Opioid analgesic medication has been increasingly prescribed over
the past decade, despite limited evidence of its effectiveness for
chronic non-cancer pain. Many physicians report apprehension when
prescribing this treatment, due to suspicions that patient medication
requests are motivated by addiction rather than pain.
Researchers at BUSM conducted a study to examine the clinical
characteristics of individuals with lifetime PDUD, among a population
of primary care patients with chronic pain. They compared those
afflicted with PDUD to individuals with other substance use disorders
(SUD) as well as those without any history of SUD. Participants
recruited for the study experienced chronic pain for more than three
months, reported use of prescription or non-prescription pain
Of the nearly 600 participants studied, researchers found that18
percent had lifetime PDUD of which in this subgroup 90 percent had an
additional substance addiction. More than 24 percent had an SUD other
than PDUD, and 57 percent had no lifetime history of any substance
problem. Of note however, only 60 were female, and 60 percent were of
African decent and likely to be unemployed and poor.
The study identified a number of factors associated with PDUD,
including jail time, severely disabling pain, cigarette smoking, family
history of substance abuse, white, male and post-traumatic stress
disorder. Except for race, the same factors also predicted having other
SUD compared to those without any substance problem. Insurance,
employment, income, education and age were not associated with
substance use disorders of any type in this sample.
"This data strongly suggests that physicians treating patients with
pain should assess for SUD prior to prescribing opioid analgesics,"
lead author Jane M. Liebschutz, MD, MPH, FACP, an associate professor
of medicine and social and behavioral sciences at BUSM and a physician
in the section of General Internal Medicine at Boston Medical Center.
"This research may help direct care, including treatment for pain
substance use disorders, as primary care physicians may not be as aware
of the overlap between pain and addictions. In particular, physicians
may not think of assessing for time spent in jail, which was the
largest predictor of having PDUD," said Liebschutz.
This study was funded by the National Institute of Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.