Tailoring Pain Self‑management for Chronic Pain and Opioid Use Disorder: Qualitative Insights from Patients and Clinicians

BACKGROUND: Chronic pain, opioid use disorder (OUD), and opioid misuse (OM) often appear as co-occurring conditions; however, they are infrequently treated simultaneously which may lead to worse health outcomes. A novel way to manage these co-occurring conditions is by using a pain self-management (PSM) approach, which focuses on changing behavior through mechanisms that focus on self-regulation. Behavioral interventions, such as PSM, are a safe and effective approach to chronic pain treatment and have the highest likelihood of impact when they are tailored to the target population and setting. OBJECTIVE: The purpose of this study was to determine how to tailor PSM for patients with co-occurring chronic pain and OUD/OM. DESIGN: Qualitative study, pragmatic clinical trial. PARTICIPANTS: Patients with chronic pain and OUD/OM (N = 31) and clinicians/staff (N = 15) from primary care settings in Pennsylvania and West Virginia were interviewed to gather information needed to develop and tailor a PSM intervention. INTERVENTIONS: Pain self-management. APPROACH: Interviews were predominantly conducted remotely and addressed thoughts about pain, pain management, and the usefulness of behavioral interventions. Interviews were transcribed verbatim and coded using an inductively developed codebook; upon completion of coding, conventional content and thematic analysis was conducted. KEY RESULTS: Results of participant interviews included key takeaways such as the risks of long-term opioid therapy, lack of pain self-efficacy, and the complex patient-provider relationships that arise during treatment of these co-occurring conditions. Clinicians/staff interviews discussed social determinants of health and stigma that can hinder clinicians from providing proper care. CONCLUSIONS: The qualitative findings described from this pragmatic clinical trial allowed for the precise formulation of a PSM intervention that specifically targets patients with chronic pain and OUD/OM and may be relevant to the future development of other psychosocial-based interventions.