Chronic pain and substance abuse: a pilot study of opioid maintenance

Recent reports suggest that opioid maintenance may be appropriate for treatment-resistant patients with chronic nonmalignant pain syndromes. However, a history of substance abuse is thought to be a contraindication for such treatment. We present a pilot study of a methadone maintenance-type treatment for patients with both chronic pain and substance abuse, evaluating the ability to attract and hold patients, the methodology for assessing change, and the potential problems and pitfalls. Weekly random urinalysis, weekly psychotherapy, and quarterly self-report tests of pain, mood, and function were used to evaluate change. Three out of 4 patients remained in treatment for 19-21 months, stopped needle use, and/or markedly decreased substance abuse, and appear to have improved functionally. Surprisingly, all 3 patients had significant psychopathology requiring treatment with psychotropic medication. This treatment may warrant further research.