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Association Between Substance Use Disorder Status and Pain-Related Function Following 12 Months of Treatment in Primary Care Patients With Musculoskeletal Pain

  • Benjamin J. Morasco
    Correspondence
    Address reprint requests to Benjamin J. Morasco, PhD, Portland VA Medical Center (R&D99), 3710 SW US Veterans Hospital Road, Portland, OR 97239.
    Affiliations
    Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, Oregon

    Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
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  • Kathryn Corson
    Affiliations
    Department of Psychiatry, Oregon Health & Science University, Portland, Oregon

    Portland Center for the Study of Chronic, Comorbid Medical and Psychiatric Disorders, Portland VA Medical Center, Portland, Oregon
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  • Dennis C. Turk
    Affiliations
    Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington
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  • Steven K. Dobscha
    Affiliations
    Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, Oregon

    Department of Psychiatry, Oregon Health & Science University, Portland, Oregon

    Portland Center for the Study of Chronic, Comorbid Medical and Psychiatric Disorders, Portland VA Medical Center, Portland, Oregon
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Published:September 20, 2010DOI:https://doi.org/10.1016/j.jpain.2010.07.010

      Abstract

      The goal of this study was to examine relationships between substance use disorder (SUD) history and 12-month outcomes among primary care patients with chronic noncancer pain (CNCP). Patients were enrolled in a randomized trial of collaborative care intervention (CCI) versus treatment as usual (TAU) to improve pain-related physical and emotional function. At baseline, 72 of 362 patients (20.0%) had a history of SUD. Compared to CNCP patients without SUD, those with comorbid SUD had poorer pain-related function and were more likely to meet criteria for current major depression and posttraumatic stress disorder (all P values <.05). Logistic regression analyses were conducted to examine whether SUD status was associated with clinically significant change over 12 months in pain-related function (30% reduction in Roland Morris Disability Questionnaire Score). The overall model was not significant in the CCI group. However, within the TAU group, participants with a SUD history were significantly less likely to show improvements in pain-related function (OR = .30, 95% CI = .11–.82). CNCP patients with comorbid SUD reported greater functional impairment at baseline. Patients with SUD who received usual care were 70% less likely to have clinically significant improvements in pain-related function 12 months postbaseline, and SUD status did not impede improvement for the CCI group.

      Perspective

      Chronic noncancer pain patients with a history of a substance use disorder (SUD) report poorer pain-related functioning and are less likely to experience clinically significant improvements from usual pain treatment. Providers should assess for SUD status and provide more intensive interventions for these patients.

      Key words

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