title: Chronic pain and depression among primary care patients treated with buprenorphine.
abstract: BACKGROUND
  Pain and depression are each prevalent among opioid dependent patients receiving maintenance buprenorphine, but their interaction has not been studied in primary care patients.
  
  
  OBJECTIVE
  We set out to examine the relationship between chronic pain, depression, and ongoing substance use, among persons maintained on buprenorphine in primary care settings.
  
  
  METHODS
  Between September 2012 and December 2013, we interviewed buprenorphine patients at three practice sites.
  
  
  METHODS
  Opioid dependent persons at two private internal medicine offices and a federally qualified health center participated in the study.
  
  
  METHODS
  Pain was measured in terms of chronicity, with chronic pain being defined as pain lasting at least 6 months; and in terms of severity, as measured by self-reported pain in the past week, measured on a 0-100 scale. We defined mild chronic pain as pain severity between 0 and 39 and lasting at least 6 months, and moderate/severe chronic pain as severity ≥ 40 and lasting at least 6 months. To assess depression, we used the Center for Epidemiologic Studies Depression (CESD) ten-item symptom scale and the two-item Patient Health Questionnaire (PHQ-2).
  
  
  RESULTS
  Among 328 participants, 169 reported no chronic pain, 56 reported mild chronic pain, and 103 reported moderate/severe chronic pain. Participants with moderate/severe chronic pain commonly used non-opioid pain medications (56.3%) and antidepressants (44.7%), yet also used marijuana, alcohol, or cocaine (40.8%) to help relieve pain. Mean CESD scores were 7.1 (±6.8), 8.3 (±6.0), and 13.6 (±7.6) in the no chronic, mild, and moderate/severe pain groups, respectively. Controlling for covariates, higher CESD scores were associated with a higher likelihood of moderate/severe chronic pain relative to both no chronic pain (OR = 1.09, p < 0.001) and mild chronic pain (OR = 1.06, p = 0.04).
  
  
  CONCLUSIONS
  Many buprenorphine patients are receiving over-the-counter or prescribed pain medications, as well as antidepressants, and yet continue to have significant and disabling pain and depressive symptoms. There is a clear need to address the pain-depression nexus in novel ways.
authors: Butler Hospital, Providence, Rhode Island, 345 Blackstone Boulevard, Providence, RI, 02906, USA, Michael_Stein@Brown.edu.
authors: Michael D
authors: MD
authors: Stein
authors: Debra S
authors: DS
authors: Herman
authors: Genie L
authors: GL
authors: Bailey
authors: John
authors: J
authors: Straus
authors: Bradley J
authors: BJ
authors: Anderson
authors: Lisa A
authors: LA
authors: Uebelacker
authors: Risa B
authors: RB
authors: Weisberg
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D059350:Chronic Pain / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D017831:Diagnosis, Dual (Psychiatry) / Q000706:statistics & numerical data; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D010147:Pain Measurement / Q000379:methods; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales
chemical_list: D002047:Buprenorphine