CONCLUSION
Pain and OUD are complex clinical conditions with consequences that go
beyond the biomedical into psychological and societal realms. When
combined, the challenge of assessing and properly addressing pain in
persons with OUD is magnified, as their pathophysiology, signs, and
symptoms overlap and modify each other. In this review, we discussed how
pain is a multidimensional biopsychosocial entity, adding nuance to the
clinical presentation of OUD. Opioids are capable of modulating pain but
can also produce phenomena that challenge their assessment such as
hyperalgesia, tolerance, and withdrawal symptoms. For a substantial
proportion of individuals with OUD, pain and opioid use become
inexorably connected, thus, clinical, and experimental assessments of
pain deserve special considerations. Pain inventories, scales,
behavioral and physiological findings, as well as technology-based
assessments have to be considered carefully, as opioid use and its
phenomena reshape traditional assessment of pain in patients without
OUD.
Unfortunately, research considering how pain and OUD are interconnected
and how these assessments can be clinically used remains relatively
undeveloped. For many of the pain assessment methods discussed in this
review, there are few clinical trials exploring their applications for
persons with OUD. Furthermore, an upstream deficit exists in medical
education and multidisciplinary clinical approaches for the
co-management of pain and addiction, with very few programs in the
country discussing these combined issues. The ongoing opioid crisis
demands more than passive acknowledgment; it calls for proactive,
informed action. Beyond serving as a review of the available literature
on the topic, we present this paper as a call-to-action, as the gaps in
knowledge regarding pain assessment in patients with OUD are alarming.
As research linking these two areas evolves, considering the needs of
diverse populations with complex psychosocial backgrounds, and
understanding the role that such psychosocial variables may play in the
worsening of pain and OUD, we will be better equipped to reduce these
gaps. Given the profound overlap between chronic pain and OUD—and the
fact that the opioid epidemic’s initial surge is closely tied to
inadequate treatment of chronic pain—it becomes clear: our united
commitment is essential. Together, pain and addiction clinicians and
scientists must strive to improve the assessment of pain in persons with
OUD, an important step to curtail the spiraling opioid crisis.
TABLE 1. Methods of pain assessment and considerations in
patients with opioid use disorder: an overview.