Recent Pain Severity Associated with Subsequent Opioid Use in Patients with Prescription Opioid Use Disorder and Chronic Pain

Chronic pain affects a substantial proportion of patients entering treatment for prescription opioid use disorder. Pain severity has not been consistently associated with non-medical use of prescription opioids (NMUPO) during treatment, but measurement issues and pain variability may have clouded an association. This secondary analysis investigated the association between past-week pain severity and subsequent-week NMUPO in 148 patients with both chronic pain and DSM-IV prescription opioid dependence who participated in a 12-week trial of buprenorphine/naloxone and counseling. NMUPO was measured by weekly self-report and urine drug testing, while pain severity was measured weekly with the 2-item Brief Pain Inventory (Short Form).

• Over the course of the study, 66% of weekly urine drug test samples were negative for opioids, while 68% of patients demonstrated significant pain severity variability, defined as crossing over between mild, moderate, and severe pain categories.
• Multivariable logistic regression adjusted for baseline characteristics and past-week opioid use demonstrated that increased pain severity in a given week was associated with an increased risk of NMUPO in the subsequent week (adjusted odds ratio, 1.15).

Comments:

These data support the association of recent pain severity with subsequent return to NMUPO among patients with co-occurring chronic pain and prescription opioid use disorder. Interventions to reduce return to NMUPO in this population would benefit from better understanding the causes of the variability in pain severity. These findings raise questions of whether assessment of pain severity—versus assessment of function—is most salient in the management of chronic pain.

Joseph Merrill, MD, MPH

Reference:

Griffin ML, McDermott KA, McHugh RK, et al. Longitudinal association between pain severity and subsequent opioid use in prescription opioid dependent patients with chronic pain. Drug Alcohol Depend. 2016;163:216–221.