Tailoring of a chronic pain self-management intervention for individuals with opioid use disorder in office-based addiction treatment.

Hamm ME, Emerson R, Rogal SS, Bulls HW, Nugent SM, Anderson A, Nash S, Salay M, Winstanley EL, de Abril Cameron F, DeMonte W, Debi P, Choo LY, Chan B, Weintraub E, Bachrach RL, van Oppen D, Edwards KA, Merlin JS. Tailoring of a chronic pain self-management intervention for individuals with opioid use disorder in office-based addiction treatment. Journal of substance use and addiction treatment. 2026 Jun 1; 185:209910, DOI: 10.1016/j.josat.2026.209910.

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Abstract:

INTRODUCTION: Office-based opioid treatment with buprenorphine for opioid use disorder (OBOT-BUP) is most effective when patients are retained in treatment long-term, but average treatment duration is less than 6 months. Up to two thirds of individuals with opioid use disorder (OUD) have chronic pain. Treatment of chronic pain in OBOT-BUP settings could improve retention in OBOT-BUP programs. Therefore, this study qualitatively assessed how to tailor pain self-management (PSM) to people with co-occurring chronic pain and OUD in OBOT-BUP settings. METHODS: This study takes a Qualitative Description approach to data collection and interpretation. We conducted semi-structured qualitative interviews with 61 participants (23 clinicians/clinic staff and 38 patients) at OBOT-BUP clinics regarding experiences with chronic pain and its treatment, experiences with opioid use disorder and its treatment, and their thoughts the desirability, feasibility, and modification of a previously developed PSM program for patients with comorbid chronic pain and opioid use disorder. Interviews were coded using a primarily inductively developed codebook, and coding was used to conduct a thematic analysis of interview transcripts. RESULTS: Participants generally reacted positively to the PSM program as presented. We identified 4 themes in the data that could affect implementation of PSM, and/or that suggested modifications that should be made to the program. (1) Patients reported relying on a wide array of treatment modalities, bolstering the case for use of PSM, but also sometimes expressing resistance to the idea if past attempts at PSM components had been unsuccessful. (2) Patients' prior experiences of stigma related to OUD negatively impacted willingness to participate in a PSM intervention. (3) Effective pain management using buprenorphine was regarded as a vital companion to PSM in patients with chronic pain and OUD. (4) Participants identified several aspects of PSM implementation that would be important, including individual sessions, peer-led group sessions, and remote visits. CONCLUSIONS: Participants reported interest in PSM, but also reluctance based in concerns about efficacy and/or fear of stigma. We identified several strategies to respond to these concerns, including positioning PSM as an evidence-based strategy that works adjunctive to buprenorphine, and directly addressing pain/OUD stigma.