5.1 Multidisciplinary pain assessment
The enduring division of healthcare professionals who typically manage
chronic pain and those who treat substance use disorders is a
contributing factor to the potentially suboptimal care received by
people living with co-occurring OUD and chronic
pain82. Both pain and OUD treatment present complex
clinical challenges that often coexist, necessitating a multifaceted
approach to care. Thus, it is expected that the collaboration among
professionals from various disciplines (e.g., physicians, nurses,
psychologists, social workers, and addiction specialists) results in
care that optimizes treatment outcomes and addresses the various facets
of these intricate illnesses.
Despite this expectation, there are few studies examining the impact of
multidisciplinary teams on pain and OUD outcomes, as well as the quality
of the pain assessment provided, with most focusing only on pain-related
outcomes but not addiction-related ones. Interdisciplinary pain clinics
have been described for various pain
conditions178-183, including patients with co-morbid
OUD, and have shown some evidence for reduced daily opioid requirements,
pain intensity, and disability184-186. When integrated
into primary care, these approaches appear to be supported by team
members who see them as particularly helpful for comprehensive pain care
and improving confidence and self-efficacy187.
Similarly, specialized opioid treatment programs have integrated pain
management as part of their OUD treatment, with positive preliminary
results regarding treatment adherence, patient satisfaction, mood, and
pain intensity188, 189.
In cases where clinics have embraced interdisciplinary teams for
assessing pain in persons OUD, they commonly integrate a comprehensive
biopsychosocial evaluation and diverse, patient-centric treatment
strategies, prioritizing functional outcomes and
safety183, 190. By taking into account the
individual’s physical, psychological, and social dimensions,
multidisciplinary teams can gain a comprehensive understanding of the
patient’s pain condition and needs, as well as related co-morbid opioid
considerations, thereby facilitating multimodal assessments. This
comprehensive approach enables the identification and management of pain
triggers related to substance use, as well as addressing any barriers to
treatment adherence or recovery. Moreover, the interdisciplinary nature
of the team ensures that patients receive integrated care, potentially
minimizing fragmentation in treatment plans and potentially improving
treatment outcomes.