 |
|
Prevalence and Characteristics of Chronic Pain Among Chemically Dependent Patients in Methadone Maintenance and Residential Treatment Facilities
Andrew Rosenblum, PhD;
Herman Joseph, PhD;
Chunki Fong, MS;
Steven Kipnis, MD;
Charles Cleland, PhD;
Russell K. Portenoy, MD
JAMA. 2003;289:2370-2378.
Context Little is known about the prevalence and characteristics of chronic pain among patients with different types of chemical dependency.
Objectives To estimate the prevalence and to examine the characteristics of chronic severe pain in chemically dependent populations receiving methadone maintenance or inpatient residential treatment.
Design, Setting, and Participants Representative samples of 390 patients from 2 methadone maintenance treatment programs (MMTPs) and 531 patients from 13 short-term residential substance abuse treatment (inpatient) programs, all in New York State, were surveyed in late 2000 and early 2001.
Main Outcome Measure Prevalence of chronic severe pain, defined as pain that persisted for more than 6 months and was of moderate to severe intensity or that significantly interfered with daily activities.
Results Chronic severe pain was experienced by 37% of MMTP patients (95% confidence interval [CI], 32%-41%) and 24% of inpatients (95% CI, 20%-28%; P = .03). Pain of any type or duration during the past week was reported by 80% of MMTP patients and 78% of inpatients. Among those with chronic severe pain, 65% of MMTP patients and 48% of inpatients reported high levels of pain-related interference in physical and psychosocial functioning. Among MMTP patients, correlates of chronic pain in a multivariate model were age (odds ratio [OR], 2.08; 95% CI, 1.17-3.70), chronic illness (OR, 1.88; 95% CI, 1.07-3.29), lifetime psychiatric illness (OR, 1.77; 95% CI, 1.06-2.97), psychiatric distress (OR, 1.63; 95% CI, 1.22-2.18), and time in treatment (OR, 2.23; 95% CI, 1.06-4.68). Among inpatients, the correlates of chronic pain were race (blacks vs whites: OR, 0.52; 95% CI, 0.31-0.90; Hispanics vs whites: OR, 0.48; 95% CI, 0.24-0.95), drug craving (OR, 2.78; 95% CI, 1.54-5.02), chronic illness (OR, 2.17; 95% CI, 1.37-3.43), and psychiatric distress (OR, 1.36; 95% CI, 1.03-1.81). Among those with chronic severe pain, inpatients were significantly more likely than MMTP patients to have used illicit drugs, as well as alcohol, to treat their pain complaint (51% vs 34%, P = .005) but were less likely to have been prescribed pain medications (52% vs 67%, P = .01).
Conclusions Chronic severe pain is prevalent among patients in substance abuse treatment, especially MMTP patients. Pain is associated with functional impairment and correlates of pain vary with the population. Self-medication for pain with psychoactive drugs appears especially problematic among substance users who enroll in drug-free treatment programs. Substance abuse treatment programs need to develop comprehensive and structured pain management programs.
Author Affiliations: Institute for Treatment and Services Research, National Development and Research Institutes, New York, NY (Drs Rosenblum and Cleland and Mr Fong); New York State Office of Alcoholism and Substance Abuse Services, New York (Dr Joseph), and Albany (Dr Kipnis); and Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY (Dr Portenoy).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED LETTER
Methadone Maintenance Therapy and Chronic Pain
Jon Streltzer and Thomas R. Kosten
JAMA. 2003;290(18):2403.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Correlates of Hospitalization for Alcohol-Using Methadone-Maintained Persons With Physical Health Problems
Nyamathi et al.
West J Nurs Res 2009;31:525-543.
ABSTRACT
Employment Outcomes of Persons With a Mental Disorder and Comorbid Chronic Pain
Braden et al.
Psychiatr. Serv. 2008;59:878-885.
ABSTRACT
| FULL TEXT
High-Efficacy 5-Hydroxytryptamine 1A Receptor Activation Counteracts Opioid Hyperallodynia and Affective Conditioning
Colpaert et al.
J. Pharmacol. Exp. Ther. 2006;316:892-899.
ABSTRACT
| FULL TEXT
Ethnic Differences in Pain Reports and the Moderating Role of Depression in a Community Sample of Hispanic and Caucasian Participants With Serious Health Problems
Hernandez and Sachs-Ericsson
Psychosom. Med. 2006;68:121-128.
ABSTRACT
| FULL TEXT
A 35-Year-Old Physician With Opioid Dependence
Knight
JAMA 2004;292:1351-1357.
FULL TEXT
Chronic non-cancer pain and opioid dependence
Littlejohn et al.
JRSM 2004;97:62-65.
FULL TEXT
Methadone Maintenance Therapy and Chronic Pain
Streltzer and Kosten
JAMA 2003;290:2403-2403.
FULL TEXT
Chronic Pain Management with Opioids in Patients with Past or Current Substance Abuse Problems
Fudin et al.
Journal of Pharmacy Practice 2003;16:291-308.
ABSTRACT
|
