Physical Pain and Associated Clinical Characteristics in Treatment‐Seeking Patients in Four Substance Use Disorder Treatment Modalities

Abstract

Physical pain among persons seeking treatment for substance use disorders (SUD) and characteristics associated with pain were examined in a secondary analysis of data from the Drug Abuse Treatment Outcome Study (DATOS), a multi-site treatment outcome study. Patients (N = 7,876) in four treatment modalities - long-term residential (LTR), short-term inpatient (STI), outpatient methadone treatment (OMT), and outpatient drug-free (ODF) - reported severity of physical pain experienced during the preceding 12 months. Moderate to severe physical pain was reported by 21.2% of LTR patients, 26.8% of STI patients, 33.6% of OMT patients, and 17.6% of ODF patients. Individuals with and without physical pain were compared across treatment modalities. Patients with pain were more likely to report weekly heroin use [aOR = 1.73 (1.44-2.08)], weekly narcotics use [aOR = 1.43 (1.18-1.74)] and greater depressive symptoms [aOR = 1.30 (1.21-1.38)]. These findings support the presence of a sizable proportion of SUD patients with pain who may benefit from pain assessment as part of their SUD treatment.

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

“…10,12,27 Patients may view this ongoing use of non-prescribed, psychoactive drugs during buprenorphine treatment as self-medication of pain and/or psychiatric symptoms, or as an attempt to improve subjective well-being. 6,7,11,13,34 Nonetheless, ongoing use of other nonprescribed substances may lead to discharge from buprenorphine treatment.…”

“…3,6,7 Several studies have reported that methadone-maintained persons with chronic pain have greater depressive symptoms 3,8 and a greater probability of occupational disability compared to patients with no chronic pain. 34 Importantly, as with chronic pain, depressive symptoms have been associated with greater likelihood of relapse in opioid dependent treatment patients. 35 Fordyce et al 36 proposed an operant conditioning model of chronic pain in which, following an injury, avoidance behavior is negatively reinforced through the reduction of physical pain.…”

Update in Addiction Medicine for the Generalist

“…Fox AD, et al [70], Pade PA, et al [71] Pain is common among patient with opioid dependence [72]. Buprenorphine is a partial opioid agonist FDA-approved in sublingual tablet and film form for the treatment of opioid dependence (combined with naloxone to deter intravenous use), and in transdermal and injectable forms as an analgesic.…”

Pain and Associated Substance Use among Opioid Dependent Individuals Seeking Office-Based Treatment with Buprenorphine-Naloxone: A Needs Assessment Study

“…Among opioid dependent patients (In this manuscript, the terms "opioid dependence" and "opioid dependent" are used in accordance with the DSM-IV-TR (APA, rates of prescription and nonprescription medication use, sleep disturbance, psychiatric distress, and relapse to illicit opioids following detoxification. [2][3][4][5][6][7][8] Providers report difficulty and frustration treating patients with co-occurring opioid dependence and chronic pain, defined here as non-cancer physical pain lasting at least three months. [9][10][11] Research to date on chronic pain and its associated morbidity and treatment implications among opioid dependent patients has focused on patients: a) in detoxification programs, 4,7,12,13 b) seeking methadone maintenance treatment (MMT), 14,15 or c) already enrolled in MMT.…”