Though rarely considered during treatment for opioid use disorder, uncontrolled pain is strongly linked to less success in treatment outcomes, a lower quality of life, and mental health issues, a new study led by a Virginia Tech addiction researcher found.

The findings, published recently in Drug and Alcohol Dependence, could inform improvements in treatment of opioid use disorder.

“We found that pain experienced during treatment and long-term recovery is a significant predictor of continued opioid misuse,” said Allison Tegge, the paper’s lead and corresponding author. “Although pain commonly co-occurs with opioid disorder, and opioid pain treatment sometimes precipitates opioid use disorder, it is often not appropriately recognized and managed during opioid addiction treatment.”

Tegge, research associate professor with the Fralin Biomedical Research Institute at VTC Addiction Recovery Research Center, said the study points to a need for protocols to proactively address chronic pain among people who enter opioid treatment.

Tegge collaborated with an international team of researchers from Virginia Tech and Canada, the United Kingdom, and Australia who examined pain related to treatment and psychosocial outcomes in 602 patients, about two-thirds men, with an average age of 40. The study integrated data from three previous opioid use disorder treatment studies that investigated buprenorphine, a drug commonly used to ease patients out of addiction.

“There is almost no research on how pain changes and impacts the treatment of opioid use disorder,” Tegge said. “This study fills a large gap in knowledge.”

While it was common for patients to experience sustained pain reduction while in treatment, moderate to severe pain was associated with lower rates of opioid abstinence despite increased distress.

In addition, patients with greater pain severity also experienced more depression, more severe withdrawal symptoms, more opioid craving, and poorer quality of life.

Researchers said they were surprised to find that pain was not connected to patients dropping out of treatment programs.

“Taking all that together, individuals with higher pain are having less success in their treatment efforts,” Tegge said.

Researchers don’t know if patients are misusing opioids because they are in pain, or if the opioids themselves impact the perceptions of pain.

While more study of those questions is needed, these research findings still point to ways to improve the efficacy of opioid use disorder treatment.

“We're always trying to change our perspective to more personalized intervention and personalized treatment, and part of that is listening to patients and recognizing the nuances of their experiences during the treatment journey,” Tegge said. “At the very least, that means monitoring and addressing pain levels alternative interventions to target pain. Reducing pain might actually improve opioid treatment outcomes.”

This study was funded by Indivior Inc., a global pharmaceutical company that develops treatments for opioid use disorder. Its headquarters are in Richmond, Virginia.

Other Virginia Tech authors on the study include the late Warren Bickel, formerly the director of the research institute’s Addiction Recovery Research Center and the Center for Health Behaviors Research; Department of Statistics Professor Marco Ferreira; postdoctoral associate Shuangshuang Xu; and Peter M. Garafola, a research assistant and data manager in the Addiction Recovery Research Center.

Additional authors include:

  • Michael Farrell, professor, National Drug and Alcohol Research Centre, University of New South Wales, Australia
  • John Marsden, professor, Addictions Department, Kings College, London
  • Ken Lee, medical director, London Rapid Access Addiction Medicine Clinic, Ontario, Canada
  • Anne Le Moigne, Research and Development, Indivior Inc.
  • Frank Gray, Research and Development, Indivior Inc.

Original study: https://doi.org/10.1016/j.drugalcdep.2025.112902

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