title: Longitudinal association between pain severity and subsequent opioid use in prescription opioid dependent patients with chronic pain.
abstract: Patients with prescription opioid use disorder commonly report relief of chronic pain as the chief reason for first opioid use; indeed, the prevalence of chronic pain is high in this population. Understanding the association between pain severity and subsequent opioid use is crucial for understanding how to manage these conditions simultaneously and has not been examined in this population. The aim of this analysis was to examine the proximal effect of pain severity on opioid use during 12 weeks of buprenorphine-naloxone therapy for patients with chronic pain and prescription opioid use disorder.
  
  
  
  This study is a secondary analysis of a national, randomized, controlled trial of buprenorphine-naloxone plus counseling for prescription opioid dependent patients. The association between past-week pain severity and opioid use in the subsequent week was examined in 148 patients presenting with chronic pain at baseline.
  
  
  
  Results from a multivariable logistic regression model showed that greater pain severity in a given week was significantly associated with increased odds of opioid use in the following week over the 12-week treatment, even after adjusting for covariates associated with opioid use (aOR=1.15, p<0.001).
  
  
  
  Despite previous reports of no association between baseline pain and subsequent opioid use, our findings suggest that patients who experience flare-ups of pain during treatment are prone to relapse to opioid use. Future studies may identify those who are at risk to use opioids by carefully monitoring patterns of their pain intensity over time.
authors.affiliation: Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: mgriffin@mclean.harvard.edu.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Griffin
authors.affiliation: Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA. Electronic address: katherine.a.mcdermott@gmail.com.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: McDermott
authors.affiliation: Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: kmchugh@mclean.harvard.edu.
authors.forename: R Kathryn
authors.initials: RK
authors.lastname: McHugh
authors.affiliation: Laboratory for Psychiatric Biostatistics, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Biostatistics, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. Electronic address: gfitzmaurice@partners.org.
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Fitzmaurice
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: rjamison@partners.org.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Jamison
authors.affiliation: Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: rweiss@mclean.harvard.edu.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000069479:Buprenorphine, Naloxone Drug Combination / Q000008:administration & dosage*; D059350:Chronic Pain / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003376:Counseling / Q000379:methods; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods / Q000639:trends; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D059408:Pain Management / Q000379:methods; D063487:Prescription Drug Misuse / Q000523:psychology / Q000639:trends*; D012008:Recurrence; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000069479:Buprenorphine, Naloxone Drug Combination
keywords: Addiction; Opioid use disorder; Outcome; Pain; Prescription opioids; Treatment