title: Pain and aberrant drug-related behaviors in medically ill patients with and without histories of substance abuse.
abstract: OBJECTIVE
  This study evaluated the prevalence and correlates of aberrant drug-taking behaviors in two populations: patients with HIV-related pain and a history of substance abuse (n = 73) and patients with cancer pain and no history of substance abuse (n = 100).
  
  
  METHODS
  All patients completed a Drug-Taking Behaviors Interview, the Brief Symptom Inventory (BSI), Brief Pain Inventory (BPI), Memorial Symptom Assessment Scale (MSAS), and the Marlowe Crowne Social Desirability Scale (MCSDS). The Pain Management Index was calculated to assess the adequacy of opioid prescribing.
  
  
  RESULTS
  The cancer sample comprised 38 men and 62 women, and the AIDS sample comprised 63 men and 10 women. Patients with AIDS-related pain had higher global distress on the MSAS (F1, 170 = 20.05, P < 0.001), greater pain-related interference in their daily functioning on the BPI (F1, 161 = 22.87, P < 0.001), and a lower percentage of relief from their current medications (F1, 156 = 76.14, P < 0.001). AIDS patients also reported more than twice as many examples of aberrant drug-related behaviors per patient (mean = 6.14, SD = 4.60) as the cancer patients (mean = 1.42, SD = 1.91).
  
  
  CONCLUSIONS
  These data suggest that AIDS patients with histories of substance abuse receiving opioid therapy are more symptomatic, have more distress, experience more interference from residual pain, and engage in more problematic drug-related behaviors than patients with no history of drug abuse receiving opioids for cancer pain. Treatment of substance abusers with pain requires skills that complement best practices in opioid prescribing. Better approaches to the long-term treatment of these populations are needed.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Passik
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Kirsh
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Donaghy
authors.forename: Russell K
authors.initials: RK
authors.lastname: Portenoy
mesh_terms: D000328:Adult; D003627:Data Interpretation, Statistical; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000523:psychology; D010146:Pain / Q000150:complications / Q000209:etiology / Q000523:psychology*; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012928:Social Desirability; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology*; D011795:Surveys and Questionnaires