Strategies for pain management in patients receiving medication-assisted treatment (MAT) services should be specified as part of the treatment plan. Providers may want to recommend nonpharmacologic treatments, such as therapeutic exercise, physical therapy, cognitive-behavioral therapy, and complementary and alternative medicine.1
If pharmacologic treatment is clinically indicated, it is best to use Nonopioid Treatments for Chronic Pain (PDF—1.53 MB). For example, the first course of treatment should be nonnarcotic medications such as acetaminophen or nonsteroidal anti-inflammatory drugs.2 Other drugs, such as serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, anticonvulsants, and topical analgesics, may have analgesic properties for certain conditions.1
Additional considerations depend on which medication the patient is taking to treat his or her opioid use disorder. For example, providers may consider adjusting the dose and schedule of buprenorphine in patients with chronic pain.2 The following resources offer guidance and recommendations for providing pain management in individuals with substance use disorders:
Individuals with chronic pain and opioid use disorders are also more likely to have co-occurring mental health disorders, for which providers should screen. These disorders may further complicate treatment of this patient population. For example, anxiety can contribute to overall suffering and harm a patient’s quality of life. Similarly, depression may interfere with treatment adherence or ongoing management of the patient’s condition.1 If needed, the practice should tailor the treatment team and interventions to address co-occurring mental health conditions.