Opiate Addiction and Chronic Pain: Results of Treatment At 6-Month Follow-up

Background & Purpose An ongoing issue for opiate addiction treatment programs (OTPs) is how to handle clients who have legitimate chronic pain issues in combination with addiction. Historically chronic pain research studies have excluded individuals with addiction, while most addiction research has not addressed chronic pain issues (Angelino, Clark, & Treisman, 2005; Portenoy, Payne & Passik, 2005). Developing a clear understanding of addiction behaviors, chronic non-cancer pain (CNCP), and how these issues interact is important to clinicians and essential to clients seeking treatment for opiate addiction. This paper examines substance use outcomes among 127 individuals in community-based OTPs and compares outcomes for clients with and without chronic non-cancer pain.

Methods A total of 127 OTP clients completed a face-to-face intake and telephone 6-month follow-up interview. Substance use measures were from the Addiction Severity Index (5th edition). All participants were enrolled in maintenance methadone (93.4%) or Suboxone (6.6%) treatment at one of eleven licensed OTPs in Kentucky and gave informed consent for the phone interview. Past 6 month substance use was compared between individuals with persistent chronic pain (chronic pain at both intake and follow-up) and those without chronic pain. The International Association of Pain's definition of CNCP includes pain lasting 3 months or longer beyond the usual healing time for an injury; this definition was used in the study to obtain client self-reported CNCP. Anova and t-test statistics were used to determine significant differences in past 6 month and past 30 day substance use and on average pain ratings. Crosstabs provided statistical comparison on categorical variables between clients by pain status.

Results One-third (33.9%) of clients in the sample reported chronic non-cancer pain. Pain intensity ratings (0=none to 10=worst) were 4.8 on average; the clinical cut point for pain requiring clinical attention is 4 or higher. Clients were asked to rate pain interference (0=does not interfere to 10=completely interferes) with daily living activities. Significant interference was reported by clients in the areas of mood, work, sleep and general activity. Compared to clients without chronic pain, significantly more clients with pain were unemployed (Pearson Χ²=9.968, df=3, p<.019), had experienced depression in the past 6 months (Pearson Χ²=4.103, df=1, p<.045), or had experienced anxiety in the past 6 months (Pearson Χ²=9.577, df=1, p<.002). There were significant reductions in substance use from intake to follow-up for all clients regardless of pain status. No significant differences were found in substance use at follow-up by pain status.

Conclusions & Implications Despite positive reductions in substance use for all clients, untreated chronic pain appears to be an ongoing issue that interferes with daily activities for clients. Further, anxiety and depression for clients with CNCP could negatively impact long-term recovery. Policies regarding interdisciplinary pain management between case managers, OTPs, and specialty pain clinics should be examined in order to improve treatment protocols for both pain and addiction which impact a large number of clients with opiate addiction. Implications are discussed for revisions to treatment plans, specifically, provision of additional recovery support and non-pharmacologically based pain management.