Quantitative Sensory Testing of Pain in Persons with Opioid Use Disorder on Opioid Agonist Treatment: A Scoping Review.

Abstract

Objective: To evaluate the use of quantitative sensory testing (QST) in assessing pain responses and mechanisms among individuals with opioid use disorder (OUD) receiving opioid agonist treatment (OAT).

Design: Scoping review following PRISMA-ScR guidelines.

Setting: Systematic literature search across five major databases.

Subjects: Studies investigating QST outcomes in adults with OUD receiving OAT (methadone, buprenorphine, or other opioid agonists) with or without co-occurring chronic pain.

Methods: We searched Ovid MEDLINE, Embase, APA PsycINFO, Cochrane Library, and Web of Science from inception through March 2025. Eligible studies included original research employing QST methodologies in adults with OUD receiving OAT. Data extraction focused on study characteristics, QST methodologies, and pain-related outcomes.

Results: Of 45 included studies, 64.4% employed cross-sectional designs with limited protocol standardization. Static QST measures predominated, with thermal stimuli most common. The most consistent finding was reduced cold pain tolerance in individuals with OUD compared to controls (60% of studies). Dynamic QST measures (3 studies) revealed altered pain modulation suggestive of central sensitization. Pain processing abnormalities frequently persisted despite prolonged abstinence from non-OAT opioids, suggesting lasting neuroadaptive changes. Methodological heterogeneity and inconsistent reporting of clinical variables limited synthesis.

Conclusions: QST demonstrates potential for enhancing clinical understanding of pain mechanisms in individuals receiving OAT. Future research should prioritize protocol standardization, longitudinal designs tracking pain sensitivity changes, and exploration of QST's predictive value for treatment responses to facilitate clinical integration.