High Level of Pain Among Methadone Maintenance Patients

Epidemiology of pain among outpatients in methadone maintenance treatment programs


Lara Dhingra, Carmen Masson, David C. Perlman, Randy M. Seewald, Judith Katz, Courtney McKnight, Peter Homel, Emily Wald, Ashly E. Jordan, Christopher Young, and Russell K. Portenoy

Drug and Alcohol Dependence, 2013-02-01, Volume 128, Issue 1-2, Pages 161-165

Copyright © 2012 Elsevier Ireland LtdAbstract

Background

This analysis explored the prevalence and correlates of pain in patients enrolled in methadone maintenance treatment (MMT).



Methods

Patients in two MMT programs starting a hepatitis care coordination randomized controlled trial completed the Brief Pain Inventory Short-Form and other questionnaires. Associations between clinically significant pain (average daily pain ≥ 5 or mean pain interference ≥ 5 during the past week) and sociodemographic data, medical status, depressive symptoms, and health-related quality of life, and current substance use were evaluated in multivariate analyses.



Results

The 489 patients included 31.8% women; 30.3% Hispanics, 29.4% non-Hispanic Blacks, and 36.0% non-Hispanic Whites; 60.1% had hepatitis C, 10.6% had HIV, and 46.8% had moderate or severe depressive symptomatology. Mean methadone dose was 95.7 mg (SD 48.9) and urine drug screening (UDS) was positive for opiates, cocaine, and amphetamines in 32.9%, 40.1%, and 2.9%, respectively. Overall, 237 (48.5%) reported clinically significant pain. Pain treatments included prescribed opioids (38.8%) and non-opioids (48.9%), and self-management approaches (60.8%), including prayer (33.8%), vitamins (29.5%), and distraction (12.7%). Pain was associated with higher methadone dose, more medical comorbidities, prescribed opioid therapy, and more severe depressive symptomatology; it was not associated with UDS or self-reported substance use.



Conclusions

Clinically significant pain was reported by almost half of the patients in MMT programs and was associated with medical and psychological comorbidity. Pain was often treated with opioids and was not associated with measures of drug use. Studies are needed to further clarify these associations and determine their importance for pain treatment strategies.