Hepatol Commun. 2026 May 22;10(6):e0955. doi: 10.1097/HC9.0000000000000955. eCollection 2026 Jun 1.

ABSTRACT

BACKGROUND: Chronic pain is common and uniquely challenging to manage in people with cirrhosis. The purpose of this pilot study was to evaluate the feasibility and acceptability of a tailored pain self-management (PSM) intervention for people with cirrhosis and chronic pain.

METHODS: This single-arm, single-site pilot study recruited patients with a diagnosis of cirrhosis and chronic pain to a virtual, health coach-led, modular PSM intervention. After 6 weekly one-on-one sessions, patients were invited to attend 6 weekly group sessions. Outcomes were measured at baseline, 6 weeks, 12 weeks (end of intervention), and 24 weeks (maintenance). The primary outcomes were acceptability, defined by a 4/5 rating on the Treatment Acceptability Questionnaire, and feasibility, defined as the ability to retain patients in 80% of the intervention sessions. Secondary outcomes of pain and function were measured using the Pain intensity, Enjoyment of life, and General activity (PEG) scales, and a rating of percent improvement with the intervention.

RESULTS: Among 21 participants who started the intervention, 16 (76%) attended ≥80% of sessions. Acceptability thresholds were met at all time points. On a scale of 0-100, where 30 is considered to be a meaningful change, participants rated their improvement in pain symptoms an average of 50 ± 25. The average PEG score decreased from 6.1 at baseline to 5.3 at 24 weeks. Participants reported increases in PSM behaviors, including cognitive and stress-reduction methods, physical activity, healthy sleep behaviors, and changes in diet.

CONCLUSIONS: This pilot identified a reduction in pain and an increase in PSM activities and demonstrated the acceptability of a health coach-led PSM intervention for adults with chronic pain and cirrhosis.

PMID:42172501 | DOI:10.1097/HC9.0000000000000955

JAMA Netw Open. 2026 May 1;9(5):e2611514. doi: 10.1001/jamanetworkopen.2026.11514.

ABSTRACT

IMPORTANCE: Due to the impact of high-potency synthetic opioids on medication for opioid use disorder (MOUD) initiation, hospital-based addiction clinicians adapted their practice to improve care, with decisions often guided by limited evidence.

OBJECTIVE: To derive expert consensus on best practices for hospital-initiated MOUD among patients with OUD using high-potency synthetic opioids.

DESIGN, SETTING, AND PARTICIPANTS: This survey study used a 2-round Delphi process conducted from January to April 2025. National experts were hospital-based physicians or advanced practice clinicians who treated at least 100 hospitalized patients with OUD in the last 2 years and self-identified as an expert in methadone and buprenorphine initiation. Experts were purposively sampled based on practice location and addiction board certification. Data were analyzed from April 2025 to March 2026.

MAIN OUTCOMES AND MEASURES: The main outcome was consensus on the appropriateness of specific practices. Appropriateness was evaluated using a 9-point Likert scale from 1, indicating very inappropriate to 9, very appropriate. The presence of consensus was determined using the RAND/UCLA appropriateness method; if consensus was obtained, it was stratified into inappropriate (median 1-3), uncertain (median 4-6), or appropriate (median 7-9).

RESULTS: Of 48 experts, 42 (87.5%; median [IQR] age, 41 [36.0-45.8] years; 25 [59.5%] female) completed round 1 and 41 of these (97.6%) completed round 2. Most were physicians (36 participants [85.7%]); of those, 30 (83.3%) were board certified in addiction medicine, 3 (14.3%) in addiction psychiatry, 2 (5.6%) in both, and 1 (2.4%) in neither. Experts treated a median (IQR) of 200 (100-315) hospitalized patients with OUD in the past year. There was consensus that buprenorphine and methadone initiation were appropriate, while the appropriateness of naltrexone initiation was uncertain. Consensus was reached that rapid methadone initiation was appropriate. Regarding buprenorphine initiation practices, experts reached consensus that high- and low-dose initiation were appropriate, traditional initiation was of uncertain appropriateness, and rescue was inappropriate. There was consensus that provision of non-MOUD full agonist opioids was appropriate to treat opioid withdrawal during methadone initiation, as a bridge during buprenorphine initiation, and to treat withdrawal among patients declining MOUD.

CONCLUSIONS AND RELEVANCE: In this survey study of hospital-based addiction specialty clinicians, consensus was reached on hospital-initiated MOUD and treatment of opioid withdrawal. These best practices can inform current clinical approaches and reflect the need for more robust research to evaluate effectiveness and safety.

PMID:42096208 | DOI:10.1001/jamanetworkopen.2026.11514

J Palliat Med. 2026 May 4:10966218261447000. doi: 10.1177/10966218261447000. Online ahead of print.

ABSTRACT

Eating disorders (ED), particularly anorexia nervosa (AN), represent high-morbidity, high-mortality psychiatric illnesses with multisystem medical complications, frequent relapse, and substantial caregiver burden. As palliative care (PC) clinicians increasingly encounter patients with severe and enduring ED, they may be asked to help manage complex symptom distress, navigate treatment refusals, support families, and participate in values-based goals of care discussions amid prognostic uncertainty. At the same time, the emerging and contested discourse around “terminal anorexia nervosa” underscores the need for careful clinical reasoning, nuanced capacity assessment, and ethically rigorous, interdisciplinary deliberation. In this article, an interdisciplinary group of PC, psychiatry, psychology, and eating-disorder specialist clinicians presents a practical “Top Ten Tips” framework to support real-world care. Tips emphasize early recognition of countertransference and moral distress, medical severity assessment and refeeding risk, trauma-informed and harm-reduction approaches, task-specific decision-making capacity evaluations, communication strategies that prioritize values and meaning over labels, and collaboration with eating-disorder specialty teams, ethics consultation, and community resources. We aim to provide actionable guidance that strengthens PC clinicians’ confidence and consistency when caring for patients with severe EDs.

PMID:42080350 | DOI:10.1177/10966218261447000

J Subst Use Addict Treat. 2026 Apr 28:209986. doi: 10.1016/j.josat.2026.209986. Online ahead of print.

ABSTRACT

INTRODUCTION: Higher buprenorphine maintenance doses (>24 mg daily) may be more effective in improving opioid use disorder (OUD) treatment outcomes in the era of fentanyl predominance. Evidence on maintenance dose trends remains limited, especially among vulnerable populations, who are disproportionately affected by opioid overdose deaths. The objective of this study was to describe trends in maintenance dose of buprenorphine for OUD and the association of social vulnerability with maintenance dose.

METHODS: We identified buprenorphine treatment episodes initiated between January 2019 and June 2021 using the IQVIA Longitudinal Prescription database. Episodes were assigned to a maintenance dose category of <16, 16-24, or >24 mg, to reflect dosages lower than, consistent with, or higher than the guideline-recommended target dose range, respectively. County-level social vulnerability was measured with the Minority Health Index (MHI). We used multinomial logistic regression with generalized estimating equations to test the association between MHI (stratified into quartiles) and maintenance doses <16 mg and >24 mg (with 16-24 mg as the reference group), adjusting for patient, geographic, and time characteristics.

RESULTS: Of 1,044,460 treatment episodes among 543,326 individuals (mean [SD] age 41.9 [12.6] years, 43% female), the most common buprenorphine maintenance dose category was 16-24 mg (62.7%), followed by <16 mg (34.5%), then >24 mg (2.8%). The median (IQR) episode duration was 64 (109) days. The proportion of episodes in the <16 mg category increased from 34.1% in 2019 to 39.2% in 2021, whereas prevalence of the remaining categories decreased. A greater proportion of episodes in the >24 mg category were in rural versus urban counties; the magnitude of this difference increased over time. Relative to 16-24 mg, maintenance dose >24 mg was more likely among individuals in the most vulnerable MHI quartile compared to the least vulnerable quartile (aOR 1.28, 95% CI 1.19-1.38).

CONCLUSION: During a period of growing evidence supporting higher buprenorphine maintenance doses, the prevalence of treatment episodes with maintenance dose <16 mg increased. Individuals in the highest social vulnerability quartile tended to receive higher doses, suggesting that some higher-risk groups may receive more intensive treatment, even as important gaps remain. These results can inform efforts targeting equitable, high-quality buprenorphine prescribing.

PMID:42061723 | DOI:10.1016/j.josat.2026.209986

J Subst Use Addict Treat. 2026 Apr 24:209998. doi: 10.1016/j.josat.2026.209998. Online ahead of print.

ABSTRACT

Despite comprising one-fifth of the population, individuals living in rural areas are underrepresented in clinical trials on substance use disorders (SUD). The inclusion of rural residents is critical to reducing disparities in health outcomes and improving adoption of evidence-based interventions for SUDs. The current commentary provides five guiding principles to assist researchers in including rural populations in trials. These principles emphasize including rural communities in the study design phase and throughout the research process, understanding the local rural context, consideration of operationalization of rural in research, suggested adaptions for research, and embracing opportunities for bi-directional and sustainable partnerships. When approached thoughtfully, research funding can catalyze rural capacity, foster durable partnerships, and enrich scientific inference to assist in establishing the evidence-base for SUD research.

PMID:42035881 | DOI:10.1016/j.josat.2026.209998

JAMA Intern Med. 2026 Apr 20. doi: 10.1001/jamainternmed.2026.0428. Online ahead of print.

NO ABSTRACT

PMID:42008248 | DOI:10.1001/jamainternmed.2026.0428

J Pain. 2026 Mar 24:106269. doi: 10.1016/j.jpain.2026.106269. Online ahead of print.

ABSTRACT

Chronic pain is common and burdensome among people with end stage kidney disease (ESKD). Pain management options are limited and prescription opioids are often used in this population, but carry unwanted risks (e.g., side effects, misuse, overdose). Buprenorphine is increasingly viewed as a safer alternative to full agonist opioids. However, buprenorphine uptake may be inhibited by access barriers and addiction stigma, given its association with opioid use disorder. These concepts have not yet been explored in the context of ESKD and chronic pain, limiting understanding of buprenorphine acceptability in patients with ESKD. Therefore, the current study sought to understand potential barriers to buprenorphine use among people with ESKD and chronic pain receiving in-center hemodialysis treatments. Using a descriptive qualitative approach, qualitative interviews were conducted with 28 patients with ESKD-related pain between April 2022 and January 2024. Thematic analysis was used to analyze interview transcripts. Themes identified included: (1) ESKD is uniquely painful, and accessing pain management is challenging for ESKD patients; (2) ESKD patients experience stigma and discrimination when seeking pain management, which is influenced by the national overdose crisis and resulting deprescribing efforts; and (3) ESKD patients were interested in buprenorphine as an alternative pain management strategy to prescription opioids – in contrast to prior work – participants were comforted by its use in opioid use disorder treatment. These findings highlight a need to identify appropriate providers and systems of care to deliver pain management, and provide non-stigmatizing information to patients regarding buprenorphine as a safer medication alternative. PERSPECTIVE: Co-occurring chronic pain and ESKD are burdensome conditions. Qualitative interviews highlighted difficulties finding a pain provider and experiencing stigma when seeking pain care. Patients were interested in buprenorphine as an alternative to prescription opioids, and were comforted by buprenorphine’s perceived safety in opioid use disorder treatment.

PMID:41887308 | DOI:10.1016/j.jpain.2026.106269

Subst Use Addctn J. 2026 Mar 17:29767342261421746. doi: 10.1177/29767342261421746. Online ahead of print.

ABSTRACT

BACKGROUND: Harm reduction services fulfill a critical need in reducing the negative consequences associated with the overdose crisis. However, many current evidence-based harm reduction services-such as syringe service programs-have access barriers including limited hours or the need for face-to-face interactions to help serve people who use drugs (PWUD).

ISSUE: To complement such traditional services, overcome barriers, and bridge gaps, harm reduction vending machines (HRVMs) are increasingly being used to offer PWUD low-barrier, 24-hour access to harm reduction supplies, such as naloxone, drug-checking strips, condoms, and more. Evidence from around the world, and more recently in the United States, demonstrates that HRVMs not only provide anonymous no- or low-cost supplies to PWUD, but also do so in ways that overcome key barriers such as stigma, cost, and transportation, while also increasing accessibility and acceptability among PWUD. Perhaps most notably, HRVMs can do all of this while remaining cost-efficient, highly accessible, and adaptable to community needs.

RECOMMENDATIONS: Accordingly, the Association for Multidisciplinary Education and Research in Substance Use and Addiction supports funding and research for the broader application of HRVMs, alongside the creation of national implementation guidance and federal and state policy alignment, to ensure that communities across the United States can access these crucial harm reduction services.

PMID:41841202 | DOI:10.1177/29767342261421746

J Pain. 2026 Mar 13:106220. doi: 10.1016/j.jpain.2026.106220. Online ahead of print.

ABSTRACT

Single session interventions (SSIs) for chronic pain are a novel and scalable intervention approach that are far less burdensome than typical 8-session behavioral treatments, and have demonstrated improvements in pain outcomes. Therefore, the current review focuses on systematically summarizing evidence from randomized controlled trials (RCTs) on behavioral SSIs for chronic pain. The review was prospectively registered (PROSPERO CRD42023447224), and the search strategy included seven electronic databases up until 11/2024. Title, abstract, and full text review was conducted with 17 RCTs identified and summarized. Eligible studies were RCTs testing a psychological SSI that targeted pain among adults with chronic pain. Study quality was analyzed using National Institute of Health (NIH)’s Quality Assessment Tool for RCTs. The review focused on synthesizing: 1) the main contents, mode, frequency and duration of interventions for patients with chronic pain; and 2) the effects of SSIs on psychological and physical outcomes. Overall, we found that various SSIs demonstrated efficacy in improving pain outcomes. Specifically, small but significant effects of SSIs were observed for pain intensity (Standardized mean difference [SMD]=0.17) and pain interference (SMD=0.27) compared to control conditions. SSIs also demonstrated significant reductions in pain catastrophizing, anxiety, and depression (SMD = 0.37, 0.29, and 0.25 respectively). Of the 17 RCTs, 13 (76%) had good internal validity, and 4 (24%) had fair internal validity. SSIs can be low burden and improve behavioral pain care access. Finally, we discuss design and methodology recommendations for future research on SSIs for chronic pain. PERSPECTIVE: Findings suggest that SSIs are generally effective in improving pain and other health outcomes across various types of chronic pain conditions. SSIs can be low burden and improve behavioral pain care access, especially in settings where longer-course behavioral treatments are infeasible or not offered.

PMID:41833852 | DOI:10.1016/j.jpain.2026.106220

JAMA Netw Open. 2026 Mar 2;9(3):e260667. doi: 10.1001/jamanetworkopen.2026.0667.

NO ABSTRACT

PMID:41838008 | DOI:10.1001/jamanetworkopen.2026.0667