Associations between chronic non-cancer pain and medication assisted treatment outcomes for opiate addiction

Abstract

Background and Objectives: An increased percentage of individuals entering opioid addiction treatment programs also report the presence of chronic non-cancer pain (CNCP). This study examined associations between the presence of CNCP and 6-month medication assisted addiction treatment (MAT) outcomes. Methods: The sample included 585 individuals at opiate treatment programs who completed a structured intake interview and a 6-month follow-up telephone interview between March 2007 and December 2010. Of the sample, 115 individuals reported CNCP at intake and 6-month follow-up. Bivariate analyses compared individuals with CNCP (n ¼ 115) and without CNCP (n ¼ 470) at MAT intake. Results: A greater percentage of individuals with CNCP were older, were retired or disabled, and had experienced depression or anxiety before intake compared to individuals without CNCP. Results of binomial logistic regression models found that having CNCP was associated with increased odds of depression/anxiety at follow-up, but had no association with employment or substance use. Conclusions and Scientific Significance: The correlations between CNCP and co-occurring depression/anxiety among MAT clients indicate an area of special concern for providers. A full biopsychosocial, including a focus on history of chronic physical pain, might be beneficial to help highlight potential co-morbidities and to encourage closer monitoring of the intertwining relationships between addiction, CNCP, and depression/anxiety. (Am J Addict 2014;XX: 1-6)

Persistence with opioid treatment in Germany in patients suffering from chronic non-malignant or cancer pain

“…This means that patients with chronic diseases would be expected to have a slightly higher persistence on account of this factor. Besides the aforementioned comorbidities, depression was commonly observed in our study cohort (35.4% of patients), which supports results from previous studies, which indicate that chronic pain has physical and psychological effects such as depression, anxiety, or sleeping problems 8,19,22,40,44,45 . It also stresses the finding that high rates of psychiatric disorders and psychological distress occur in persons who regularly use prescribed opioids and therefore often require a greater level of management, care, and use of healthcare resources 11,19,22,40,46,47 .…”

Comparison of psychiatric comorbidity in treatment‐seeking, opioid‐dependent patients with versus without chronic pain

“…The significantly higher prevalence of anxiety‐related symptoms in the chronic pain group is consistent with the findings of other studies . Given the high prevalence of anxiety‐related symptoms in the present cohort (based on the GHQ‐28 and the CORE‐OM)—particularly in the chronic pain group—and the relatively small proportion in receipt of anxiolytic treatment, this may indicate undertreatment of anxiety in both groups, which may reflect a patient reluctance to seek help for psychological distress.…”

“…Higher prevalence of depressive symptoms in the chronic pain group is consistent with the findings of other studies . Jamison and colleagues reported that antidepressant medication was prescribed to 28% of the chronic pain group compared with 15% of methadone‐maintained patients with no pain.…”

Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration

“…18 Nevertheless, opioid use in IBS and other GI patients with functional GI disorders has not been closely examined. 19 While preliminary data from one tertiary out-patient GI setting revealed that 43% (eg, dementia = 1; metastatic solid tumour = 6). This measure allows for stratification into "mild", "moderate" and "severe" illness categories, and is validated as a predictor of patient survival over a 10-year period.…”