title: Buprenorphine/Naloxone dose and pain intensity among individuals initiating treatment for opioid use disorder.
abstract: BACKGROUND
  Opioid use disorder and pain often co-occur, complicating the treatment of each condition. Owing to its partial agonist properties, buprenorphine/naloxone (BUP/NX) may confer advantages over full agonist opioids for treatment of both conditions. The optimal dose of BUP/NX for comorbid pain is not known. We examined dose and other factors associated with pain intensity among patients initiating BUP/NX for opioid use disorder.
  
  
  METHODS
  We studied 1106 patients initiating BUP/NX treatment for opioid use disorder from 2003 to 2010. Information on pain level, diagnoses, and treatment were extracted from medical records. Eligible patients had at least one self-reported pain intensity numerical rating score (NRS) within 30 days before BUP/NX initiation (baseline) and at least one between 15 and 90 days after BUP/NX initiation (during treatment). The primary outcome was NRS decrease (2 or greater) from baseline to during treatment. We used generalized estimating equations to model odds of the primary outcome with BUP/NX dose as the independent variable of interest in the subset of patients with a baseline NRS ≥ 2.
  
  
  RESULTS
  The sample was 94% male and 73% White. Mean age was 50. Psychiatric and non-opioid substance use comorbidities were common. The following demographic and clinical correlates were associated with a decrease in pain intensity: age 18-29 (compared to 30-39 and 40-49); absence of PTSD diagnosis and absence of a chronic pain diagnosis. BUP/NX dose was not associated with decreased pain intensity in bivariate or multivariable analysis.
  
  
  CONCLUSIONS
  BUP/NX maintenance treatment was generally consistent with improvements in pain intensity; however, factors other than BUP/NX dose contribute to improved pain intensity among those initiating the medication.
authors.affiliation: VA Connecticut Healthcare System, 950 Campbell Avenue, Mail Stop 151B, West Haven, CT 06516, USA; Yale University School of Medicine, E.S. Harkness Building A, 367 Cedar Street, Suite 406A, New Haven, CT 06510, USA. Electronic address: william.becker@yale.edu.
authors.forename: William C
authors.initials: WC
authors.lastname: Becker
authors.affiliation: Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Department of Veterans Affairs, 2215 Fuller Road (11H), Ann Arbor, MI 48105, USA.
authors.forename: Dara
authors.initials: D
authors.lastname: Ganoczy
authors.affiliation: Yale University School of Medicine, E.S. Harkness Building A, 367 Cedar Street, Suite 406A, New Haven, CT 06510, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.affiliation: Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Department of Veterans Affairs, 2215 Fuller Road (11H), Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
authors.forename: Amy S B
authors.initials: AS
authors.lastname: Bohnert
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000494:pharmacology*; D002047:Buprenorphine / Q000008:administration & dosage / Q000494:pharmacology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage / Q000494:pharmacology*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology; D010147:Pain Measurement; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009270:Naloxone; D002047:Buprenorphine
keywords: Buprenorphine/Naloxone; Opioid use disorder; Pain; Treatment