Pain interference and catastrophizing are not associated with polysubstance use among treatment-seeking patients with substance use disorders and chronic pain

Abstract Background Patients with substance use disorders are more likely than those without to have a self-directed hospital discharge, putting them at risk for poor health outcomes including progressing illness, readmissions, and death. Inadequate pain management has been identified as a potential motivator of self-directed discharge in this patient population. The objective of this study was to describe the association between acute pain and self-directed discharges among persons with opioid-related conditions; the presence of chronic pain in self-directed discharges was likewise considered. Methods We employed a large database of all hospitalizations at acute care hospitals during 2017 in the city of Philadelphia to identify adults with opioid-related conditions and compare the characteristics of admissions ending with routine discharge versus those ending in self-directed discharge. We examined all adult discharges with an ICD-10 diagnoses related to opioid use or poisoning and inspected the diagnostic data to systematically identify acute pain for the listed primary diagnosis and explore patterning in chronic pain diagnoses with respect to discharge outcomes. Results Sixteen percent of the 7972 admissions involving opioid-related conditions culminated in self-directed discharge, which was more than five times higher than in the general population. Self-directed discharge rates were positively associated with polysubstance use, nicotine dependence, depression, and homelessness. Among the 955 patients with at least one self-directed discharge, 15.4% had up to 16 additional self-directed discharges during the 12-month observation period. Those admitted with an acutely painful diagnosis were almost twice as likely to complete a self-directed discharge, and for patients with multiple admissions, rates of acutely painful diagnoses increased with each admission coinciding with a cascading pattern of worsening infectious morbidity over time. Chronic pain diagnoses were inconsistent for those patients with multiple admissions, appearing, for the same patient, in one admission but not others; those with inconsistent documentation of chronic pain were substantially more likely to self-discharge. Conclusions These findings underscore the importance of pain care in disrupting a process of self-directed discharge, intensifying harm, and preventable financial cost and suffering. Each admission represents a potential opportunity to provide harm reduction and treatment interventions addressing both substance use and pain.

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Ethnoracial differences in treatment-seeking veterans with substance use disorders and co-occurring PTSD: Presenting characteristics and response to integrated exposure-based treatment

Journal of Ethnicity in Substance Abuse ◽

10.1080/15332640.2020.1836699 ◽

2020 ◽

pp. 1-24

Author(s):

Delisa G. Brown ◽

Julianne C. Flanagan ◽

Amber Jarnecke ◽

Therese K. Killeen ◽

Sudie E. Back

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Treatment Seeking

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Pain interference and incident mood, anxiety, and substance-use disorders: Findings from a representative sample of men and women in the general population

Journal of Psychiatric Research ◽

10.1016/j.jpsychires.2013.08.004 ◽

2013 ◽

Vol 47 (11) ◽

pp. 1658-1664 ◽

Cited By ~ 25

Author(s):

Declan T. Barry ◽

Corey E. Pilver ◽

Rani A. Hoff ◽

Marc N. Potenza

Keyword(s):

Substance Use ◽

General Population ◽

Substance Use Disorders ◽

Representative Sample ◽

Pain Interference ◽

Men And Women

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Negative Affect–Related Factors Have the Strongest Association with Prescription Opioid Misuse in a Cross-Sectional Cohort of Patients with Chronic Pain

Pain Medicine ◽

10.1093/pm/pnz249 ◽

2019 ◽

Vol 21 (2) ◽

pp. e127-e138 ◽

Cited By ~ 2

Author(s):

Gadi Gilam ◽

John A Sturgeon ◽

Dokyoung S You ◽

Ajay D Wasan ◽

Beth D Darnall ◽

...

Keyword(s):

Chronic Pain ◽

Substance Use ◽

Negative Affect ◽

Substance Use Disorders ◽

Opioid Misuse ◽

Related Factors ◽

Opioid Prescription ◽

Increased Risk ◽

Patient Reported ◽

Opioid Medications

Abstract Objective Increased opioid prescription to relieve pain among patients with chronic pain is associated with increased risk for misuse, potentially leading to substance use disorders and overdose death. We aimed to characterize the relative importance and identify the most significant of several potential risk factors for the severity of self-reported prescribed opioid misuse behaviors. Methods A sample of 1,193 patients (mean age ± SD = 50.72 ± 14.97 years, 64.04% female) with various chronic pain conditions completed a multidimensional registry assessing four pain severity measures and 14 physical, mental, and social health status factors using the National Institutes of Health’s Patient-Reported Outcomes Measurement Information System (PROMIS). A validated PROMIS measure of medication misuse was completed by 692 patients who endorsed currently taking opioid medication. Patients taking opioid medications were compared across all measures with those who do not take opioid medications. Subsequently, a data-driven regression analysis was used to determine which measures best explained variability in severity of misuse. We hypothesized that negative affect–related factors, namely anxiety, anger, and/or depression, would be key predictors of misuse severity due to their crucial role in chronic pain and substance use disorders. Results Patients taking opioid medications had significantly greater impairment across most measures. Above and beyond demographic variables, the only and most significant predictors of prescribed opioid misuse severity were as follows: anxiety (β = 0.15, P = 0.01), anger (β = 0.13, P = 0.02), Pain Intensity–worst (β = 0.09, P = 0.02), and depression (β = 0.13, P = 0.04). Conclusions Findings suggest that anxiety, anger, and depression are key factors associated with prescribed opioid misuse tendencies in patients with chronic pain and that they are potential targets for therapeutic intervention.

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