Contemporaneous Link Between Pain and Craving in Patients Recovering from Prescription Opioid Use Disorder During Residential Treatment

Objective: The study examined the relationship between pain and craving in the daily lives of patients in residential treatment for prescription opioid use disorder (OUD) and the extent to which the contemporaneous assessment-level association between pain and craving was moderated by individuals’ average pain levels. Methods: Participants (n = 73; 33% female, M_age = 30.10) in residential treatment for prescription opioid use disorder were prompted 4 times per day to complete smartphone-based assessments of pain and craving for 12 consecutive days. Using multilevel modeling, we examined the associations of assessment-level craving with assessment-, day-, and person-level pain and the moderation of the assessment-level association by person-level pain. Results: There was a significant association between assessment-level pain and craving (B = 0.01, β = 0.12, p < 0.05), controlling for age, biological sex, the day of the study (time in treatment), the time of the day the survey was administered, and whether the participant was treated for chronic pain during the study. During assessments, when participants experienced higher-than-usual pain, they also experienced higher craving on average. Conclusions: These results indicate that the experience of higher-than-usual pain, regardless of individual patients’ usual pain levels, is linked to higher contemporaneous craving. This finding supports the importance of assessing and managing pain in the prescription OUD patient’s early treatment experience to help reduce craving and its role in return to illicit use.