Drug and Alcohol Dependence 2016;163(1):216-221. [doi: 10.1016/j.drugalcdep.2016.04.023]
Margaret L. Griffin, PhD (McLean Hospital, NEC Node), Katherine A. McDermott (McLean Hospital, NEC Node), R. Kathryn McHugh, PhD (McLean Hospital, NEC Node), Garrett M. Fitzmaurice, ScD (McLean Hospital, NEC Node), Robert N. Jamison, PhD (Harvard Medical School, NEC Node), Roger D. Weiss, MD (McLean Hospital, NEC Node).
Patients with prescription opioid use disorder commonly report relief of chronic pain as the chief reason for first opioid use; indeed, the prevalence of chronic pain is high in this population. Understanding the association between pain severity and subsequent opioid use is crucial for understanding how to manage these conditions simultaneously and has not been examined in this population. The aim of this analysis was to examine the proximal effect of pain severity on opioid use during 12 weeks of buprenorphine-naloxone therapy for patients with chronic pain and prescription opioid use disorder.
This study is a secondary analysis of the NIDA Clinical Trials Network's randomized, controlled trial of buprenorphine-naloxone plus counseling for prescription opioid dependent patients (CTN-0030, Prescription Opioid Addiction Treatment Study (POATS)). The association between past-week pain severity and opioid use in the subsequent week was examined in 148 patients presenting with chronic pain at baseline. Results from a multivariable logistic regression model showed that greater pain severity in a given week was significantly associated with increased odds of opioid use in the following week over the 12-week treatment, even after adjusting for covariates associated with opioid use (aOR=1.15, p<.001).
Conclusions: This longitudinal study is the first examination of the association between pain severity and subsequent opioid use in patients with prescription opioid use disorder. Despite previous reports of no association between baseline pain and subsequent opioid use, these findings suggest that patients who experience flare-ups of pain during treatment are prone to relapse to opioid use. Understanding the mechanism by which pain flare-ups may lead to substance use would be clinically meaningful; identification of those who are at risk to use opioids may be facilitated by carefully monitoring patterns of pain intensity over time. (Article (Peer-Reviewed), PDF, English, 2016)
Keywords: Buprenorphine | Buprenorphine/Naloxone | CTN platform/ancillary study | Opioid dependence | Pain management | Prescription-type opiates | Relapse | Drug and Alcohol Dependence (journal)
Document No: 1203, PMID: 27161860, PMCID: PMC4880512 (available 6/1/2017).
Submitted by CTN Dissemination Librarians, 5/10/2016.