Self-Reported Chronic Pain as a Predictor of Relapse Post Residential Addiction Treatment: a 6-Month Follow-up Pilot Study

Abstract

With the rise of prescription opioids and the subsequent increase in opioid use disorders, the relationship between chronic pain, opioid use disorders, and drug replacement therapy has received great attention. However, few studies have examined the relationship between chronic pain and relapse from a variety of substance use disorders following residential addiction treatment. This pilot study seeks to examine the role of self-reported chronic pain as a predictor of relapse from a variety of substance use disorders for individuals who attended residential addiction treatment. In 198 adult patients, a Spearman’s rank correlation coefficient determined that there was not a significant relationship between self-reported chronic pain and relapse at 6 months following treatment: r (198) = −.056, p = .433. However, among those self-reporting chronic pain, women reported slightly more slips and complete relapses than men. The findings of this study can inform professionals working within a residential addiction treatment setting.

This is a preview of subscription content, log in to check access.

Change history

  • 07 April 2017

    An erratum to this article has been published.

References

  1. Alford, D. P., German, J. S., Samet, J. H., Cheng, D. M., Lloyd-Travaglini, C. A., & Saitz, R. (2016). Primary care patients with drug use report chronic pain and self-medicate with alcohol and other drugs. Journal of General Internal Medicine, 31(5), 486–491. doi:10.1007/s11606-016-3586-5.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Apkarian, A. V., Baliki, M. N., & Geha, P. H. (2009). Towards a theory of chronic pain. Progress in Neurobiology, 87(2), 81–97. doi:10.1016/j.pneurobio.2008.09.018.

    Article  PubMed  Google Scholar 

  3. Barry, D. T., Beitel, M., Joshi, D., & Schottenfeld, R. S. (2009). Pain and substance-related pain reduction behaviors among opioid dependent individuals seeking methadone maintenance treatment: An exploratory study. The American Journal on Addictions/American Academy of Psychiatrists in Alcoholism and Addictions, 18(2), 117–121. doi:10.1080/10550490902772470.

    PubMed Central  Google Scholar 

  4. Booker, E. A., Haig, A. J., Geisser, M. E., & Yamakawa, K. (2003). Alcohol use self report in chronic back pain—relationships to psychosocial factors, function performance, and medication use. Disability and Rehabilitation, 25(22), 1271–1277.

    Article  PubMed  Google Scholar 

  5. Brown, R. L., Patterson, J. J., Rounds, L. A., & Papasouliotis, O. (1996). Substance abuse among patients with chronic back pain. Journal of Family Practice, 43(2), 152.

    CAS  PubMed  Google Scholar 

  6. Caldeiro, R. M., Malte, C. A., Calsyn, D. A., Baer, J. S., Nichol, P., Kivlahan, D. R., & Saxon, A. J. (2008). The association of persistent pain with out-patient addiction treatment outcomes and service utilization. Addiction, 103(12), 1996–2005. doi:10.1111/j.1360-0443.2008.02358.x.

    Article  PubMed  Google Scholar 

  7. Decker, K. P., Peglow, S. L., & Samples, C. R. (2014). Participation in a novel treatment component during residential substance use treatment is associated with improved outcome: a pilot study. Addiction Science & Clinical Practice, 9(1), 7.

    Article  Google Scholar 

  8. Dennis, B. B., Samaan, M. C., Bawor, M., Paul, J., Plater, C., Pare, G., et al. (2014). Evaluation of clinical and inflammatory profile in opioid addiction patients with comorbid pain: results from a multicenter investigation. Neuropsychiatric Disease and Treatment, 10, 2239–2247. doi:10.2147/ndt.s72785.

    PubMed  PubMed Central  Google Scholar 

  9. Dennis, B. B., Bawor, M., Naji, L., Chan, C. K., Varenbut, J., Paul, J., et al. (2015). Impact of chronic pain on treatment prognosis for patients with opioid use disorder: a systematic review and meta-analysis. Substance Abuse: Research and Treatment, 9, 59. doi:10.4137/sart.s30120.

    Google Scholar 

  10. Dennis, B. B., Bawor, M., Paul, J., Plater, C., Pare, G., Worster, A., et al. (2016). Pain and opioid addiction: a systematic review and evaluation of pain measurement in patients with opioid dependence on methadone maintenance treatment. Current Drug Abuse Reviews, 9(1), 49–60. doi:10.2174/187447370901160321102837.

    CAS  Article  PubMed  Google Scholar 

  11. Dersh, J., Polatin, P. B., & Gatchel, R. J. (2002). Chronic pain and psychopathology: research findings and theoretical considerations. Psychosomatic Medicine, 64(5), 773–786. doi:10.1097/01.PSY.0000024232.11538.54.

    PubMed  Google Scholar 

  12. Dunn, K. E., Brooner, R. K., & Clark, M. R. (2014). Severity and interference of chronic pain in methadone-maintained outpatients. Pain Medicine, 15(9), 1540–1548. doi:10.1111/pme.12430.

    Article  PubMed  Google Scholar 

  13. Fox, A. D., Sohler, N. L., Starrels, J. L., Ning, Y., Giovanniello, A., & Cunningham, C. O. (2012). Pain is not associated with worse office-based buprenorphine treatment outcomes. Substance Abuse, 33(4), 361–365. doi:10.1080/08897077.2011.638734.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Herrera Duran, L., Falgas, I., Cook, B., Noyola, N., Toro, M., & Alegria, M. (2016). Chronic non-malignant pain (CNMP) and substance use disorders. European Psychiatry, 33(Supplement), S206–S206. doi:10.1016/j.eurpsy.2016.01.494.

    Article  Google Scholar 

  15. Ilgen, M. A., Trafton, J. A., & Humphreys, K. (2006). Response to methadone maintenance treatment of opiate dependent patients with and without significant pain. Drug and Alcohol Dependence, 82(3), 187–193. doi:10.1016/j.drugalcdep.2005.09.005.

    CAS  Article  PubMed  Google Scholar 

  16. Kinney, R. K., Gatchel, R. J., Polatin, P. B., Fogarty, W. T., & Mayer, T. G. (1993). Prevalence of psychopathology in acute and chronic low back pain patients. Journal of Occupational Rehabilitation, 3(2), 95–103.

    CAS  Article  PubMed  Google Scholar 

  17. Lawton, J., & Simpson, J. (2009). Predictors of alcohol use among people experiencing chronic pain. Psychology, Health & Medicine, 14(4), 487–501.

  18. Matta, M. S., Porter, J. R., Chintakrind, S., & Cosby, A. G. (2016). Addictive behaviors and chronic pain in a high-risk population. Journal of Drug Issues, 46(2), 135–147. doi:10.1177/0022042615623984.

    Article  Google Scholar 

  19. McCance, K. L., & Huether, S. E. (2006). Pathophysiology: the biological basis for disease in adults and children (5th ed.). St. Louis, MO: Mosby.

    Google Scholar 

  20. Meana, M., Cho, R., & DesMeules, M. (2004). Chronic pain: the extra burden on Canadian women. BMC women's health, 4(1), S17.

  21. National Institute on Drug Abuse (1994). Clinical report series. relapse prevention. Retrieved from http://lib.adai.washington.edu/pubs/Relapse%20Prevention_NIDA%20Clinical%20Report%20Series.pdf

  22. National Institute on Drug Abuse (2016). Substance use in women. Retrieved from https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use-disorder-treatment

  23. Nunes, V., Neilson, J., O’Flynn, N., Calvert, N., Kuntze, S., Smithson, H., et al. (2009). Clinical guideline and evidence review for medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners.

    Google Scholar 

  24. Pearson, C., Janz, T., & Ali, J. (2013). Mental and substance use disorders in Canada. Retrieved from http://www.statcan.gc.ca/pub/82-624-x/2013001/article/11855-eng.pdf

  25. Reitsma, M. L., Tranmer, J. E., Buchanan, D. M., & VanDenKerkhof, E. G. (2012). The epidemiology of chronic pain in Canadian men and women between 1994 and 2007: results from the longitudinal component of the national population health survey. Pain Research and Management, 17(3), 166–172.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rosenblum, A., Marsch, L. A., Joseph, H., & Portenay, R. K. (2008). Opioids and the treatment of chronic pain: controversies, current status, and future directions. Experimental and Clinical Psychopharmacology, 16(5), 405–416. doi:10.1037/a0013628.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Salsitz, E. A. (2016). Chronic pain, chronic opioid addiction: A complex nexus. Journal of Medical Toxicology, 12(1), 54–57. doi:10.1007/s13181-015-0521-9.

    CAS  Article  PubMed  Google Scholar 

  28. Schopflocher, D., Taenzer, P., & Jovey, R. (2011). The prevalence of chronic pain in Canada. Pain Research and Management, 16(6), 445–450. doi:10.1155/2011/876306.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Smith, B. H., Elliott, A. M., Chambers, W. A., Smith, W. C., Hannaford, P. C., & Penny, K. (2001). The impact of chronic pain in the community. Family Practice, 18(3), 292–299. doi:10.1093/fampra/18.3.292.

    CAS  Article  PubMed  Google Scholar 

  30. Stack, K., Cortina, J., Samples, C., Zapata, M., & Arcand, L. F. (2000). Race, age, and back pain as factors in completion of residential substance abuse treatment by veterans. Psychiatric Services, 51(9), 1157–1161.

    CAS  Article  PubMed  Google Scholar 

  31. Statistics Canada. (2012). Canadian community health survey: mental health. Retrieved from http://www.statcan.gc.ca/daily-quotidien/130918/dq130918a-eng.htm

  32. Stocker, S. (1998). Men and women in drug abuse treatment relapse at different rates and for different reasons. Retrieved from https://archives.drugabuse.gov/NIDA_Notes/NNVol13N4/Relapse.html

  33. Trafton, J. A., Oliva, E. M., Horst, D. A., Minkel, J. D., & Humphreys, K. (2004). Treatment needs associated with pain in substance use disorder patients: implications for concurrent treatment. Drug and Alcohol Dependence, 73(1), 23–31. doi:10.1016/j.drugalcdep.2003.08.007.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Carson McPherson.

Ethics declarations

The study underwent an organizational ethics review at Cedars. Furthermore, patients, family members, and caregivers are informed about the nature and practice of research at Cedars and that their information would remain confidential and anonymized.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

Statement of Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

The original version of this article was revised: There were two inaccuracies in this article as originally published, both of which have now been corrected in the article: In Table 4 in the paper, the columns are not properly labeled which is misrepresenting the data. From left to right, the tables are: Complete Relapse, Chronic Relapse with Periods of Abstinence, 1–3 Slips but otherwise Abstinent, Complete Abstinence. There was an issue with the percentages in the section titled Descriptive Statistics, second paragraph. While the n sizes are the same, the percentages were not representing that data correctly.

An erratum to this article is available at https://doi.org/10.1007/s11469-017-9757-8.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

McPherson, C., Collins, E., Boyne, H. et al. Self-Reported Chronic Pain as a Predictor of Relapse Post Residential Addiction Treatment: a 6-Month Follow-up Pilot Study. Int J Ment Health Addiction 15, 1069–1079 (2017). https://doi.org/10.1007/s11469-017-9751-1

Download citation

Keywords

  • Substance use disorder
  • Relapse
  • Chronic pain
  • Abstinence
  • Addiction treatment