Both clinical recommendations and empirical studies suggest that buprenorphine-naloxone (BUP-NLX) is a viable pharmacotherapy for chronic pain patients with prescription opioid addiction. Compared to full opioid agonists like methadone, it offers improved safety and diminished abuse liability.
Because persistent pain is often associated with relapse following addiction treatment, it could also trigger a return to opioid use during or following treatment with BUP-NLX.
This study, a secondary analysis of data from the CTN’s Prescription Opioid Addiction Treatment Study (POATS), estimated whether changes in pain over time and pain volatility (unpredictable fluctuations in pain severity) during BUP-NLX maintenance would predict opioid use during the BUP-NLX taper.
Study participants, from community clinics affiliated with POATS in 10 U.S. cities, were subjects with chronic pain who entered the BUP-NLX taper phase (N=125), with enrollment occurring from June 2006 to July 2009 (52% male, 88% Caucasian, 31% married). Controlling for baseline pain and treatment condition, increased pain and greater pain volatility predicted greater odds of positive opioid urine screen during BUP-NLX taper. Increased pain and greater pain volatility also predicted greater frequency of self-reported opioid use.
Conclusions: Adults with chronic pain receiving outpatient treatment with buprenorphine-naloxone (BUP-NLX) for prescription opioid addiction have elevated risk for opioid use when tapering off maintenance treatment. Those with relative persistence in pain over time and greater volatility in pain during treatment are less likely to sustain abstinence during BUP-NLX taper. These findings suggest that stabilizing and/or reducing subjective pain prior to discontinuation of BUP-NLX maintenance may be a means to improve treatment outcomes in this population.
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Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Worley MJ, et al. Volatility and Change in Chronic Pain Severity Predict Outcomes of Treatment for Prescription Opioid Addiction. Addiction 2017 (in press).