Targeting pain to improve opioid use disorder treatment outcomes: Results of a randomized trial.
Mark Ilgen, Frederic Blow, John D Piette et al.
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In 30 seconds
This randomized trial tested whether adding telehealth psychosocial pain management to buprenorphine improved outcomes for 200 adults with opioid use disorder and pain lasting at least 3 months. At 3 months, the intent-to-treat analysis found no statistically significant difference in buprenorphine discontinuation (20.4% with the intervention vs 27.5% with enhanced usual care; p = 0.24), and no significant difference in opioid abstinence. In a per-protocol analysis of participants receiving an adequate intervention dose, discontinuation was lower with pain management (7.5% vs 20.2%; p = 0.04). Overall, the trial did not show improved outcomes in the full randomized sample.
Key findings
- At 3 months, buprenorphine discontinuation was 20.4% with pain management and 27.5% with enhanced usual care in the intent-to-treat analysis (p = 0.24).
- Among participants receiving an adequate intervention dose, discontinuation was 7.5% with pain management versus 20.2% with enhanced usual care (p = 0.04).
- Intent-to-treat analyses found no significant between-group differences in opioid abstinence, pain outcomes, or substance-related outcomes.
- Per-protocol opioid abstinence was 99.57% with pain management and 97.48% with enhanced usual care at 3 months (p = 0.03); the reported difference was small.
Why it matters
Chronic pain commonly co-occurs with opioid use disorder and may complicate treatment. This trial found no overall benefit from adding telehealth behavioral pain management to buprenorphine, while analyses restricted to participants who engaged sufficiently suggested possible early retention and abstinence benefits. The distinction between the overall randomized findings and the per-protocol results is important when interpreting the intervention’s potential.
What to keep in mind
The favorable findings came from per-protocol analyses rather than the intent-to-treat analysis, and follow-up was limited to 3 and 12 months; the abstract notes that long-term impacts require further study.