Context Little is known about the prevalence and characteristics of chronic
pain among patients with different types of chemical dependency.
Objectives To estimate the prevalence and to examine the characteristics of chronic
severe pain in chemically dependent populations receiving methadone maintenance
or inpatient residential treatment.
Design, Setting, and Participants Representative samples of 390 patients from 2 methadone maintenance
treatment programs (MMTPs) and 531 patients from 13 short-term residential
substance abuse treatment (inpatient) programs, all in New York State, were
surveyed in late 2000 and early 2001.
Main Outcome Measure Prevalence of chronic severe pain, defined as pain that persisted for
more than 6 months and was of moderate to severe intensity or that significantly
interfered with daily activities.
Results Chronic severe pain was experienced by 37% of MMTP patients (95% confidence
interval [CI], 32%-41%) and 24% of inpatients (95% CI, 20%-28%; P = .03). Pain of any type or duration during the past week was reported
by 80% of MMTP patients and 78% of inpatients. Among those with chronic severe
pain, 65% of MMTP patients and 48% of inpatients reported high levels of pain-related
interference in physical and psychosocial functioning. Among MMTP patients,
correlates of chronic pain in a multivariate model were age (odds ratio [OR],
2.08; 95% CI, 1.17-3.70), chronic illness (OR, 1.88; 95% CI, 1.07-3.29), lifetime
psychiatric illness (OR, 1.77; 95% CI, 1.06-2.97), psychiatric distress (OR,
1.63; 95% CI, 1.22-2.18), and time in treatment (OR, 2.23; 95% CI, 1.06-4.68).
Among inpatients, the correlates of chronic pain were race (blacks vs whites:
OR, 0.52; 95% CI, 0.31-0.90; Hispanics vs whites: OR, 0.48; 95% CI, 0.24-0.95),
drug craving (OR, 2.78; 95% CI, 1.54-5.02), chronic illness (OR, 2.17; 95%
CI, 1.37-3.43), and psychiatric distress (OR, 1.36; 95% CI, 1.03-1.81). Among
those with chronic severe pain, inpatients were significantly more likely
than MMTP patients to have used illicit drugs, as well as alcohol, to treat
their pain complaint (51% vs 34%, P = .005) but were
less likely to have been prescribed pain medications (52% vs 67%, P = .01).
Conclusions Chronic severe pain is prevalent among patients in substance abuse treatment,
especially MMTP patients. Pain is associated with functional impairment and
correlates of pain vary with the population. Self-medication for pain with
psychoactive drugs appears especially problematic among substance users who
enroll in drug-free treatment programs. Substance abuse treatment programs
need to develop comprehensive and structured pain management programs.