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Chronic Pain Prevalent Among Patients with Opioid Use Disorder

January 4, 2017
Hser Y, et al.
Hser Y, et al. Chronic Pain Among Patients with Opioid Use Disorder: Results from Electronic Health Records Data. Journal of Substance Abuse Treatment 2017 (in press).
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  • Opioid use disorder (OUD) is associated with excess mortality, morbidities, and other adverse health and social conditions. OUD is common among individuals with chronic pain conditions, and chronic pain is common among individuals with OUD.
  • The relationship between chronic pain and OUD and the time course of the two is complex and other physical and mental health problems often co-occur with them both as well.
  • The goal of this study was to examine chronic pain among patients with OUD, as well as to examine other substance use disorders, health, mental health, and treatment for health and mental health among patients in medical settings using electronic health records (EHRs).
    Using an EHR database from 2006-2015, the study assessed 5307 adult patients with OUD in a large healthcare system (University of California, Los Angeles of the former CTN Pacific Region Node), separating them into four categories:
  • No chronic pain (No Pain):  35.6%,
  • OUD prior to pain (OUD First): 9.7%,
  • OUD and pain at the same time (Same Time): 14.9%, and
  • Pain condition prior to OUD (Pain First): 39.8%

Results found:

  • Most patients in treatment for OUD had chronic pain conditions (64.4%), and of those patients, 61.8% had chronic pain before their first OUD diagnosis;
  • OUD First patients had higher rates of other SUDs, including:
    • alcohol (33.4% vs. 25.4% for No Pain, 20.7% for Same Time, and 20.3% for Pain First),
    • cocaine (19% vs. 13.8%, 9.4%, 7.1%), and
    • alcohol or drug-induced disorders;
  • OUD First patients also had the highest rates of HIV and HCV (4.7% and 28.2%);
  • Pain First patients had the highest rates of mental disorder, heart disease, respiratory disease, sleep disorder, cancer, and diabetes.

Conclusions: This study adds to a rapidly growing knowledge base concerning the intersection of chronic pain and opioid use disorder. The alarmingly high rates of chronic pain conditions occurring before OUD and the associated severe mental health and physical health conditions require better models of assessment and coordinated care plans to address these complex medical conditions.

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