Response to methadone maintenance treatment of opiate dependent patients with and without significant pain

Stanford University, Palo Alto, California, United States
Drug and Alcohol Dependence (Impact Factor: 3.42). 06/2006; 82(3):187-93. DOI: 10.1016/j.drugalcdep.2005.09.005
Source: PubMed


Both clinicians and researchers have expressed doubt that opiate dependent patients with significant pain can be effectively treated in methadone maintenance treatment (MMT) programs; however, little research exists on this topic. Patients who report significant pain in the month preceding entry to MMT present with a distinct and more severe pattern of polysubstance use, medical and psychosocial problems than do those without pain. The present study investigated the 1-year treatment outcomes of MMT patients with opiate dependence and pain.
Analyses were based on a national sample of 200 patients presenting in MMT programs for treatment of opiate dependence. Substance use and related problems were measured at treatment entry and 12 months later. Patients reported pain severity over the month preceding treatment entry.
Compared to patients without significant pain, patients who reported significant pain at baseline (n = 103) showed similar substance-related functioning, but poorer psychosocial functioning at 1 year.
Patients with and without significant pain experience comparable reductions in substance use when provided with standard care in MMT programs. However, additional medical and/or mental health treatment is needed for their pain and other problems.

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Available from: Jodie Trafton, Jul 25, 2014
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    • "Some small studies have suggested that buprenorphine/naloxone may be associated with improved pain in opioid dependent patients with chronic pain [5] [16]. However, a study of opioid dependent patients who were treated with methadone did not find overall changes in pain level at one year [13]. Alternative, non-opioid pharmacologic therapies are needed to address pain in opioid dependent populations. "
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    • "Survey items addressed the following domains: demographics, treatment history, opioid use, drug craving, and pain; the survey also asked patients for their 5-digit ZIP code. Pain items were included because of the high prevalence of pain complaints among OTP patients [9, 10]. These measures are described below. "
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    • "This is, to our knowledge, the first report describing pain and its association with SUD outcome among individuals receiving bup-nx for opioid detoxification in a controlled clinical trial. As such, our findings extend previous reports indicating that persistent pain is associated with negative SUD treatment outcomes and confirm the importance of examining co-occurring physical pain in SUD populations (Caldeiro et al., 2008; Ilgen et al., 2006; Larson et al., 2007). "
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