Pain assessment tools in patients with substance use disorders: a systematic scoping review

Chronic pain and substance use disorders (SUD) frequently co-occur and are associated with poorer treatment outcomes. The way pain is measured affects which patients are identified as having clinically meaningful pain, which functional consequences are linked to substance use outcomes, and whether findings can be compared across studies or translated into care. Pain measurement practices in SUD research have not been systematically mapped.

We conducted a systematic scoping review of studies from 1990 to 2025 that reported pain assessment in SUD populations, including opioid, alcohol, tobacco, stimulant, and polysubstance use disorders. We searched PubMed, MEDLINE, Embase, CINAHL and PsycINFO. We extracted data on pain assessment tools, substance use categories, SUD-specific psychometric evaluation, and coverage of eight NIH HEAL Pain Common Data Element domains: intensity, interference, location, physical functioning, quality of life, psychological factors, sleep disturbance, and treatment satisfaction.

Ninety-six studies (25,872 participants; mean per study 269, median 113) met inclusion criteria. Most used unidimensional pain intensity measures. Pain intensity scales appeared in 91% of studies, but only 14.6% reported SUD-specific psychometric evaluation. Pain interference, location, and treatment satisfaction were assessed in fewer than 60% of studies, and 11.5% assessed at least six of the eight NIH HEAL domains. Randomized controlled trials assessed more domains on average than cross-sectional studies. Studies focusing on opioid use disorder (OUD) more often used multidimensional tools than studies of alcohol, tobacco, stimulant, or polysubstance use. In the subset of studies that examined pain-substance use relationships, pain interference more often showed stronger associations with substance use outcomes than pain intensity alone.

Pain assessment in SUD research relies largely on unidimensional intensity scales. Substance Use Disorder specific validation is infrequent, and multidimensional pain domains are not consistently used. Brief multidimensional assessment approaches and systematic psychometric evaluation of pain measures in SUD populations are needed to improve the accuracy and clinical usefulness of pain measurement in research and treatment. We propose a candidate framework and minimum set for such studies.