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Prescription Opioid Addiction Treatment Outcomes in Patients with Chronic Pain

January 4, 2016
Worley, MJ, et al.
Worley MJ, et al. Pain Volatility and Prescription Opioid Addiction Treatment Outcomes in Patients With Chronic Pain. Experimental and Clinical Psychopharmacology 2015;23(6):428-435.
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  • Prescription opioids are currently the second-most commonly abused drug in the nation. Increased rates of prescription opioid addiction in adults with chronic non-cancer pain have contributed significantly to these trends, and the combination of chronic pain and prescription opioid addiction is particularly challenging clinically.
  • Buprenorphine/naloxone is a promising pharmacological intervention for co-occurring chronic pain and prescription opioid addiction, with an improved safety profile and diminished abuse liability compared to full-opioid agonists.

This study used data from the NIDA Clinical Trials Network’s Prescription Opioid Addiction Treatment Study (POATS) to examine pain trajectories and volatility in patients with chronic pain receiving buprenorphine/naloxone (BUP/NLX) treatment for prescription opioid addiction.

Secondary analyses of adults with chronic pain (n=149) who received BUP/NLX and counseling for 12 weeks in outpatient settings were performed. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (week 12) and during at least 2 of the previous 3 weeks.
Results found:

  • Pain severity significantly declined over time during treatment;
  • Patients with greater pain volatility were less likely to have a good treatment outcome (a 1 standard deviation increase in pain volatility was associated with a 44% reduction in the probability of endpoint abstinence).

Conclusions: The significant reduction in subjective pain during treatment provides observational support for the analgesic effects of BUP/NLX in patients with chronic pain and opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling.

Clinicians providing treatment for co-occurring prescription opioid addiction and chronic pain may want to consider monitoring pain volatility to monitor for risk for poor treatment outcomes and adjust treatment regimens accordingly. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain.

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