Opioid prescription patterns and pain severity among patients with opioid use disorder and other substance use disorders: a mixed methods study

Abstract. Objective:. Pain management for patients with substance use disorders (SUDs) poses challenges, yet little is known about their pain severity perceptions. We conducted a mixed-methods study to understand numeric pain severity reporting among patients with SUD. We assessed how interactions b...

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Main Authors: Erin F. Madden, Gintare Daulys, Benjamin Tingey, Felicia Frabis, Pooja Lagisetty, Philip J. Kroth, Fares Qeadan
Format: Article
Language:English
Published: Wolters Kluwer 2025-06-01
Series:PAIN Reports
Online Access:http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001261
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author Erin F. Madden
Gintare Daulys
Benjamin Tingey
Felicia Frabis
Pooja Lagisetty
Philip J. Kroth
Fares Qeadan
author_facet Erin F. Madden
Gintare Daulys
Benjamin Tingey
Felicia Frabis
Pooja Lagisetty
Philip J. Kroth
Fares Qeadan
author_sort Erin F. Madden
collection DOAJ
description Abstract. Objective:. Pain management for patients with substance use disorders (SUDs) poses challenges, yet little is known about their pain severity perceptions. We conducted a mixed-methods study to understand numeric pain severity reporting among patients with SUD. We assessed how interactions between opioid prescribing and time, medications for opioid use disorder (MOUD), complementary medicine (CM), and outpatient SUD-related services (OS) predict differences in reported pain severity among patients with SUD. Methods:. We analyzed electronic health records (EHR) data, from 2003 to 2023, among the Oracle EHR Real-World Database, which comprised 141 US health systems from 50 states. We used longitudinal patient-reported numeric rating scale pain severity scores in linear mixed effects regressions to predict mean pain severity scores. We also conducted 2 focus-groups, from 2022 to 2023, with patients with SUD and SUD-treating clinicians aiming to explore pain severity reporting. Results:. Overall, predicted mean pain scores (95% confidence interval) were highest for patients with OUD (4.52 [4.51, 4.53]), lower for other patients with SUD (3.80 [3.79, 3.81]), and lowest for controls (3.28 [3.27, 3.29]) across all opioid prescription doses and durations. Complementary medicine use was associated with lower pain scores for all patients prescribed opioids. Pain scores were also lower for patients with OUD and SUD prescribed opioids and using OS, and for patients with OUD treated with MOUD and prescribed higher dose opioids. Focus-groups revealed pain reporting is influenced by anticipated clinician disbelief, treatment changes, and stigma. Conclusion:. These findings highlight the need to address pain within addiction treatment and further examine effective pain management interventions for this complex patient population.
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spelling doaj-art-e848bbf850c548ffb09d31550a34fe722025-08-20T03:53:31ZengWolters KluwerPAIN Reports2471-25312025-06-01103e126110.1097/PR9.0000000000001261PR90000000000001261Opioid prescription patterns and pain severity among patients with opioid use disorder and other substance use disorders: a mixed methods studyErin F. Madden0Gintare Daulys1Benjamin Tingey2Felicia Frabis3Pooja Lagisetty4Philip J. Kroth5Fares Qeadan6a Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USAb Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USAb Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USAa Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USAc Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USAe Department of Biomedical Informatics, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USAb Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USAAbstract. Objective:. Pain management for patients with substance use disorders (SUDs) poses challenges, yet little is known about their pain severity perceptions. We conducted a mixed-methods study to understand numeric pain severity reporting among patients with SUD. We assessed how interactions between opioid prescribing and time, medications for opioid use disorder (MOUD), complementary medicine (CM), and outpatient SUD-related services (OS) predict differences in reported pain severity among patients with SUD. Methods:. We analyzed electronic health records (EHR) data, from 2003 to 2023, among the Oracle EHR Real-World Database, which comprised 141 US health systems from 50 states. We used longitudinal patient-reported numeric rating scale pain severity scores in linear mixed effects regressions to predict mean pain severity scores. We also conducted 2 focus-groups, from 2022 to 2023, with patients with SUD and SUD-treating clinicians aiming to explore pain severity reporting. Results:. Overall, predicted mean pain scores (95% confidence interval) were highest for patients with OUD (4.52 [4.51, 4.53]), lower for other patients with SUD (3.80 [3.79, 3.81]), and lowest for controls (3.28 [3.27, 3.29]) across all opioid prescription doses and durations. Complementary medicine use was associated with lower pain scores for all patients prescribed opioids. Pain scores were also lower for patients with OUD and SUD prescribed opioids and using OS, and for patients with OUD treated with MOUD and prescribed higher dose opioids. Focus-groups revealed pain reporting is influenced by anticipated clinician disbelief, treatment changes, and stigma. Conclusion:. These findings highlight the need to address pain within addiction treatment and further examine effective pain management interventions for this complex patient population.http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001261
spellingShingle Erin F. Madden
Gintare Daulys
Benjamin Tingey
Felicia Frabis
Pooja Lagisetty
Philip J. Kroth
Fares Qeadan
Opioid prescription patterns and pain severity among patients with opioid use disorder and other substance use disorders: a mixed methods study
PAIN Reports
title Opioid prescription patterns and pain severity among patients with opioid use disorder and other substance use disorders: a mixed methods study
title_full Opioid prescription patterns and pain severity among patients with opioid use disorder and other substance use disorders: a mixed methods study
title_fullStr Opioid prescription patterns and pain severity among patients with opioid use disorder and other substance use disorders: a mixed methods study
title_full_unstemmed Opioid prescription patterns and pain severity among patients with opioid use disorder and other substance use disorders: a mixed methods study
title_short Opioid prescription patterns and pain severity among patients with opioid use disorder and other substance use disorders: a mixed methods study
title_sort opioid prescription patterns and pain severity among patients with opioid use disorder and other substance use disorders a mixed methods study
url http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001261
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