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Co-occurring chronic pain is common among people with substance use disorders, particularly opioid use disorder (OUD). Studies suggest that between 36 and 68% of people on opioid agonist treatment for OUD also have chronic pain.
In this episode, Dr. Rita McCracken and David Ball talk with guests about chronic pain and OUD. How can we respond to new or changing pain for people already on opioid agonist treatment? How can we navigate pain treatment for people with OUD in the context of the overdose crisis?
In this episode, you’ll hear:
- 2:22 – Dr. Michael Butterfield – Psychiatrist, pain medicine specialist, and Director, UBC Pain Medicine Residency Program
- 15:16 – Dwayne Patmore – Veteran and patient advocate
Here’s what listeners can take away from this episode:
- Knowing your patient and the longitudinal relationship you have is a gift that is going to help you serve those with OUD who are also experiencing pain. Being able to listen carefully, develop an accurate diagnosis for the pain or why the pain has transitioned, and develop trusting relationships where you can have close follow-up will make all the difference.
- Not all pain is the same. For patients who are taking OAT, the duration of pain relief that OAT provides can help determine if their pain is opioid resistant or not. When someone on OAT is experiencing pain, changing the timing of their dose may help in managing pain. For example, instead of methadone being delivered once a day, what happens if you split that into multiple doses?
- While OAT is appropriate for co-occurring chronic pain and OUD, There are non-pharmacological options that can be helpful for patients. Supportive listening and counseling can be practiced by almost every clinician, no matter where they work. More expert types of counseling and physical therapies can also be important supports for people experiencing OUD and chronic pain.
- We know that sleep disruption can actually increase people’s experience of pain, so it can also be important to ask good questions about quality of sleep, and sleep disruption related to the pain. Taking both a pharmacological and non-pharmacological approach may be appropriate: asking about sleep hygiene components such as screen time before bed as well as potentially adding a non-sedative sleep aid.
De-centring western colonial approaches
- Pain, Pain Killers and Indigenous Peoples: Choose the right medicine for you in partnership with your physician
- Sharma, S., Abbott, J. H., & Jensen, M. P. (2018). Why clinicians should consider the role of culture in chronic pain. Brazilian journal of physical therapy, 22(5), 345–346. https://doi.org/10.1016/j.bjpt.2018.07.002
- Addiction Care and Treatment Online Course (Online, self-paced, free) — See Module 12, Pain and substance use disorder
- BC ECHO on Substance Use, OUD Cycle 4, Session 6: Managing patients with co-occurring chronic pain and opioid use disorder
- BC ECHO for Chronic Pain (Free, online interactive sessions)
- Pain Foundations for Primary Care Providers and Allied Health Providers (Online, self-paced, free)
- BC Centre on Substance Use. Guideline for the clinical management of opioid use disorder [Internet]. 2017
- Busse JW, Wang L, Kamaleldin M, et al. Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA. 2018;320(23):2448–2460. doi:10.1001/jama.2018.18472
- Gorfinkel L, Voon P, Wood E, Klimas J. Diagnosing opioid addiction in people with chronic pain BMJ 2018; 362 :k3949 doi:10.1136/bmj.k3949
- Hser YI, Mooney LJ, Saxon AJ, Miotto K, Bell DS, Huang D. Chronic pain among patients with opioid use disorder: Results from electronic health records data. J Subst Abuse Treat. 2017 Jun;77:26-30. doi: 10.1016/j.jsat.2017.03.006.
- Simpson NS, Scott-Sutherland J, Gautam S, Sethna N, Haack M. Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain. 2018;159(1):33-40.