Associations Among Sleep, Pain, and Medications for Opioid Use Disorder: a Scoping Review.

We present current evidence on the associations among sleep, pain, and medications for opioid use disorder (MOUD) among individuals with opioid use disorder (OUD). We searched MEDLINE, Embase, PsycInfo, Web of Science, and Cochrane Library from inception until September 2023 for original research studies examining sleep, pain, and MOUD. We identified 19 manuscripts (14 were cross-sectional studies, four were prospective cohort studies, and one was a randomized controlled trial). Measures of sleep and pain varied. Sleep disturbance and pain were highly prevalent and associated. However, the associations between MOUD treatment characteristics (e.g., initiation, type, dose, and prior MOUD) and a) sleep and b) pain were mixed or unclear. Limited sample sizes and covariates such as opioid use disorder severity sometimes complicated the examination or interpretation of these associations. Few studies examined possible mediators underlying these associations. While sleep and pain were consistently associated, it is unclear whether sleep and pain are associated with MOUD treatment characteristics or other covariates such as opioid use disorder severity. Future research on the associations among sleep, pain, and MOUD among individuals with OUD should consider a) comparing different MOUD treatments including formulations and dose schedules, b) qualitative and mixed methods studies to assess patient and provider preferences for the treatment of sleep and pain in OUD treatment settings, c) longitudinal studies that employ reliable and valid measures with sufficiently powered sample sizes to examine mediation and moderation, and d) testing whether interventions addressing pain or sleep among patients receiving MOUD improve pain, sleep, and MOUD outcomes.