Targeting pain to improve opioid use disorder treatment outcomes: Results of a randomized trial

Chronic pain is highly prevalent in adults receiving medications for opioid use disorder (MOUD) and predicts poorer longer-term functioning and greater substance use. This study evaluated whether adding a behavioral pain management intervention to prescribed buprenorphine improved treatment retention and clinical outcomes.

Two hundred individuals receiving buprenorphine who reported pain for at least 3-months were randomized to receive either a telehealth delivered Psychosocial Pain Management Intervention (PPMI; n = 98) or Enhanced Usual Care (EUC; n = 102). Participants were assessed at 3- and 12-months post intervention on measures of treatment retention, substance use and pain severity. Primary outcomes were examined via both intent-to-treat and per-protocol analyses.

At 3-month follow-up, in the intent-to-treat analysis, buprenorphine discontinuation was slightly higher in the EUC group (27.5%) compared to the PPMI group (20.4%), although not statistically significant (p = 0.24). However, in per-protocol analyses limited to those who received an adequate intervention dose (≥4 PPMI sessions or ≥ 1 EUC session), the PPMI group had statistically significantly lower rates of buprenorphine discontinuation at 3-months than the EUC group (PPMI: 7.5%; EUC: 20.2%; p = 0.04). In the intent-to-treat analyses, there were no significant differences in rates of opioid abstinence between groups. In the per-protocol analyses, the PPMI group had slightly higher rates of opioid abstinence at 3-months compared to the EUC group, although the magnitude of this difference was small (PPMI: 99.57%; EUC: 97.48%; p = 0.03). Among patients in the intent-to-treat sample, primary and secondary analyses did not find support for the behavioral intervention in enhancing OUD retention, pain outcomes, or substance-related outcomes among those receiving buprenorphine for OUD with co-occurring chronic pain.

Participants reported high buprenorphine retention and substantial improvements in pain and substance use outcomes, with no overall differences between intervention and control conditions. However, post hoc analyses indicate that behavioral pain management interventions may initially improve retention and opioid abstinence for those who engage sufficiently, underscoring the potential value of new ways to engage and support patients receiving buprenorphine. More research is needed to determine the long-term impacts of the intervention.

This study has been registered with ClincialTrials.gov under ID NCT04433975.