Cognitive behavioral therapy for chronic pain and opioid use disorder

Chronic pain and opioid use disorder (OUD) are prevalent and interrelated chronic medical conditions. Patients with chronic pain and OUD often have medical and psychiatric comorbidities. While substance use disorders and chronic pain were traditionally treated by separate providers in different settings, they experience similar clinical management challenges. The optimal treatment for comorbid chronic pain and OUD is an interdisciplinary approach that uses a biopsychosocial model combining medication for opioid use disorder with nonopioid pharmacotherapy, psychotherapy, and other nonpharmacological pain management interventions. One promising psychotherapy is cognitive behavioral therapy (CBT) for chronic pain and OUD, which was designed to improve coping skills to address common clinical problems experienced by patients with these conditions. A core task of CBT is to interrupt the “Pain-OUD Dysfunction Cycle,” whereby patients manage pain or associated distress with illicit opioid and other substance use, leading to negative consequences, which fuel poor pain management.