Abstract
Abstract
Background and aim
Co‐occurring chronic pain affects nearly half of people receiving opioid use disorder (OUD) treatment. Although this pain is often severe, it is usually inadequately managed. Stigma and clinical complexity associated with OUD are thought to further restrict access to pain care. This study examined barriers to pain treatment from the perspectives of people with both chronic pain and OUD.
Methods
A qualitative study was conducted using semi‐structured interviews with 20 adults with lived experience of chronic pain and opioid agonist treatment (OAT) (i.e. prescribed methadone or buprenorphine) for OUD, across three sites in Melbourne, Australia. Interviews were conducted in person, between December 2024 and February 2025. Interviews were audio‐recorded and transcribed verbatim. NVivo 15 was used to manage and organise the transcripts. Data were analysed using reflexive thematic analysis informed by Levesque
et al
.’s patient‐centred access to healthcare framework.
Results
Three interrelated themes were identified regarding barriers to accessing pain care among people with chronic pain and OUD. “Misalignment between health systems and everyday life” highlighted issues such as fragmented service delivery, limited coordination between pain and addiction services, and inconsistent pathways for referral and ongoing care. ‘Stigma, distrust and exclusion in pain care’ reflected participants' experiences of perceived and enacted stigma within healthcare settings, contributing to reduced help‐seeking, delayed disclosure of pain and reluctance to engage with services. ‘Deprioritised pain care in the context of OAT’ illustrated how pain was often not systematically assessed or treated in addiction‐focused care, with OUD frequently taking precedence over pain‐related concerns.
Conclusion
Pain care for people with opioid use disorder (OUD) appears to be influenced by intersecting structural, social and clinical barriers, including socioeconomic disadvantage and stigma. Pain management is reported as being deprioritised within OUD treatment contexts, with inconsistent attention to the assessment and treatment of chronic pain.