evidence for the effectiveness | #3 |
other pharmacological treatments (opioid and nonopioid) | neutral | co-occurring chronic pain and opioid use disorder (OUD) management | - | - | are also underlined | #4 |
nonpharmacological treatments (e.g. physiotherapy) | neutral | co-occurring chronic pain and opioid use disorder (OUD) management | - | - | are also underlined | #5 |
service delivery models (e.g. simultaneous treatment of comorbidities, interdisciplinary and interprofessional collaboration) | neutral | co-occurring chronic pain and opioid use disorder (OUD) management | - | - | are also underlined | #6 |
a combination of strategies | increase | patient needs | - | - | authors recommend | #7 |
integrated treatment of the multiple biopsychosocial dimensions of the co-occurring disorders | increase | co-occurring chronic pain and OUD | - | - | experts recommend the uptake | #8 |
collaborative interdisciplinary work | increase | co-occurring chronic pain and OUD | - | - | experts recommend the uptake | #9 |
BACKGROUND AND AIMS: Opioid use disorder often co-occurs with chronic pain but assessment and treatment of these co-occurring disorders is complex. This review aims to identify current treatments and delivery models for co-occurring chronic pain and opioid use disorder (OUD) documented in the scientific literature. DESIGN: Scoping review. METHODS: The review was conducted in six databases in June 2022 (no time limit): CINAHL, PsycINFO, Web of Science, Cochrane, PubMed and Embase. The PRISMA-ScR checklist was used to guide reporting. RESULTS: Forty-seven publications addressing the issue of co-occurring chronic pain and OUD management were included. Randomized controlled trials provide evidence for the effectiveness of opioid agonist treatments (OAT) such as methadone or buprenorphine/naloxone, as well as for combining OAT with Mindfulness-Oriented Recovery Enhancement or cognitive behavioural therapy. A number of other pharmacological treatments (opioid and nonopioid), nonpharmacological treatments (e.g. physiotherapy) and service delivery models (e.g. simultaneous treatment of comorbidities, interdisciplinary and interprofessional collaboration) are also underlined. In most cases, authors recommend a combination of strategies to meet patient needs. CONCLUSIONS: The scoping review reveals gaps in evidence-based knowledge to effectively care for co-occurring chronic pain and OUD, but several experts recommend the uptake of known 'best' practices such as integrated treatment of the multiple biopsychosocial dimensions of the co-occurring disorders as well as collaborative interdisciplinary work. CLINICAL RELEVANCE: Improving services is dependent on alleviating barriers such as working in silos, the costs associated with nonpharmacological treatments, and the double stigma associated with pain in people with a substance use disorder.