PTSD in different treatment settings: A preliminary investigation of PTSD symptomatology in substance abuse and chronic pain patients

Background: Psychopathology (depression, anxiety, somatization disorder) and substance abuse (opioid mis-use and illicit drug use) are common in patients with chronic pain and present problems for public health and clinical management. Despite a body of literature describing various methods for identifying psychopathology, opioid misuse, and illicit drug use in chronic pain patients, the relationship between psychopathologies, substance abuse, and chronic pain has not been well characterized.Methods: This report describes a total of500 consecutive pain patients prescribed and receiving stable doses of opioids. The patients were evaluated for psychopathology, opioid abuse, and illicit drug use during the course of regular pain management treatment. The relationships between psychopathology and drug abuse and/or illicit drug use in chronic pain patients were examined, and psychological evaluation for depression, anxiety, and somatization disorder was performed.Results: Depression, anxiety, and somatization disorder were documented in 59, 64, and 30percent of chronic pain patients, respectively. Drug abuse was significantly higher in patients with depression as compared to patients without depression (12percent with depression versus 5percent without). Current illicit drug use was higher in women with depression (22 percent) than women without depression (14percent) and in men with or without depression (12percent). Current illicit drug use was also higher in men with somatization disorder (22 percent) than men without (9 percent).Conclusion: This study demonstrated that the presence of psychological features of depression and somatization disorder may be markers of substance abuse diathesis in chronic pain patients.

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Treating substance abuse among chronic pain patients: a more compassionate approach

Journal of Pain ◽

10.1016/j.jpain.2011.02.326 ◽

2011 ◽

Vol 12 (4) ◽

pp. P80 ◽

Cited By ~ 1

Author(s):

A. Lyon-Bramhall ◽

L. Wargolet ◽

K. Lofland ◽

A. Rodolff

Keyword(s):

Substance Abuse ◽

Chronic Pain ◽

Chronic Pain Patients ◽

Pain Patients

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Is Kratom the New ‘Legal High’ on the Block?: The Case of an Emerging Opioid Receptor Agonist with Substance Abuse Potential

January 2018 - Pain Physician ◽

10.36076/ppj.2017.1.e195 ◽

2017 ◽

Vol 1 (21;1) ◽

pp. E195-E198 ◽

Cited By ~ 16

Author(s):

George C. Chan ge Chien

Keyword(s):

Substance Abuse ◽

Chronic Pain ◽

Opioid Receptor ◽

Receptor Agonist ◽

Abuse Potential ◽

Herbal Extract ◽

Opioid Overdose ◽

Opioid Receptor Agonist ◽

Chronic Pain Patients ◽

Pain Patients

Kratom is an unscheduled herbal extract that contains alkaloids with opioid receptor agonist activity. It is currently available in the form of dietary supplements and is used and abused by chronic pain patients on prescription opioids. Active alkaloids isolated from Kratom such as mitragynine and 7-hydroxymitragynine are thought to act on mu and delta opioid receptors as well as alpha 2 adrenergic and 5-HT2A receptors. Animal studies suggest that Kratom may be more potent than morphine. Consequently, Kratom consumption produces analgesic and euphoric feelings among users. Some chronic pain patients on opioids take Kratom to counteract the effects of opioid withdrawal. Although the Food and Drug Administration has banned its use as a dietary supplement, Kratom continues to be widely available and easily accessible on the internet at much lower prices than other opioid replacement therapies like buprenorphine. There are no Federal regulations monitoring the sale and distribution of this substance. Consumption of Kratom has been associated with hallucination, delusion, depression, myalgia, chill, nausea/vomiting, respiratory depression, hepatotoxicity, seizure, coma and death. A search of the pain literature shows past research has not described the use and potential deleterious effects of this extract. Many pain physicians are not familiar with Kratom. As providers who take care of high-risk chronic pain patients using prescribed opioids, knowledge of all current substances with opioid receptor agonists with abuse potential is of paramount importance. The goal of this article is to introduce Kratom to pain specialists and identify issues for further studies that will be required to help better understand the clinical and long-term effects of Kratom use among chronic pain patients. Key words: Opioid receptor agonist, Kratom, Mitragynine, opioid overdose, chronic pain, substance abuse :

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Chronic Pain Patients and Substance Abuse

Substance Abuse ◽

10.1007/978-1-4939-1951-2_32 ◽

2015 ◽

pp. 407-427

Author(s):

Rahul Rastogi ◽

Narendren Narayanasamy ◽

Paul Sraow

Keyword(s):

Substance Abuse ◽

Chronic Pain ◽

Chronic Pain Patients ◽

Pain Patients

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Faculty Opinions recommendation of The opioid renewal clinic: a primary care, managed approach to opioid therapy in chronic pain patients at risk for substance abuse.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1093989.548941 ◽

2007 ◽

Author(s):

Lynda Wells

Keyword(s):

Primary Care ◽

At Risk ◽

Substance Abuse ◽

Chronic Pain ◽

Opioid Therapy ◽

Chronic Pain Patients ◽

Patients At Risk ◽

Pain Patients

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Patients with Substance Abuse and Chronic Pain

10.1093/med/9780190271787.003.0032 ◽

2018 ◽

Author(s):

Dmitri Souza ◽

Denis Snegovskikh ◽

Julia K. Hunter

Keyword(s):

Substance Abuse ◽

Chronic Pain ◽

Multimodal Analgesia ◽

Pain Tolerance ◽

Prescription Opioid ◽

Opioid Use ◽

Medication Assisted Treatment ◽

Chronic Pain Patients ◽

Prescription Opioid Use ◽

Pain Patients

Treating chronic pain in patients with a substance abuse history is challenging. Patients abusing opioids may have a high pain tolerance, making pain control difficult. Available treatments for acute pain include regional and multimodal analgesia. Non-opioid and nonpharmacological analgesia (including interventional modalities, physical rehabilitation, chiropractic manipulations, and pain psychology) can be used to treat chronic pain. Patients’ past and present opioid use—illicit drug or nonmedical prescription opioid use, maintenance on medication-assisted treatment, or abstinence—should be taken into consideration when choosing between chronic pain treatments. Consultation with an addictionologist can facilitate this population’s successful treatment.

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