The Role of Childhood Trauma in Chronic Pain and Substance Use Among Individuals Receiving Methadone Treatment for Opioid Use Disorder

The Role of Childhood Trauma in Chronic Pain and Substance Use Among Individuals Receiving Methadone Treatment for Opioid Use Disorder

Published: May/June 2026
Journal Article

Overview

This one-hour, journal article-based activity examines the relationships between childhood trauma, chronic pain, and substance use among individuals receiving methadone treatment for opioid use disorder (OUD). Using validated measures of trauma exposure, pain severity, and recent substance use, the study identifies clinically relevant associations between early life adversity and adult pain and substance use patterns. Findings highlight the importance of integrating trauma-informed assessment and care into OUD treatment settings, particularly for patients experiencing co-occurring pain and substance use behaviors.

The target audience for this intermediate continuing education activity includes physicians, nurse practitioners, physician assistants, and other clinicians, researchers, students, and policymakers. 

This activity addresses the following ACGME Core Competencies: Patient Care, Medical Knowledge, and Practice-Based Learning and Improvement.

Abstract

Aims 

This study explored the correlations between childhood trauma, chronic pain, and substance use among individuals receiving methadone for opioid use disorder (OUD). We hypothesized that, among individuals with OUD, a history of childhood trauma would correlate with more severe pain and substance use compared to those without such history.

Methods

We conducted a cross-sectional study of 82 individuals receiving methadone for OUD. Participants completed the Childhood Trauma Questionnaire (CTQ) to assess childhood trauma exposure, the Brief Pain Inventory (BPI) to characterize chronic pain, and the Timeline Followback (TLFB) method to assess substance use in the past 28 days. Correlation analyses and ANOVA examined the relationships between these variables.

Results

Higher childhood trauma scores correlated with greater pain severity (r = 0.27, P = 0.03), increased alcohol consumption (r = 0.25, P = 0.04), and earlier age of cannabis initiation (r = -0.45, P <.001). Among trauma subscales, emotional abuse most closely correlated with greater pain severity ( r= 0.33, P = 0.008) and interference (r = 0.28, P = 0.03), and alcohol consumption (r = 0.28, P = 0.02). Individuals who used cannabis reported significantly higher levels of emotional abuse (P = 0.04), sexual abuse (P = 0.03), and physical neglect (P = 0.02) compared to those who did not. Conversely, our analysis did not reveal significant correlations between childhood trauma and heroin, tobacco, cocaine, or stimulant use.

Conclusion

Childhood trauma correlated with greater pain severity and interference, higher alcohol use, earlier cannabis initiation, and increased likelihood of cannabis use among individuals receiving methadone for OUD. These findings suggest the importance of integrating trauma-focused assessment and treatment into OUD treatment programs.

Learning Objectives

Upon completion of this activity, learners will be able to:

1. Describe the relationship between childhood trauma and pain severity among individuals receiving methadone treatment for OUD. 
2. Identify substance use patterns associated with childhood trauma in patients receiving methadone for OUD. 
3. Recognize the clinical implications of trauma-informed care in the assessment and management of pain and substance use in OUD treatment settings.  

Registration Rates

*Residents, Fellows-in-training, Interns, and Students must join ASAM to receive a discounted registration rate. Click here to become an ASAM member. National and Chapter membership dues apply. There is no charge for Students to become a Member, but verification of student status is required.

Membership Question?  Call ASAM at 1.301.656.3920, email us, or view the ASAM website for more information.

Refunds & Cancellations

All ASAM eLearning Center refund requests must be made in writing to education@asam.org within 90 days of purchase. Those requesting refunds for courses that are in progress will receive partial refunds or eLearning Center credit. Automatic full refunds will be made for any course with a live-course component that has been canceled.

Open Registration: 06/02/2026 - 02/10/2029

Close Access Date: 02/10/2029

Course Instructions

1. Click on the Contents tab to begin this activity.
2. Click Download Journal Article in the box titled Journal Article and read the journal article in its entirety. 
3. Click Complete Post-Test to answer multiple-choice questions. You will have 10 attempts to pass and must answer 2 out of 3 questions correctly.
4. Click Complete General Evaluation to provide valuable activity feedback. Scroll down on all questions, as there may be answer options that expand past the size of the window.
5. Click the button Claim Medical Credits in the box titled Claim Credits & Certificate. Choose the type of credit and click submit. Click the button View/Print Certificate to save or print your certificate. You can view/print your certificate at any time by visiting the ASAM eLearning Center, clicking Dashboard, and clicking Transcript/Achievements.

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Accreditation & Credits

Joint Accreditation Statement

In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credits Available

• Physicians: 1.00 Credit
• Nurses & NPs: 1.00 Nursing Contact Hour
• PAs: 1.00 Credit
• Interprofessional Continuing Education: 1.00 Credit
• Certified Counselors: NBCC Contact Hours Not Offered

  

  American Society of Addiction Medicine has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7062. Programs that do not qualify for NBCC credit are clearly identified. American Society of Addiction Medicine is solely responsible for all aspects of the programs.

Maintenance of Certification (MOC)/Continuing Certification Program (CCP)

This activity is designed to meet the requirements for MOC/CCP for several primary physician boards and for state licensing CME requirements. MOC Credit is only reported and designated for ABA, ABP, ABIM, and ABS. By completing the online credit application and evaluation, the learner permits ASAM to report credits to the appropriate Board. Learn more.

• ABIM MOC Points: 1.00 Medical Knowledge
• ABP MOC: 1.00 Lifelong Learning & Self-Assessment
• ABS Continuing Certification: 1.00 Accredited CME
• ABA MOCA 2.0®*: 1.00 Lifelong Learning MOCA 2.0® is a trademark of the American Board of Anesthesiology®. This activity contributes to the CME requirement for Part II: Lifelong Learning and Self-Assessment of the American Board of Anesthesiology's (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0®. Please consult the ABA website, https://www.theaba.org/, for a list of all MOCA 2.0 requirements.

Additionally, this activity has been designed to satisfy the requirements of the following primary physician board certification requirements. Please confirm with your individual Board.

• American Board of Addiction Medicine (ABAM)
• American Board of Preventive Medicine (ABPM)
• American Board of Psychiatry and Neurology (ABPN)
• Royal College of Physicians and Surgeons of Canada (RCPSC)

Certificates for other professions

All participants may request a certificate of participation upon completion of the activity and an online evaluation confirming their participation. Learners are strongly advised to contact their professional licensing board or professional association to confirm this certificate will be accepted as evidence supporting continuing education requirements.

California Association for Drug/Alcohol Educators (CAADE)

This educational program is approved by CAADE: #CP40 999 1225.

California Association of DUI Treatment Centers (CADTP)

This educational program is approved by CADTP: #205.

California Consortium of Addiction Programs and Professionals (CCAPP)

This educational program is approved by CCAPP: #OS-20-330-0227.

Disclosure Information

In accordance with the disclosure policies of ASAM and Joint Accreditation, the effort is made to ensure balance, independence, objectivity, and scientific rigor in all accredited continuing education activities. These policies include identifying and mitigating all relevant financial relationships with ineligible companies for those involved in the creation and dissemination of accredited continuing education. 

See the attached article and pdf for a list of disclosures