title: Pain acceptance and opiate use disorders in addiction treatment patients with comorbid pain.
abstract: OBJECTIVE
  Studies from pain treatment settings indicate that poor acceptance of pain may be an important and modifiable risk factor for higher severity of opioid use. However, the degree to which pain acceptance relates to opioid use severity in the addiction treatment population is unknown. In this study of addiction treatment patients with co-morbid pain, we examined correlates of severity of opiate (heroin and prescription opioid) use, with a particular focus on the role of pain acceptance.
  
  
  METHODS
  Patients in residential addiction treatment with comorbid pain (N=501) were stratified into low, moderate and high severity of opiate use. Demographic and clinical characteristics were compared across opiate severity categories.
  
  
  RESULTS
  72% (N=360) of the participants had symptoms that were consistent with an opiate use disorder. Younger age, Caucasian race, female gender, cocaine use and lower pain acceptance were associated with higher severity of opiate use, whereas pain intensity was not. Controlling for demographic and other risk factors, such as substance use and pain intensity, higher pain acceptance was associated with lower odds of severe prescription opioid (AOR 0.50, 95% CI 0.38-0.68 for a one SD increase in pain acceptance) and heroin use (AOR 0.57, 95% CI 0.44-0.75 for a one SD increase in pain acceptance).
  
  
  CONCLUSIONS
  Problematic opiate use is common in addictions treatment patients with chronic pain. Lower pain acceptance is related to greater opiate use severity, and may be an important modifiable target for interventions to successfully treat both pain and opiate use disorders.
authors.affiliation: University of Michigan, Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States. Electronic address: leweil@med.umich.edu.
authors.forename: Lewei Allison
authors.initials: LA
authors.lastname: Lin
authors.affiliation: University of Michigan, Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States.
authors.forename: Amy S B
authors.initials: AS
authors.lastname: Bohnert
authors.affiliation: University of Michigan, Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Price
authors.affiliation: University of Michigan, Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States.
authors.forename: Mary
authors.initials: M
authors.lastname: Jannausch
authors.affiliation: University of Michigan, Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Bonar
authors.affiliation: University of Michigan, Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ilgen
mesh_terms: D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000523:psychology*; D017288:Pain Threshold / Q000523:psychology*; D012114:Residential Treatment; D012307:Risk Factors; D012737:Sex Factors; D044465:White People / Q000523:psychology
chemical_list: D000701:Analgesics, Opioid
keywords: Acceptance; Heroin; Opiate; Opioid; Pain; Treatment