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.