Pain and its Perceived Relatedness to the Onset, Maintenance, and Relapse of Opioid use Disorder: A Descriptive Study of Non-Treatment-Seeking Individuals.

Background: Previous research has found chronic pain to be prevalent among individuals with opioid use disorder (OUD). The perception that pain is related to OUD onset, maintenance, relapse, and treatment delay has been noted in this population. However, prior works primarily involved treatment-engaged populations. Scant research describes such perceptions among non-treatment-seeking individuals. Aims: This study describes pain burden and perceptions regarding the role of pain in OUD onset, maintenance, relapse, and addiction treatment delay in a sample of individuals with untreated OUD. Methods: This cross-sectional study surveyed syringe exchange participants (n = 141). Participants responded to a survey including Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition OUD criteria, pain survey scales, demographic characteristics, and questions regarding pain and its perceived relatedness to aspects of OUD. Results: Most participants reported pain within the past 4 weeks (127, 91.4%). Data displayed a skew toward more intense pain ratings, with 120 reporting their pain as greater than mild (86.3%). A majority of participants agreed that pain was responsible for their OUD onset (79, 56.4%), maintenance (76, 54.3%), past relapse experience (82, 57.9%), and treatment delay (81, 57.9%). Correlative analyses revealed that pain severity and interference measures displayed moderate and statistically significant associations with extent of perceived relatedness of pain to these aspects of OUD. Conclusions: Among this sample of individuals with untreated OUD, pain and pain interference were prevalent. Pain was perceived to be related to OUD onset, maintenance, relapse, and treatment delay by a majority of the sample. These findings are in accordance with and expand upon prior works. Abbreviations: OUD: opioid use disorder; DSM-5: Diagnostic and Statistical Manual 5; BPI: Brief Pain Inventory; NIDA: National Institute on Drug Abuse; IASP: International Association for the Study of Pain; MOUD: Medications for Opioid Use Disorder; IQR: Interquartile Range.

Contexte: Des recherches antérieures ont montré que la douleur chronique est prévalente chez les personnes souffrant d'un trouble lié à l'utilisation d'opioïdes (TUO). La perception que la douleur est liée à l'apparition, au maintien, à la rechute et au retard dans le début du traitement a été constatée au sein de cette population. Toutefois, les travaux antérieurs portaient principalement sur les populations engagées dans un traitement. Peu de recherches décrivent ces perceptions chez les personnes qui ne sont pas à la recherche d'un traitement.Objectifs: Cette étude décrit le fardeau de la douleur et les perceptions concernant le rôle de la douleur dans l'apparition, le maintien, la rechute et le retard dans le début du traitement du trouble lié à l'utilisation d'opioïdes chez un échantillon de personnes souffrant d'un trouble lié à l'utilisation d'opioïdes non traité.Méthodes: Cette étude transversale a interrogé des participants pratiquant l'échange de seringues (n = 141). Les participants ont répondu à un questionnaire comprenant les critères de la cinquième édition du Manuel diagnostique et statistique des troubles mentaux pour le trouble lié à l'utilisation d'opioïdes, des échelles d'évaluation de la douleur, leurs caractéristiques démographiques, ainsi que des questions concernant la douleur et son lien perçu avec différents aspects du trouble lié à l'utilisation d'opioïdes.Résultats: La plupart des participants ont déclaré avoir ressenti de la douleur au cours des quatre dernières semaines (127, 91,4 %). Les données ont montré une tendance à évaluer la douleur de façon plus intense, 120 participants ayant déclaré que leur douleur était plus que légère (86,3 %). La majorité des participants ont reconnu que la douleur était responsable de l'apparition (79, 56,4 %), du maintien (76, 54,3 %), des rechutes antérieures (82, 57,9 %) et du retard dans le début du traitement (81, 57,9 %) du trouble lié à l'utilisation des opioïdes. Les analyses corrélatives ont révélé que les mesures de l'intensité et de l'interférence de la douleur présentaient des associations modérées et statistiquement significatives avec l'étendue du lien perçu entre la douleur et ces aspects du trouble lié à l'utilisation des opioïdes.Conclusions: Dans cet échantillon de personnes atteintes d'un trouble lié à l'utilisation des opioïdes non traité, la douleur et l'interférence de la douleur étaient prévalentes. La douleur était perçue comme étant liée à l'apparition, au maintien, à la rechute et au retard dans le début du traitement du trouble lié à l'utilisation des opioïdes par la majeure partie de l'échantillon. Ces résultats sont conformes aux travaux antérieurs et les étayent.Abréviations: TUO : trouble lié à l'utilisation d'opioïdes; DSM-5 : Manuel diagnostique et statistique 5; BPI : Questionnaire concis sur la douleur; NIDA : National Institute on Drug Abuse; IASP : Association internationale pour l'étude de la douleur; MTUO : Médicaments pour le trouble lié à l'utilisation des opioïdes; EIQ : Écart interquartile.

Untreated Opioid Use Disorder and Health-Related Quality of Life Among Syringe Service Program Clients.

This cross-sectional study explores health-related quality of life (HRQoL) and the challenges to physical, emotional, and social functioning among individuals with opioid use disorder.

Nociplastic Pain and Pain-Motivated Drinking in Alcohol Use Disorder.

Heavy chronic alcohol use may produce pain amplification through neurochemical and neuroplastic changes at multiple levels of the nervous system. Similar changes are thought to underlie nociplastic pain. The American College of Rheumatology Fibromyalgia Survey has been used as a surrogate for nociplastic pain, including among individuals with alcohol use disorder (AUD). However, studies linking nociplastic pain to pain-motivated drinking are lacking. The present study aimed to determine if nociplastic pain is associated with pain-motivated drinking in AUD. To achieve this aim, a new scale-the Pain-Motivated Drinking Scale (PMDS)-was developed to measure how often participants were motivated by pain to drink alcohol. Measurement properties of this new scale were determined, including its factor structure, internal consistency reliability, and construct validity. In this cross-sectional observational study, participants with AUD (n = 138) were consecutively recruited from the patient pool at an academic addiction treatment facility. Seventy-two percent (95, 72.0%) reported they drank alcohol "to get relief from physical pain" at least some of the time, and over forty-two percent (56, 42.4%) reported pain relief motivated their drinking at least half of the time. PMDS had a single-factor structure, strong internal consistency reliability, and construct validity. A multiple hierarchical linear regression was run to determine if nociplastic pain was associated with pain-motivated drinking. Nociplastic pain was associated with PMDS even after controlling for potential confounders and pain severity. These findings suggest nociplastic pain is uniquely associated with pain-motivated drinking in AUD. PERSPECTIVE: Nociplastic pain is independently associated with pain-motivated drinking in alcohol use disorder (AUD). The Pain-Motivated Drinking Scale (PMDS) is a new scale to measure how often people drink to cope with pain. PMDS has promising psychometric properties. Nociplastic pain may be uniquely associated with pain-motivated drinking in AUD.

The Perceived Role of Withdrawal in Maintaining Opioid Addiction among Adults with Untreated Opioid Use Disorder: A Survey of Syringe Exchange Program Participants.

Background: Withdrawal is believed to play a central role in the brain disease model of addiction. However, little research describes withdrawal-motives among untreated individuals in community settings. Methods: This cross-sectional study surveyed syringe exchange program participants (n = 139) with untreated opioid use disorder (OUD) in Columbus, Ohio from January 10th to March 25th, 2023, to assess their perceptions of the role of withdrawal in OUD maintenance, treatment delay, and OUD's refractoriness to buprenorphine. Participants responded to a survey including DSM-5 OUD criteria, demographics, and questions about substance use and opioid withdrawal. Participant ages ranged from 21 to 65 years with a mean age of 37.5 years and standard deviation of 8.1. The racial distribution of the sample was as follows: 81% White/Caucasian, 12% Black/African American, 3% Native American or Alaskan Native. Results: Sixty-six percent of participants agreed, or strongly agreed that opioid withdrawal was "the most important reason" they had been unable to stop using opioids. Almost seventy-one percent agreed, or strongly agreed that worry about opioid withdrawal had caused them to "put off or delay" OUD treatment. Although all participants had active, untreated OUD at the time of recruitment, most (85%) had previously tried buprenorphine, and the majority (78%) reported having experienced buprenorphine-precipitated withdrawal. Conclusions: Among this community sample of individuals with untreated OUD, withdrawal was perceived to have an important role in maintaining OUD, including by motivating OUD treatment delay. Prior buprenorphine-precipitated withdrawal was common, suggesting aversion to withdrawal might possibly be associated with OUD's refractoriness to buprenorphine.