They assessed both chronic pain and pain-related dysfunction using questions derived from the validated Graded Chronic Pain Scale 17, 18 (“ in the past 3 months, on average, how intense was your pain rated on a 0 to 10 scale where 0 is no pain and 10 is pain as bad as could be” and “ in the past 3 months, how much has pain interfered with your daily activities rated on a 0 to 10 scale, where 0 is no interference and 10 is unable to carry on any activities”). Trained research associates conducted in-person structured interviews with all participants. In addition, we examine the prevalence of alcohol and illicit drug use and prescription drug misuse for the purpose of self-medicating chronic pain in this population. The purpose of this study is to describe the prevalence of chronic pain and pain-related dysfunction among primary care patients who screen positive for drug use.
This issue has particular importance in light of the recently published studies that demonstrated lack of efficacy of brief intervention for unhealthy drug use in primary care. If patients are self-medicating pain, then counseling interventions aimed at decreasing substance use, focused solely on the negative consequences of drug use, while not addressing pain symptoms, may be less effective. 11 – 13 The multi-site Prescription Opioid Addiction Treatment Study 14 found that 83 % of patients with chronic pain and prescription opioid dependence initially used opioids to treat chronic pain.
While there are numerous reasons why individuals use substances, one theory is that individuals use psychoactive substances to “self-medicate” disturbing symptoms (e.g., posttraumatic stress). Because alcohol, 10 many illicit drugs (e.g., heroin, marijuana) and prescription opioids have analgesic properties, it is possible that patients are using these drugs to self-medicate pain.
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The prevalence and severity of chronic pain and pain-related dysfunction in patients who screen positive for the full spectrum (at-risk use to substance use disorders) of drug use (Illicit, prescription misuse) in primary care is unknown.
However, other studies over the past decade have shown a wide range (3-26 %) of reported drug use in primary care. In one recent study, 7 10 % of patients in an urban primary care setting screened positive for drug use (illicit and prescription misuse). population has used an illicit drug, including nonmedical use of prescription drugs in the past month. 2 Cross-sectional surveys 3 – 5 among patients treated with medication assisted treatment (methadone, buprenorphine) report a prevalence of chronic pain ranging from 36 % to 61 %.Īccording to the 2013 National Survey on Drug Use and Health, 6 an estimated 9.4 % of the U.S. One survey reported that 52 % of treatment-seeking, opioid dependent veterans complained of moderate to severe chronic pain. 1 Chronic pain is particularly common among those with drug use disorders. It is estimated that chronic pain currently affects approximately 100 million people in the US, and is one of the most common reasons patients seek medical care.
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