7. FUTURE RESEARCH DIRECTIONS
In striving towards a more comprehensive and patient-centered approach
to pain assessment, thereby improving pain treatment and fostering
improved quality of life and outcomes for individuals with pain and OUD,
we set out a brief research agenda for next steps on this topic.
First, validating pain scales tailored specifically to individuals with
OUD remains an essential undertaking. Understanding how opioid use
impacts pain perception is critical to developing accurate and reliable
pain assessment tools that consider the unique characteristics of this
population (including opioid-pain phenomena such as hyperalgesia,
tolerance, and withdrawal. An additional direction includes the use of
the data points obtained from these scales to inform patients and shared
decision-making regarding medication changes and dose increases, as well
as potentially quantifying the analgesic potential of each drug using
multimodal methods.
Validating these assessments would involve evaluating their content
validity to ensure they measure key pain domains relevant to this
population, and its criterion validity by correlating each tool’s scores
against other pain measures. Construct validity would be assessed by
correlating scores with related factors like depression and disability.
Its responsiveness, or ability to detect changes over time or with
treatment, must also be analyzed. Finally, these tools should
demonstrate inter-rater reliability, ensuring consistent scores between
different raters, and test-retest reliability to assess score
consistency upon repeated administrations.
Second, assessing and validating various technologies and tools for the
assessment of pain (e.g., QST, EEG, fMRI) and how they may impact
clinical outcomes is needed. QST allows for a more precise evaluation of
sensory perception and pain responses. Functional MRI and EEG can offer
insights into the neural mechanisms underlying pain and chronic opioid
effects, and how they intersect in OUD, with varying degrees of spatial
and temporal resolution. Future research should investigate the
neurobiological mechanisms underlying pain modulation in OUD and explore
potential alterations in pain processing pathways, as these could inform
objective methods of pain assessment, as well as using these
technologies to expand the role of potential non-opioid analgesic
strategies207. Integrating these cutting-edge
technologies into pain and OUD care may someday allow for
mechanistic-based treatment of pain rather than symptom-based
management, the current panorama.
Third, we highlight the necessity to advance pain assessment approaches
in minoritized populations. Historically biased approaches to pain
assessments among these populations have repeatedly resulted in worse
clinical outcomes208. Recognizing the impact of social
stress and racism on the pain experience is essential to address
disparities in treatment outcomes. Future research should delve into the
social determinants of pain experiences, considering racism-related
stress, cultural factors, social support networks, and stigma. By
understanding these dynamics, healthcare professionals can develop
culturally sensitive pain interventions that acknowledge and respect the
diversity of experiences within these communities. The groundwork and
methodological considerations for the elaboration of anti-racist pain
research have been thoughtfully described in the three-part work by
Morais and colleagues208.
Finally, the expansion of pain assessment education for healthcare
professionals and the use of multidisciplinary care for pain and
addiction management present promising avenues for future research.
Particularly refining the training of the professionals involved in the
assessment of pain among patients with OUD is as important as improving
the assessments themselves. Multidisciplinary education is necessary to
guarantee that the various forms of assessments discussed in this
manuscript are correctly and widely used.