title: Treatment needs associated with pain in substance use disorder patients: implications for concurrent treatment.
abstract: Although pain problems are prevalent in substance use disorder (SUD) patients, the special treatment needs of SUD patients with pain have not been investigated. This study examines the problems and behaviors associated with reported pain among veterans treated at eight opioid substitution treatment clinics. Patients reporting pain had more severe medical and psychiatric problems and greater health care utilization. Pain was associated with an increased propensity for misuse of substances with analgesic effects, suggesting that ongoing pain contributes to an altered and more severe pattern of drug-seeking behavior. Patients without pain rarely abused sedatives or opioid medication, indicating that misuse of these substances is unique to co-morbid pain and SUD patients. Patients reporting pain did not differ from patients without pain in use of heroin, alcohol, cocaine or in injection practices, demonstrating that they are truly SUD patients in need of SUD treatment. Pain complicates the treatment of SUD and should be addressed as an important co-morbidity during treatment.
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, CA 94025, USA. jodie.trafton@med.va.gov
authors.forename: Jodie A
authors.initials: JA
authors.lastname: Trafton
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Oliva
authors.forename: Doyanne A
authors.initials: DA
authors.lastname: Horst
authors.forename: Jared D
authors.initials: JD
authors.lastname: Minkel
authors.forename: Keith
authors.initials: K
authors.lastname: Humphreys
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid; D000704:Analysis of Variance; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D006993:Hypnotics and Sedatives; D013287:Illicit Drugs; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D008692:Methadyl Acetate / Q000008:administration & dosage; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D010147:Pain Measurement / Q000706:statistics & numerical data; D013223:Statistics as Topic; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D014481:United States; D014600:Utilization Review; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D013287:Illicit Drugs; D009294:Narcotics; D008692:Methadyl Acetate; D008691:Methadone