Volatility and change in chronic pain severity predict outcomes of treatment for prescription opioid addiction.
OBJECTIVE
Buprenorphine-naloxone (BUP-NLX) can be used to manage prescription opioid addiction among persons with chronic pain, but post-treatment relapse is common and difficult to predict. This study estimated whether changes in pain over time and pain volatility during BUP-NLX maintenance would predict opioid use during the taper BUP-NLX taper.


METHODS
Secondary analysis of a multi-site clinical trial for prescription opioid addiction, using data obtained during a 12-week BUP-NLX stabilization and 4-week BUP-NLX taper.


METHODS
Community clinics affiliated with a national clinical trials network in 10 US cities.


METHODS
Subjects with chronic pain who entered the BUP-NLX taper phase (n = 125) with enrollment occurring from June 2006 to July 2009 (52% male, 88% Caucasian, 31% married).


METHODS
Outcomes were weekly biologically verified and self-reported opioid use from the 4-week taper phase. Predictors were estimates of baseline severity, rate of change and volatility in pain from weekly self-reports during the 12-week maintenance phase.


RESULTS
Controlling for baseline pain and treatment condition, increased pain [odds ratio (OR) = 2.38, P = 0.02] and greater pain volatility (OR = 2.43, P = 0.04) predicted greater odds of positive opioid urine screen during BUP-NLX taper. Increased pain (IRR = 1.40, P = 0.04) and greater pain volatility [incidence-rate ratio (IRR) = 1.66, P = 0.009] also predicted greater frequency of self-reported opioid use.


CONCLUSIONS
Adults with chronic pain receiving out-patient treatment with buprenorphine-naloxone (BUP-NLX) for prescription opioid addiction have an elevated risk for opioid use when tapering off maintenance treatment. Those with relative persistence in pain over time and greater volatility in pain during treatment are less likely to sustain abstinence during BUP-NLX taper.
Department of Psychiatry, University of California, San Diego, CA, USA.|Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
Matthew J
MJ
Worley
Department of Family Medicine, University of California, Los Angeles, CA, USA.
Keith G
KG
Heinzerling
Department of Family Medicine, University of California, Los Angeles, CA, USA.
Steven
S
Shoptaw
Department of Psychiatry, University of California, Los Angeles, CA, USA.
Walter
W
Ling
D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D059350:Chronic Pain / Q000503:physiopathology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine
Buprenorphine-naloxone; chronic pain; multilevel modeling; prediction; prescription opiates; treatment outcomes