Significantly higher methadone dose for methadone maintenance treatment (MMT) patients with chronic pain

Abstract

The aim of this study is to characterize patients with chronic pain in methadone maintenance treatment (MMT). Between September and December, 2003, 170 consecutive patients from an MMT clinic participated in a questionnaire survey on pain (duration and severity). Chronic pain was defined as current pain lasting for >or=6 months. The patients' maintenance methadone dosage and urine tests for drug abuse during the month before and of the survey were recorded. Of the 170 patients, 94 (55.3%) experienced chronic pain. They had a significantly higher proportion of chronic illness (74.5%) compared to non-pain patients (44.7%) (Fisher's Exact Test P<0.0005). Twelve (12.8%) of the chronic pain patients scored their pain as mild, 38 (40.4%) as moderate, 22 (23.4%) as severe and 22 (23.4%) as very severe. Pain duration significantly correlated with pain severity (Pearson R=0.3, P>0.0005) and was significantly associated with methadone daily dosage: patients with pain duration of >or=10 years (n=26) were receiving the highest methadone dosage (182.1+/-59.2 mg/day), those with pain duration from 1 to 10 years (n=59) 160.9+/-56.2 mg/day, and those with pain duration of <1 year (n=9) 134.2+/-73.2 mg/day. Patients in the non-pain group (n=76) were receiving 147.1+/-52.8 mg/day of methadone (ANOVA, F=3.1, P=0.03). We conclude that pain duration and severity significantly correlated. Although methadone was not prescribed for the treatment of pain but rather for opiate addiction, the patients in the MMT clinic with prolonged pain were prescribed a significantly higher methadone dosage compared to patients with short pain duration, and non-pain patients.

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

“…61 Chronic pain patients received modestly but significantly higher buprenorphine doses than patients without pain, similar to reports from methadone maintenance treatment (MMT) programs. 7 As one might expect, there was also a graded positive relationship between chronic pain and non-opioid pain medication use. However, compared to those without pain, buprenorphine patients with pain (again in a graded fashion based on severity of pain) reported higher misuse rates of additional substances that may produce analgesia, including cocaine, alcohol, and marijuana.…”

“…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.…”

“…2 Patients with a history of opioid use report high rates of experiencing pain [3][4][5] that is often severe and interferes with daily activities. [3][4][5][6][7][8] Indeed, a large percentage of patients with opioid dependence who receive opioid agonist treatment report that pain preceded any use of addictive substances, 3,6,[9][10][11] and that the primary reason for starting opioid use was to reduce pain. 9 Among buprenorphine patients, 36-48 % report chronic pain.…”

“…[28][29][30][31][32][33] Amongst methadone patients, higher psychiatric distress is associated with lower general functioning. 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.…”

Assessment and Management of Chronic Pain in Individuals Seeking Treatment for Opioid Dependence Disorder

“…A more recent study employed a less conservative definition of chronic pain (requiring 6 months but eliminating the intensity and interference criteria) and reported even higher rates (55%) of chronic pain. 22 Although prevalence rates vary, the low (about 30%) and high end (about 60%) of the range are higher than most general population estimates. [21][22][23][24][25][26][27] While the higher rate of chronic pain in drug-dependent patients is not surprising, it is cause for substantial concern.…”