Pain severity contributes to worse outcomes in opioid use disorder recovery than pain status.

Background: Opioid use disorder (OUD) continues to pose a significant challenge to public health in the United States. Chronic pain and OUD are highly comorbid conditions, yet few studies have examined the relative associations of pain status and severity toward multidimensional OUD recovery outcomes (e.g., psychopathology and withdrawal).

Methods: Participants (N = 214) were from the RECOVER-LT study, conducted 4.2-years after completion of a clinical trial program assessing extended-release buprenorphine. Group differences by pain status (i.e., chronic, acute, or no pain) were evaluated in this cross-sectional data set using analysis of variance and Fisher's exact test. Linear regression was utilized to understand the associations between average pain severity and recovery outcomes. Model selection was performed to examine the relative importance of pain status and average pain severity to recovery outcomes.

Results: A majority of the sample endorsed chronic pain (73.8 %). The multivariate regression analysis with model selection found that higher average pain severity (p < .001), but not pain status, was significantly associated with the multidimensional recovery outcomes greater total number of DSM-5 OUD symptoms, higher opioid withdrawal score, reduced physical quality of life, higher depressive symptoms, negative affect, and greater psychological distress. Pain status and average pain severity were not associated with past 7- or 30-day opioid use (p > 0.001).

Conclusions: These findings highlight pain severity, but not pain status, as a key dimension of OUD recovery. This suggests a need for integration of OUD treatment and pain management, particularly for individuals experiencing elevated pain severity regardless of pain status.