Principles for managing OUD related to chronic pain in the Nordic countries based on a structured assessment of current practice

Research output: Contribution to journalReview article


Background: Long-term use of opioid analgesics (OA) for chronic pain may result in opioid use disorder (OUD). This is associated with adverse outcomes for individuals, families and society. Treatment needs of people with OUD related to chronic pain are different compared to dependence related to use, and also injection, of illicit opioids. In Nordic countries, day-to-day practical advice to assist clinical decision-making is insufficient. Aim: To develop principles based on expert clinical insights for treatment of OUD related to the long-term use of OA in the context of chronic pain. Methods: Current status including an assessment of barriers to effective treatment in Finland, Denmark, Iceland, Norway, Sweden was defined using a patient pathway model. Evidence to describe best practice was identified from published literature, clinical guidelines and expert recommendations from practice experience. Results: Availability of national treatment guidelines for OUD related to chronic pain is limited across the Nordics. Important barriers to effective care identified: patients unlikely to present for help, healthcare system set up limits success, diagnosis tools not used, referral pathways unclear and treatment choices not elucidated. Principles include the development of a specific treatment pathway, awareness/ education programs for teams in primary care, guidance on use of diagnostic tools and a flexible treatment plan to encourage best practice in referral, treatment assessment, choice and ongoing management via an integrated care pathway. Healthcare systems and registries in Nordic countries offer an opportunity to further research and identify population risks and solutions. Conclusions: There is an opportunity to improve outcomes for patients with OUD related to chronic pain by developing and introducing care pathways tailored to specific needs of the population.


  • Johan Kakko
  • Charlotte Gedeon
  • Mikael Sandell
  • Henrik Grelz
  • Inge Birkemose
  • Thomas Clausen
  • Valgerur Rúnarsdóttir
  • Kaarlo Simojoki
  • Richard Littlewood
  • Hannu Alho
  • Fred Nyberg
External organisations
  • Skåne University Hospital
  • University of Oslo
  • University of Helsinki
  • Helsinki University Central Hospital
  • Uppsala University
  • Umeå University
  • Norrland University Hospital
  • Solstenen i Skåne AB
  • Capio Maria
  • Odense Municipality
  • Vogur Hospital
  • Applied Strategic
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Substance Abuse


  • Chronic pain, Nordics countries, Opioid use disorder
Original languageEnglish
Article number22
JournalSubstance Abuse: Treatment, Prevention, and Policy
Issue number1
Publication statusPublished - 2018 Jun 1
Publication categoryResearch