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Substances Abusers at Risk of Chronic Severe Pain

More than one third of methadone maintenance treatment program (MMTP) patients and about one fourth of inpatients of residential treatment programs for alcohol or cocaine dependence may experience chronic severe pain, new research suggests.

According to Andrew Rosenblum, PhD, with the Institute for Treatment and Services Research, National Development and Research Institutes, New York, United States, and colleagues, few studies have directly explored the relationships between chronic pain disorders and diverse types of chemical dependency.

The researchers surveyed representative samples of 390 patients from 2 MMTPs and 531 patients from 13 short-term residential substance abuse inpatient programs, all in New York State.

They found that 37% of MMTP patients experienced chronic severe pain as did 24% of inpatients. In addition, 80% of MMTP patients and 78% of inpatients reported experiencing pain of any type within the previous week.

Among those experiencing chronic pain, 65% of MMTP patients and 48% of inpatients also reported high levels of pain-related interference in physical and psychosocial functioning. Subsequent multivariate analysis suggested that age, chronic illness, lifetime psychiatric illness, psychiatric distress, and time in treatment, all increased the likelihood of chronic severe pain.

Among inpatients, blacks and Hispanics were less likely than whites to experience chronic pain, the researchers found. In contrast, those with drug cravings and chronic illness were more than twice as likely as those without these symptoms to experience chronic pain. Inpatients with chronic severe pain were significantly more likely than MMTP patients with chronic severe pain to have used illicit drugs, as well as alcohol, to treat their pain complaint (p=0.005) but were less likely to have been prescribed pain medications (p=0.01).

"Many chronic illnesses are painful and an association between physical illness and pain was expected," Dr. Rosenblum and colleagues note. "The differences between patient samples, however, illustrate the complexity of these medical factors," they add.

According to the researchers, "it is possible that unrelieved pain could encourage a variety of adverse outcomes, such as illicit drug use, use of non-prescribed pain medication, or the negative medical and psychosocial effects associated with continued drug-seeking behaviour."
JAMA 2003;289:18: 2370-2378. "Prevalence and Characteristics of Chronic Pain Among Chemically Dependent Patients in Methadone Maintenance and Residential Treatment Facilities"

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