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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Article Info
Publication History
Published online: September 20, 2010
Accepted:
July 26,
2010
Received in revised form:
June 22,
2010
Received:
February 11,
2010
Footnotes
Supported in part by the Department of Veterans Affairs, Veterans Health Administration , and Health Services Research and Development Service Projects PMI 03-195 and RCD04129 , awarded to Dr Dobscha. Dr Morasco also received support from award K23DA023467 from the National Institute on Drug Abuse . During the past 12 months, Dr Turk has received research support from Endo, Johnson & Johnson, Philips Respironics , and the National Institutes of Health , and consulting fees from Eli Lilly, Empi, Johnson & Johnson, Pfizer, Philips Respironics, and SK LifeScience. He is also a Special Government Employee of the U.S. Food and Drug Administration. The authors also appreciate support provided from the Oregon Clinical and Translational Research Institute at OHSU , grant number Ul1RR024140 from the National Center for Research Resources , a component of the National Institutes of Health and NIH Roadmap for Medical Research .
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Published by Elsevier Inc.
