Patients with Opioid Use Disorder Diagnosed Before and After Chronic Pain Diagnoses Have Differing Patterns of Other Diagnoses

Research in substance use disorder (SUD) treatment settings has identified high rates of chronic pain among patients with opioid use disorder (OUD), but less information is available about the prevalence of chronic pain and other clinical characteristics of those identified with OUD in general medical settings. This study compared electronic health record (EHR) SUD, mental health, and other health condition diagnoses among 4 groups of patients with OUD in a general healthcare system: those with OUD and no chronic pain; those with OUD diagnosis prior to a pain diagnosis; those with OUD and pain diagnoses at the same time point; and those with a chronic pain diagnosis prior to OUD.

  • Of 4.6 million patients seen between 2006 and 2015, 5307 had a diagnosis of OUD (0.1%).
  • Two-thirds (64%) of patients with OUD had a chronic pain diagnosis; of these, 62% had a chronic pain diagnosis prior to OUD diagnosis.
  • Patients with OUD diagnosed prior to chronic pain had higher rates of other SUD diagnoses, as well as higher rates of HIV and hepatitis C.
  • Patients with pain diagnoses prior to OUD had the highest rates of mental health disorders as well as multiple chronic medical problems.

Comments: Although it was limited by the unknown accuracy of EHR diagnoses, this study was able to identify patterns of mental health, SUD, and chronic medical diagnoses in different groups of patients with OUD and chronic pain. The high rates of chronic pain diagnoses among patients with OUD likely reflects the general medical setting, with low overall rates of OUD diagnoses and likely low rates of OUD treatment availability. The interplay of chronic pain and OUD in this setting indicates the complexity facing general medical care providers.

Joseph Merrill, MD, MPH

Reference: Hser YI, Mooney LJ, Saxon AJ, et al. Chronic pain among patients with opioid use disorder: Results from electronic health records data. J Subst Abuse Treat. 2017;77:26–30.

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