Few evidence-based approaches exist for treating co-occurring opioid use disorder and chronic pain. From the 1990s until recently, many Americans with non-cancer chronic pain (i.e., pain lasting at least three months) were prescribed opioid medications for pain relief.
This practice led to an increase in the prevalence of co-occurring opioid use disorder and chronic pain. Previous studies conducted at Yale and elsewhere have estimated that at least 37 percent of patients entering medication for opioid use disorder with methadone or buprenorphine have chronic pain.
A new study by researchers at Yale School of Medicine and the University of New Mexico published in Clinical Journal of Pain found that sleep disturbance may be an important treatment target for opioid use disorder and chronic pain among patients receiving methadone maintenance treatment. Led by senior author Declan T. Barry, PhD, associate professor of psychiatry and in the Child Study Center, they built on their previous work demonstrating that pain catastrophizing is a driver of pain severity among patients receiving methadone maintenance treatment. The authors examined the associations between catastrophizing, sleep disturbance, and pain severity.
Pain catastrophizing is a thinking error characterized by magnification of pain, helplessness, and rumination, and is an important focus of cognitive-behavioral therapy for chronic pain. Participants were 89 individuals with opioid use disorder and chronic pain drawn from a larger cross-sectional study of 164 patients receiving methadone maintenance at the APT Foundation, Inc., one of the largest providers of evidence-based treatment for opioid use disorder in Southern New England. Using a series of mediation models, the investigators found that greater sleep disturbance was associated with greater pain catastrophizing, which in turn was associated with greater pain severity.
"These new findings are notable since they indicate that sleep disturbance may be an important, yet often overlooked, clinical target for patients with opioid use disorder and chronic pain," Barry said.
Co-author Mark Beitel, PhD, Associate Research Scientist, Yale Child Study Center, and Director of Research at APT Pain Treatment Service, a research-based clinic for opioid use disorder and chronic pain, who was a study investigator, noted: “Addressing sleep disturbance is likely to be an attractive option for many patients, either as a stand-alone treatment or as a component of an interdisciplinary treatment approach.”
Barry noted that his team planned to start pilot testing a variety of approaches for addressing sleep disturbance in methadone maintained patients with chronic pain.
Caridad Ponce Martinez, MD, from Yale School of Medicine was the study's first author. Other Yale-affiliated co-authors were Corey Roos, PhD (Department of Psychiatry) and Anthony Eller, MPH (Department of Internal Medicine-AIDS). Karlyn Edward, MS (University of New Mexico, Department of Psychology) was also a co-author.