Patients with Chronic Pain and a Substance Use Disorder May Have Better Pain Outcomes with More Intensive Treatments
Many patients with chronic pain have a current or past substance use disorder (SUD). This study included patients recruited from Veterans Administration primary-care clinics for a clinical trial comparing treatment as usual (TAU) with a collaborative care initiative (CCI) for management of chronic pain. The initiative included collaboration between a psychologist case manager and an internist to develop treatment recommendations. The primary outcome was pain disability as self-reported on the Roland-Morris Disability Questionnaire. A 30% improvement was considered clinically significant. Among those patients who completed baseline and 12-month follow-up evaluations (n=362), 20% had a history of SUD.
- Patients assigned to CCI were more likely to have improvement in pain-related disability than those assigned to TAU (22% versus 14%, respectively).
- Patients with an SUD were younger, less likely to be married or cohabitating, reported greater pain-related disability, and were more likely to be prescribed an opioid. They were also more likely to have current major depression or post-traumatic stress disorder.
- In the TAU group, patients with an SUD were less likely to have improvement in pain-related function (adjusted odds ratio [AOR], 0.30; 95% CI, 0.11–0.82).
- In contrast, no difference in improvement was detected between those with and without an SUD in the CCI group (although the confidence interval was wide) (AOR, 1.06; 95% CI, 0.37–3.01).