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.