Abstract
BACKGROUND: Among patients with chronic pain (CP; pain persisting for 3+ months) and opioid use disorder (OUD), ~3 in 4 report co-occurring mental health conditions, which may exacerbate difficulties accessing and engaging in behavioral health treatment. Beyond rates of co-occurring diagnoses, little is known about the differences in specific behavioral health needs of individuals with CP versus those without CP when they seek behavioral health treatment for OUD and co-occurring mental health disorders. METHODS: These secondary analyses utilized data from a randomized controlled trial. Patients (n = 396) were individuals with (n = 281) and without CP (n = 115) seeking behavioral health treatment for OUD and co-occurring mental health disorders. Analyses focused on intake assessment data from validated patient-reported outcome measures for CP, OUD, and mental health: (1) pain intensity and interference (ie, impact on daily activities), (2) mental health symptoms and functioning, (3) current substance use, (4) quality of life, (5) sleep disturbance, (6) physical function, and (7) cognitive function. RESULTS: Seventy-one percent of patients reported current CP at intake, and these patients reported high pain intensity and interference. Compared to those without CP, patients with CP reported significantly more depression, anxiety, and trauma symptoms; more difficulty with mental health functioning; lower quality of life; more sleep disturbance; and worse physical function. There were no significant differences in self-reported substance use or cognitive function. CONCLUSIONS: This study suggests that individuals with CP as well as OUD and co-occurring mental health disorders may have worse mental health, quality of life, sleep, and physical functioning upon entering treatment compared to those without CP. Thus, behavioral health treatment providers should assess broad mental and physical health needs in addition to screening for CP to address any issues, which may interfere with successful behavioral health treatment.