Chronic overlapping pain conditions in individuals with active opioid use disorder: a descriptive study of syringe program participants

Comorbidity between opioid use disorder (OUD) and chronic pain is substantial. Pain has been shown to be a motivator for OUD onset, maintenance, relapse, and treatment delay. A cluster of pain conditions known as chronic overlapping pain conditions (COPCs), also now referred to in contemporary ICD classification as primary pain conditions, are particularly refractory to traditional forms of pain treatment, and likely adversely impact comorbid OUD. This cross-sectional descriptive study sought to obtain a better understanding of the prevalence of COPCs among individuals with OUD. The COPCs screener was originally developed to address the challenges of readily assessing for multiple of these conditions; which is important given that the number of said conditions acts as a marker for the likely presence of nociplastic pain. This screener was used alongside supplementary survey items to describe COPCs and pain distribution in a sample of individuals with active OUD recruited from a syringe exchange program. Comparisons of COPC prevalence between the study sample and global prevalence estimates found that among those with OUD, there is a significantly higher-than-expected prevalence of chronic low back pain, myalgic encephalomyelitis/chronic fatigue syndrome, chronic migraine headache, and fibromyalgia. Results support further investigations into COPCs in the context of OUD. Further research may reveal methods of enhancing OUD treatment and identifying additional targets for intervention and prevention.