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Research Summary

Pain Characterization and Prior Pain Treatment among Patients Initiating Opioid Agonist Therapy for Opioid Dependence

Unalleviated pain is common in patients receiving opioid agonist treatment (OAT) for opioid dependence and is related to poor psychosocial functioning and increased psychological distress. Additionally, few OAT programs have dedicated pain-treatment services. This needs-assessment study explored the prevalence and nature of pain and prior pain treatment among patients enrolling in OAT, focusing specifically on complementary and alternative approaches to pain management. The sample included 293 opioid-dependent participants consecutively enrolled in OAT over a 6-month period at a private community-based addiction treatment center.

  • Eighty-eight percent of participants (n=257) reported having pain within the last week. Of these, 17% reported mild pain, 44% reported moderate pain, and 39% reported severe or unbearable pain.
  • Sixty-seven percent of participants reporting moderate, severe, or unbearable pain described a lifetime history of chronic pain.
  • Participants reporting recent pain of at least moderate intensity used conventional pain-management approaches more often than complementary or alternative approaches. The most common conventional approach was over-the-counter pain medication (>40%), and the most common alternative approach was prayer (>20%).
  • Nearly 30% of all participants reported past-week use of opioid medication. Thirteen percent of participants who did not have a lifetime history of chronic pain and 20% of those who did reported using benzodiazepines in the past 7 days for pain relief.
  • Sixty-seven percent of participants supported integrating pain-treatment services into the OAT program.

Comments:

Despite concerns over generalizability, response bias, and the failure to include physical and psychiatric comorbidity and prior drug-treatment information, these results suggest the need for further investigation into chronic pain comorbidity and pain management among opioid-dependent patients. More conclusive evidence could have an impact on OAT-program resource planning. Jeanette M. Tetrault, MD

Reference:

Barry DT, Beitel M, Cutter CJ, et al. Conventional and nonconventional pain treatment utilization among opioid dependent individuals with pain seeking methadone maintenance treatment: A needs assessment study. J Addict Med. 2010;4(2):81–7.

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