Accepted for/Published in: JMIR Research Protocols
Date Submitted: Jun 30, 2025
Date Accepted: Nov 20, 2025
Chronic pain and post-traumatic stress among patients in substance use treatment: Protocol for NOR-APT, a longitudinal cohort study
ABSTRACT
Background:
Chronic pain conditions and post-traumatic stress disorder (PTSD) are highly prevalent among patients with substance use disorders (SUDs). Both can impact outcomes of SUD treatment and quality of life. There is a need for a large-scale study on the overlap of, and interactions between SUD, chronic pain and PTSD.
Objective:
The Norwegian Addiction, Pain and Trauma study (NOR-APT) is the first longitudinal study to describe how substance use and outcomes of SUD treatment are impacted by (1) chronic pain and pain characteristics, and (2) interactions between comorbid chronic pain and PTSD.
Methods:
Self-reported questionnaire data were collected from patients in all types of SUD treatment at four hospital sites in Norway. The questionnaire data on substance use, pain and post-traumatic stress symptoms will be combined with retrospective and prospective longitudinal data from high-quality demographic and health registries. The registry data covers e.g. treatment episodes, ICD-10 diagnoses, and prescribed medications and socioeconomic variables, with a follow-up period of altogether 20 years (approximately 2008-2029).
Results:
Questionnaire data was collected during March 2021-June 2024. Altogether 1 890 patients were approached and 1 645 questionnaires were completed (87%). The estimated final sample size pending data cleaning (e.g. removal of duplicates, validation of consent forms) is n=1 400-1 500. Linkage of registry data for approximately n=1 000 with valid id-numbers and consent is planned for 2025/2026 (retrospective) and 2029/2030 (prospective). Ten publications are planned in the period 2025-2028, based on funding received from the Foundation Dam, The Norwegian Research Council and Akershus University Hospital and Oslo University Hospital. We plan to apply for further funding related to use of the prospective registry data.
Conclusions:
Results from the NOR-APT study will contribute to a better understanding of SUD, chronic pain and PTSD comorbidities, their interactions, trajectories and impact on SUD treatment outcomes and subjective quality of life. Results can also contribute knowledge towards development and assessment of treatment interventions that can improve SUD treatment outcomes. Clinical Trial: Clinical Trials: NCT04908410; https://clinicaltrials.gov/study/ NCT04908410 Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/AKWSZ
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