title: Primary Care Patients with Drug Use Report Chronic Pain and Self-Medicate with Alcohol and Other Drugs.
abstract: BACKGROUND
  Chronic pain is common among patients with drug use disorders. The prevalence of chronic pain and its consequences in primary care patients who use drugs is unknown.
  
  
  OBJECTIVE
  To examine: 1) the prevalence of chronic pain and pain-related dysfunction among primary care patients who screen positive for drug use, and 2) the prevalence of substance use to self-medicate chronic pain in this population.
  
  
  METHODS
  This was a cross-sectional analysis.
  
  
  METHODS
  This study included 589 adult patients who screened positive for any illicit drug use or prescription drug misuse, recruited from an urban, hospital-based primary care practice.
  
  
  METHODS
  Both pain and pain-related dysfunction were assessed by numeric rating scales, and grouped as: (0) none, (1-3) mild, (4-6) moderate, (7-10) severe. Questions were asked about the use of substances to treat pain.
  
  
  RESULTS
  Among 589 participants, chronic pain was reported by 87% (95% CI: 84-90%), with 13% mild, 24% moderate and 50% severe. Pain-related dysfunction was reported by 74% (95% CI: 70-78%), with 15% mild, 23% moderate, and 36% severe. Of the 576 that used illicit drugs (i.e., marijuana, cocaine, and/or heroin), 51% reported using to treat pain (95% CI: 47-55% ). Of the 121 with prescription drug misuse, 81% (95% CI: 74-88%) used to treat pain. Of the 265 participants who reported any heavy drinking in the past 3 months, 38% (95% CI: 32-44%) did so to treat pain compared to 79% (95% CI: 68-90%) of the 57 high-risk alcohol users.
  
  
  CONCLUSIONS
  Chronic pain and pain-related dysfunction were the norm for primary care patients who screened positive for drug use, with nearly one-third reporting both severe pain and severe pain-related dysfunction. Many patients using illicit drugs, misusing prescription drugs and using alcohol reported doing so in order to self-medicate their pain. Pain needs to be addressed when patients are counseled about their substance use.
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd floor, Boston, MA, 02118, USA. Dan.Alford@bmc.org.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Alford
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd floor, Boston, MA, 02118, USA.
authors.forename: Jacqueline S
authors.initials: JS
authors.lastname: German
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd floor, Boston, MA, 02118, USA.|Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd floor, Boston, MA, 02118, USA.|Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Lloyd-Travaglini
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd floor, Boston, MA, 02118, USA.|Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D059350:Chronic Pain / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D015995:Prevalence; D011320:Primary Health Care; D012651:Self Medication / Q000379:methods / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology
chemical_list: D013287:Illicit Drugs
keywords: chronic pain; primary care; substance use
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