Chronic Pain Elevates Risk for Opioid Use During Buprenorphine Taper

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<li> Prescription opioid addiction in adults with chronic pain has become increasingly common and problematic in many developed nations. </li>
<li> Chronic pain patients are now prescribed opioids for longer durations and at higher doses than in previous decades, putting them at greater risk for physiological tolerance and potential addiction.</li>
<li> Additionally, treatment of this population is complicated by&nbsp;complex medical and psychiatric problems&nbsp;that often intensify upon opioid withdrawal, prompting relapse.</ul> <p>Both clinical recommendations and empirical studies suggest that&nbsp;buprenorphine-naloxone (BUP-NLX) is a viable pharmacotherapy for chronic pain patients&nbsp;with prescription opioid addiction. &nbsp;Compared to full opioid agonists like methadone, it offers improved safety and diminished abuse liability.<br>
Because&nbsp;persistent pain is often associated with relapse&nbsp;following addiction treatment, it could also  trigger a return to opioid use during or following treatment with BUP-NLX.<br>
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This study, a secondary analysis of data from the CTN&rsquo;s <a href="http://ctndisseminationlibrary.org/display/ctn0030.htm">Prescription Opioid Addiction Treatment Study (POATS)</a>, 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.<br>
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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,&nbsp;increased pain and greater pain volatility predicted greater odds of positive opioid urine screen&nbsp;during BUP-NLX taper. Increased pain and greater pain volatility also predicted greater frequency of self-reported opioid use.<br>
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Conclusions: Adults with chronic pain receiving outpatient treatment with buprenorphine-naloxone (BUP-NLX) for prescription opioid addiction have&nbsp;elevated risk for opioid use when tapering off&nbsp;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&nbsp;stabilizing and/or reducing subjective pain prior to discontinuation of BUP-NLX maintenance&nbsp;may be a means to improve treatment outcomes in this population.<br>
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Worley MJ, et al. Volatility and Change in Chronic Pain Severity Predict Outcomes of Treatment for Prescription Opioid Addiction. Addiction 2017 (in press).