Chronic Pain Severity in Opioid-Dependent Patients

Abstract

Treatment-seeking opioid dependent patients present frequently with chronic pain (CP). This pilot study examined the feasibility and utility of a single-item rapid screening tool for identifying CP with implications for SUD treatment in a sample of patients presenting for inpatient opioid detoxification (n=110). Most respondents (91.2%) reported pain in the past week. Forty-seven (42.8%) had CP. Individuals with severe CP had significantly greater depressive symptom severity, pain-related functional interference, and were more likely to be on disability than individuals with mild to moderate CP or no CP. The relationships were supported in a multivariate model. The results suggest it is feasible and important to assess for CP severity in SUD treatment settings. Keywords chronic pain; opioid dependence; assessmentPatients with opioid use disorders present frequently present with chronic pain (CP). These patients are more likely to have higher rates of psychosocial stressors than their non-pain counterparts, which places them at greater risk for difficulties with their substance use disorder 1, 2 . Because pain is common in SUD populations, clinicians would benefit from an efficient and clinically meaningful method to identify those patients whose pain warrants direct attention in their SUD treatment.In pain clinics, where pain is typically the reason for seeking treatment, assessment of chronic pain includes information regarding pain severity and pain-related functional interference 3 . Pain-related functional interference is associated disproportionately with increased pain severity, with greater interference most likely when pain severity is moderate or greater. When assessing cancer and chronic pain, categorizing the level of pain as mild (1-4), moderate (5-6), or severe (7-10) on a 10-point numeric rating scale provides a simple, reliable, and valid method for communicating with patients about pain and guiding pain-related treatment decisions 4-6 .In contrast, there has been relatively little research regarding the assessment of chronic pain and its severity among patients with co-occurring SUD. In SUD treatment, pain is not generally the primary focus of treatment. Thus, in addition to categorizing pain, clinicians must determine the extent to which pain may be relevant to the SUD. One approach is to determine the extent to which pain is associated with other factors that may affect the likelihood of continued substance use or relapse (e.g. psychosocial stressors) 7 . The purpose of this pilot study was to examine the feasibility and utility of a single-item rapid screening METHODSParticipants were 110 opioid-dependent adults, age 18 or older, admitted for detoxification to one of three inpatient units in Massachusetts. Participants were excluded if they were unable to provide informed consent due to cognitive impairment, psychiatric instability, or language barrier. After receiving approval from the McLean Hospital Institutional Review Board, the authors obtained written informed consent and admin...

Relations Among Psychopathology, Substance Use, and Physical Pain Experiences in Methadone-Maintained Patients

“…Whereas previous reports on chronic pain in MMT have documented higher levels of general psychiatric distress and lower levels of general functioning in the former (as compared to the latter) group (1, 2, 6), our findings specify discrete psychiatric domains that distinguish MMT patients with chronic severe pain from those who have not experienced pain in the past week. Similar to recent findings on opioid dependent patients seeking inpatient detoxification (10), the presence of chronic pain in this study was associated with increased levels of depression. Our findings of elevated depression, anxiety, somatization and personality disorder criteria among the chronic pain group may in part explain MMT counselors’ reported difficulty treating these patients (3), emphasize the importance of multidisciplinary assessment and treatment in addressing chronic pain (11), and point to discrete psychiatric disorders that may be important for providers to address when treating these patients.…”

“…Given that chronic pain (a) is most frequently associated with depressive disorders, anxiety disorders, somatoform disorders, and personality disorders among non-addicted individuals (9), (b) is related to higher levels of depressive symptoms among opioid dependent patients seeking inpatient detoxification (10) and among patients with substance use disorders seeking a range of treatments (11, 12), and (c) has been linked to personality disorders, anxiety, and depression among patients suspected of non-medical use of prescription opioids who were seeking prescription opioid medication refills at an emergency department (13), we hypothesized that, in comparison to methadone patients without pain, those with CSP would exhibit higher levels of depression, anxiety, somatization and personality disorder criteria. We also examined whether self-reported past week use of psychoactive substances: alcohol and tobacco; illegal drugs (cannabis, cocaine, and heroin); and non-medical use of prescription drugs (opioids, amphetamines, and benzodiazepines) differed among pain groups.…”

Barriers to Medical Provider Support for Prescription Naloxone As Overdose Antidote for Lay Responders

“…Addiction and chronic noncancer pain are common conditions that often cooccur (Chelminski et al, 2005;Rosenblum et al, 2003;Savage, Kirsh, & Passik, 2008). A 2006 literature review reported the prevalence of opioid dependence among chronic pain patients ranges from 3% to 19% across different clinical settings and patient populations (Kahan, Srivastava, Wilson, Gourlay, & Midmer, 2006), whereas other studies estimate 29%-60% of people with opioid addiction report chronic pain (Heimer et al, 2012;Peles, Schreiber, Gordon, & Adelson, 2005;Potter, Shiffman, & Weiss, 2008;Rosenblum et al, 2003;Sheu et al, 2008). At the most fundamental level, reducing risk for these disparate groups raises practical challenges.…”

Comorbid Pain and Opioid Addiction: Psychosocial and Pharmacological Treatments

“…Comorbid pain and addiction patients are more likely to have serious medical, psychological, or social issues compared with: (1) individuals in addiction treatment programs (Potter, Shiffman, & Weiss, 2008), and (2) non-comorbid chronic pain patients (Kouyanou, Pither, & Wessely, 1997). Among other issues, patients with opioid dependence and comorbid pain were 1.77 times more likely to have a psychiatric illness compared with those with opioid dependence alone (Cheatle & Gallagher, 2006).…”