S2 Ep3: Treatment considerations for co-occurring chronic pain and opioid use disorder

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Summary

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?

Lineup

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

Pearls

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.

Resources

De-centring western colonial approaches

Online learning