Linking To And Excerpting From The Curbsiders’ “#487 Chronic Pain & Opioid Use Disorder with Dr. Jessie Merlin”

Posted on June 18, 2025 by Tom Wade MD

Today, I review, link to, and excerpt from The Curbsiders’ #487 Chronic Pain & Opioid Use Disorder with Dr. Jessie Merlin.*

*Chan, CA; Merlin J; Roy, PJ; Cohen CA “#487 Chronic Pain & Opioid Use Disorder with Dr. Merlin”. The Curbsiders Addiction Medicine Podcast.https://thecurbsiders.com/addiction  June 16th, 2025.

All that follows is from the above.

 

Transcript available via YouTube

Dive into practical, evidence-based approaches to managing pain in patients with opioid use disorder, bust common myths, and explore strategies to support patients. This episode will enhance your skills in providing holistic, patient-centered care. We’re joined by Dr. Jessica Merlin, @JessicaMerlinMD (University of Pittsburgh).

Claim CME for this episode at curbsiders.vcuhealth.org!

By listening to this episode and completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education.

Episodes | Subscribe | Spotify | iTunes | CurbsidersAddictionMed@gmail.com | CME!

Production Partner: ACAAM

The Curbsiders Addiction Medicine are proud to partner with The American College of Addiction Medicine (ACAAM) to bring you this mini-series.  ACAAM is the proud home for academic addiction medicine faculty and trainees and is dedicated to training and supporting the next generation of academic addiction medicine leaders. Learn more about their educational offerings and resources here.

Show Segments

  • Intro, disclaimer, guest bio
  • Guest one-liner
  • Case from Kashlak; Definitions
  • Reciprocal Model of Pain and Addiction
  • Assessment
  • Methadone and Buprenorphine
  • Behavioral Interventions
  • Goal Setting
  • Long-term opioid treatment (LTOT) for chronic pain
  • Acute flares of chronic pain
  • Diagnosis OUD in a patient on LTOT
  • Outro

Chronic Pain & Opioid Use Disorder Pearls

  1. Opioid use disorder and chronic pain commonly co-occur.
  2. Reciprocal Model of Pain and Addiction: A model that describes how pain can drive substance use for short-term relief, but over time, substance use can worsen pain, creating a reinforcing cycle.
  3. Directly ask patients how their addiction and pain intersect to tailor a care plan.
  4. Recognize that building trust with patients experiencing pain and OUD may take multiple visits. Acknowledge the urgency of pain while managing expectations of needing time to see clinical improvement.
  5. Utilize the PEG scale (pain intensity, enjoyment of life, general activity) to track pain over time.
  6. Medications such as buprenorphine and methadone can treat OUD and may help with chronic pain for some patients.
  7. Cognitive Behavioral Therapy (CBT) and pain self-management programs are often the safest and most effective treatments for chronic pain.
  8. When setting goals with patients with chronic pain, consider SMART goals –  make them specific, measurable, achievable, relevant, and time-bound.
  9. Be aware that chronic opioid therapy for non-cancer pain has limited evidence of sustained benefit and potential for harm.
  10. For acute flares of chronic pain, first rule out other medical causes. After appropriate work-up, Dr. Merlin recommends non-opioid management, as flares are often expected in chronic pain.

Chronic Pain & Opioid Use Disorder Notes 

Chronic pain is defined as pain lasting more than three months and persisting after normal tissue healing. It affects  20% of the U.S. population, with 6% experiencing high-impact chronic pain (CDC, 2022).  Approximately 45% of patients with opioid use disorder (OUD) who are on medication treatment also have co-occurring pain (Delorme, 2023) .

 

 

 

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