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

Abstract

Objective-Differences in psychiatric distress and substance use (licit and illicit) were examined in methadone maintenance treatment (MMT) patients with a variety of pain experiences.Method-Parametric and non-parametric statistical tests were performed on data obtained from 150 patients currently enrolled in MMT.Results-In comparison to MMT patients reporting no pain in the previous week, those with chronic severe pain (CSP) (i.e., pain lasting at least 6 months with moderate to severe pain intensity or significant pain interference) exhibited significantly higher (p < 0.01) levels of depression, anxiety, somatization, overall psychiatric distress, and personality disorder criteria, but reported comparable rates of substance use. A third group, i.e., non-CSP MMT patients reporting some pain in the past week, differed significantly (p < 0.05) from the other two pain groups on somatization, anxiety, and global psychiatric distress but reported comparable rates of substance use.Conclusions-Pain-related differences in psychiatric problems exist in MMT patients and may have implications for program planning and outreach efforts.

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

“…38,57 . Banks and Kerns suggest that having a chronic medical condition increases depression risk, and that the specific nature of chronic pain increases this risk further, noting that pain is Binextricably associated with negative affect.^3 8 Pain is aversive and seemingly psychologically inescapable; it follows that a substantial minority of patients with chronic pain experience depression. Conversely, being depressed predicts the development of chronic pain (e.g., the conversion of acute low back pain to chronic low back pain), 58 likely through varied mechanisms, including decreased engagement in physical activity 59 or increased attention to somatic symptoms.…”

“…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.…”

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

“…18 Research findings point to the importance of assessing recent pain (i.e., pain experienced in the past week) as well as chronic pain among opioid dependent patients entering treatment. 2,19,20 Therefore, the aim of this needs assessment study was to examine the pain experiences of opioid dependent individuals seeking BNT. Specifically, we set out to examine, among those seeking BNT: (a) the prevalence of pain types (i.e., recent pain, chronic pain), (b) the characteristics of pain (intensity, frequency, duration, interference, location, and genesis), and (c) substance use to alleviate pain.…”

“…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.…”