Pain Core Curriculum Module 6: Understanding and Assessing Opioid Use Disorder in Patients with Chronic Pain-Presentation

Video Transcription

Video Summary

This presentation by Sarah Edmond, PhD, explores the complex relationship between chronic pain and opioid use disorder (OUD). Chronic pain and OUD often co-occur and reinforce each other through shared neurobiological pathways involving reward, motivation, and emotion-processing brain systems. Persistent pain shifts brain activity from sensory to emotional and reward centers, making patients vulnerable to compulsive relief-seeking behaviors, including opioid misuse. Risk factors for OUD in chronic pain patients include younger age, high opioid doses, mental health disorders, and prior substance use. Differentiating between physical opioid dependence and true OUD is challenging, requiring careful assessment of key features such as loss of control, compulsive use, continued use despite harm, and craving (“four Cs”). The evaluation involves pain assessment, review of behaviors, psychosocial factors, urine drug testing, and prescription monitoring. Treatment integrates pain and OUD management, favoring patient-centered approaches and multidisciplinary care. Medications like buprenorphine and methadone effectively address both pain and OUD. Two patient cases illustrate complexities: one with OUD and pain benefited from buprenorphine and therapy, while the other with chronic pain but no OUD improved after opioid rotation and adjunct treatments. Ultimately, clinicians should validate pain while carefully monitoring for OUD, aiming to optimize safety and function through individualized, evidence-based care.

Keywords

chronic pain

opioid use disorder

neurobiological pathways

opioid misuse

risk factors

pain assessment

buprenorphine treatment