FIGURE LEGENDS
Figure 1. Biopsychosocial considerations in the assessment of
pain for persons with opioid use disorder.
Pain and opioid use disorder are multidimensional entities.
Biologically, ascending pain pathways carry neural signals from the
spine and periphery to the corticolimbic system, which in turn, through
descending pathways, modulate the actual physical and emotional
experience of pain. Opioids may disrupt such pathways, increasing pain
perception (hyperalgesia) and hindering modulatory input. Psychological
aspects may alter these perceptions and lead to behaviors and thoughts
patterns which in turn, can worsen or improve that experience. Finally,
social support networks are a cornerstone of this assessment, as support
can improve or worsen outcomes for both OUD and pain treatment. It is
also important to acknowledge the role that healthcare disparities may
play both in the perception of pain as well as on its treatment.
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Figure 2. Opioid-induced hyperalgesia, tolerance, and
withdrawal as important considerations for pain assessment in opioid use
disorder.
The illustrated table describes the hallmarks to differentiate
opioid-related phenomena. Patients with hyperalgesia tend to experience
pain symptoms that are different than their original presentation,
worsening with increased opioid use. Tolerance leads to worsening pain
due to desensitization, but the pain is often similar to the initial
symptom and tends to improve with additional opioids. Finally, those
patients experiencing withdrawal develop certain signs and symptoms
otherwise described in opioid withdrawal assessment instruments, such as
the Clinical Opioid Withdrawal Scale (COWS).