Psychiatric comorbidity and order of condition onset among patients seeking treatment for chronic pain and opioid use disorder

Barry, Declan T.; Beitel, Mark; Cutter, Christopher J.; Fiellin, David A.; Madden, Lynn M.; Lipkind, Nathan; Bollampally, Pooja; Liong, Christopher; Schottenfeld, Richard S.

doi:10.1016/j.drugalcdep.2021.108608

Cited by 5 publications

(3 citation statements)

References 34 publications

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“…This finding is congruent with previously published research that described high rates of co-occurring Chronic pain, anxiety, and depression within the general population 46 -49 and, specifically, among patients with OUD. 2,50,51 A high prevalence of co-occurring PTSD and Chronic pain severity and interference have also been established among the general population, 52 veterans, 53 and patients with OUD receiving MOUD. 8,9 In the present study, PTSD was more prevalent in participants with Chronic pain (45% vs 36%), but the association was not statistically significant ( P = .119).…”

Section: Discussionmentioning

confidence: 99%

Mental Health Distress Is Associated With Higher Pain Interference in Patients With Opioid Use Disorder Stabilized on Buprenorphine or Methadone

Leyde,

Price,

Colgan

et al. 2024

Substance Use & Addiction Journal

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Background: The relationships between opioid use disorder (OUD), chronic pain, and mental health distress are complex and multidirectional. The objective of this exploratory study was to examine the relationship between mental health conditions and Chronic pain severity and interference among patients stabilized on either buprenorphine or methadone. Methods: We report baseline data from a randomized trial of a mind-body intervention conducted at 5 outpatient clinics that provided either buprenorphine or methadone treatment. Validated scales were used to measure substance use, mental health distress, and pain severity and interference. Statistical analyses examined the relationship between mental health conditions and pain severity and interference. Results: Of 303 participants, 57% (n = 172) reported Chronic pain. A total of 88% (n = 268) were prescribed buprenorphine. Mental health conditions were common, with one-quarter of the sample screening positive for all 3 mental health conditions (anxiety, depression, and posttraumatic stress disorder [PTSD]). Compared to participants without Chronic pain, participants with Chronic pain were more likely to screen positive for moderate-severe anxiety (47% vs 31%); moderate-severe depression (54% vs 41%); and the combination of anxiety, depression, and PTSD (31% vs 18%). Among participants with Chronic pain, mental health conditions were associated with higher pain interference. Pain severity was higher among participants with mental health conditions, but only reached statistical significance for depression. Pain interference scores increased with a higher number of co-occurring mental health conditions. Conclusions: Among individuals stabilized on either buprenorphine or methadone, highly symptomatic and comorbid mental health distress is common and is associated with increased pain interference. Adequate screening for, and treatment of, mental health conditions in patients with OUD and Chronic pain is needed.

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Section: Discussionmentioning

confidence: 99%

Mental Health Distress Is Associated With Higher Pain Interference in Patients With Opioid Use Disorder Stabilized on Buprenorphine or Methadone

Leyde,

Price,

Colgan

et al. 2024

Substance Use & Addiction Journal

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“…First, when used for long periods and at higher doses, opioids induce tolerance to their analgesic effects, 4 which is sometimes accompanied by a higher sensitivity to pain—a phenomenon known as opioid‐induced hyperalgesia 5 . Notably, among persons with OUD, unrelieved pain is associated with negative clinical outcomes, including impaired social functioning, poor sleep and OUD treatment dropout 6–8 . Second, opioids cause dose‐dependent adverse gastrointestinal, immune and endocrine effects, which collectively may lead to a lower quality of life and a higher utilization of healthcare services 9,10 .…”

Section: Introductionmentioning

confidence: 99%

“…5 Notably, among persons with OUD, unrelieved pain is associated with negative clinical outcomes, including impaired social functioning, poor sleep and OUD treatment dropout. [6][7][8] Second, opioids cause dose-dependent adverse gastrointestinal, immune and endocrine effects, which collectively may lead to a lower quality of life and a higher utilization of healthcare services. 9,10 Together, these challenges underscore the need for novel strategies to enhance pain and OUD therapeutics, an initiative recognized by the US Food and Drug Administration (FDA) Congressional Research Service.…”

Section: Introductionmentioning

confidence: 99%

Delta‐9‐tetrahydrocannabinol modulates pain sensitivity among persons receiving opioid agonist therapy for opioid use disorder: A within‐subject, randomized, placebo‐controlled laboratory study

De Aquino,

Meyerovich,

Xie

et al. 2023

Addiction Biology

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The opioid and cannabinoid receptor systems are inextricably linked—overlapping at the anatomical, functional and behavioural levels. Preclinical studies have reported that cannabinoid and opioid agonists produce synergistic antinociceptive effects. Still, there are no experimental data on the effects of cannabinoid agonists among humans who receive opioid agonist therapies for opioid use disorder (OUD). We conducted an experimental study to investigate the acute effects of the delta‐9‐tetrahydrocannabinol (THC) among persons receiving methadone therapy for OUD. Using a within‐subject, crossover, human laboratory design, 25 persons on methadone therapy for OUD (24% women) were randomly assigned to receive single oral doses of THC (10 or 20 mg, administered as dronabinol) or placebo, during three separate 5‐h test sessions. Measures of experimental and self‐reported pain sensitivity, abuse potential, cognitive performance and physiological effects were collected. Mixed‐effects models examined the main effects of THC dose and interactions between THC (10 and 20 mg) and methadone doses (low‐dose methadone defined as <90 mg/day; high dose defined as >90 mg/day). Results demonstrated that, for self‐reported rather than experimental pain sensitivity measures, 10 mg THC provided greater relief than 20 mg THC, with no substantial evidence of abuse potential, and inconsistent dose‐dependent cognitive adverse effects. There was no indication of any interaction between THC and methadone doses. Collectively, these results provide valuable insights for future studies aiming to evaluate the risk–benefit profile of cannabinoids to relieve pain among individuals receiving opioid agonist therapy for OUD, a timely endeavour amidst the opioid crisis.

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Endogenous opiates and behavior: 2021

Bodnar

2023

Peptides

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Psychiatric comorbidity and order of condition onset among patients seeking treatment for chronic pain and opioid use disorder

Cited by 5 publications

References 34 publications

Mental Health Distress Is Associated With Higher Pain Interference in Patients With Opioid Use Disorder Stabilized on Buprenorphine or Methadone

Mental Health Distress Is Associated With Higher Pain Interference in Patients With Opioid Use Disorder Stabilized on Buprenorphine or Methadone

Delta‐9‐tetrahydrocannabinol modulates pain sensitivity among persons receiving opioid agonist therapy for opioid use disorder: A within‐subject, randomized, placebo‐controlled laboratory study

Endogenous opiates and behavior: 2021

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