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Does Buprenorphine-Naloxone Treatment for Opioid Use Disorder Also Help with Chronic Pain?

March 9, 2022
Meg Brunner, MLIS
Edwards KA, et al. Changes in pain during buprenorphine maintenance treatment among patients with opioid use disorder and chronic pain. Journal of Consulting and Clinical Psychology 2022 (in press). 
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Addiction Science Made Easy
March 2022
CTN Dissemination Library


Key points:

  • Buprenorphine-naloxone treatment for opioid use disorder (OUD) seems to help with both pain intensity and interference for people who also have chronic pain
  • A subgroup of patients do not see improvements in pain intensity or interference while on buprenorphine-naloxone for OUD and may need more care

While some research has shown that medication treatment for opioid use disorder (MOUD) alone may be effective for the treatment of chronic pain inMan in back pain people with OUD, patients with chronic pain taking MOUD also consistently exhibit worse health-related quality of life and distress, more disruptions in social and physical functioning, and poorer sleep quality compared to those without chronic pain. They also benefit less from MOUD overall, suggesting there may be additional treatment needs. 

This study analyzed data from the National Drug Abuse Treatment Clinical Trials Network (CTN) Prescription Opioid Addiction Treatment Study (POATS) to examine pain interference (how much pain interferes with relevant aspects of a person’s life) and pain intensity over the course of 12 weeks of buprenorphine/naloxone (BUP-NX) treatment using a person-centered statistical approach. 

Each model (interference and intensity) identified a high and low profile. Profiles were then examined in relation to several different treatment outcomes, including opioid use, depression severity, and mental health quality of life while still maintained on BUP-NX and 2 months following a 4-week BUP-NX taper. 

At baseline, before starting treatment with BUP-NX, the majority of participants were in the low pain interference but high pain intensity models. In both models, patients were more likely to remain in or transition to the low profiles by Week 12 of treatment with BUP-NX. 

A few factors seemed to be tied to profile membership and could be used to help identify patients who may need additional care. Worse depression was associated with membership in the high pain interference profile at both Weeks 12 and 24, and women were more likely to be in the high pain intensity profile at baseline. Additionally, those who were in the high pain intensity and high pain interference profiles at Week 12 reported worse mental health quality of life at Week 12 and were still in the high profiles for both models at Week 24.

Conclusions: BUP-NX treatment appears to be effective for the treatment of OUD and chronic pain, though there remains a subgroup who continue to experience high pain intensity and interference 3 months following treatment. Continual assessment of pain intensity and interference can help identify this group, who may need additional care.

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