Gender Differences in Chronic Pain Among Opiate Treatment Clients

Background and purpose: Though research on chronic pain has expanded over the past decade, little is known about a unique subset of individuals with both chronic pain and a history of opiate addiction. Given the complexity of the biological and psychological aspects of both pain and addiction, treatment becomes uniquely difficult for individuals with both addiction problems and chronic pain. Developing a clear understanding of addiction behaviors is important when working with clients who have chronic pain, particularly in settings like pain clinics which do not typically treat addiction. This study examines psychological and behavioral differences between individuals in medication assisted opiate addiction treatment programs (MAT) that also have chronic pain and focuses on mental health and addiction relapse behaviors in relation to gender.

Methods: Intake data from 784 adult clients in licensed MAT programs were examined including drug screens and medication dose. Differences between clients with and without chronic pain were examined. Logistic regression determined odds of chronic pain based on gender, age, body mass index (BMI), anxiety, depression, positive drug screens and dose levels.

Results: One-fourth of the MAT clients reported experiencing chronic physical pain lasting 3 months or longer ((mean current pain rating of 4.5 (sd=2.17) on a standard 10 point scale (10=worst possible pain)). Ratings of 4 or higher identify clinically significant pain levels. Males with pain were significantly older (F = 30.7, p<.001) and had higher mean BMI (F=10.5, p<.001). Serious anxiety was reported by more men with chronic pain (X²=6.8, df=1, p<.01) and a higher percentage of females with chronic pain reported depression (X²=4.6, df=1, p<.05). More females with chronic pain were in the ‘high dose' group (X²=21.3, df=2, p<.001). No differences were found for ratio of positive drug screens by chronic pain or gender. For each year increase in age, males' odds of reporting chronic pain increased by 1.07 times (p<.001). For males, a one point increase in BMI, increased the odds of reporting chronic pain 1.05 times (p<.05). Females with a low or medium dose of medication were less likely to be in the chronic pain group compared to those with a high dose. Conclusions and implications: The sample matches expected chronic pain prevalence and reveals new information about gender differences in this MAT client sample. Co-morbid mental health issues relating to both pain and recovery are important to address with clients, particularly anxiety for men and depression for women. Dose also appears to be a consideration for women as higher dose may be a flag that counseling and pain control assistance should be considered. Suggestions and implications are discussed in regards to treatment plan, MAT recovery support, and gender-specific opiate addiction treatment programs.