Pain and Opioid Dose Reduction Based on Substance Use Disorder Status: Secondary Analysis from a Pragmatic...

Co-occurring substance use disorder (SUD) is common among patients with chronic pain prescribed long-term opioid therapy (LTOT); unfortunately, limited empirical data are available to guide treatment.

Our goal was to examine the extent to which baseline SUD status was associated with changes in pain interference, pain intensity, and prescription opioid dose reduction.

The present results are a secondary analysis of a pragmatic multisite 12-month randomized comparative effectiveness trial.

Eligible patients included veterans who were receiving LTOT for treatment of chronic pain.

Participants were randomized to receive one of two interventions, both of which were based on the collaborative care model for chronic pain; the interventions differed by resource intensity and included an intensive interdisciplinary pain team or less resource intensive pharmacist collaborative management. For these analyses, the treatment conditions were collapsed and we examined the extent to which SUD status at baseline predicted treatment outcomes.

Primary outcomes were changes at 12 months in pain interference, pain intensity, and prescription opioid dose.

At baseline, 250 of 778 participants (32.1%) met criteria for potential SUD. Participants with potential SUD were younger and more likely to have co-occurring mental health diagnoses, compared to participants without SUD, though had no differences in pain interference, pain intensity, or prescription opioid dose. During treatment, participants in both the potential SUD and No SUD group had significant reductions in pain interference and pain intensity, as well as reductions in prescription opioid dose. In adjusted analyses, there was no difference between groups in change on any of these outcomes.

Participants with and without potential SUD experienced improvements in pain interference and pain intensity, and had reductions in prescription opioid dose. These results suggest SUD status does not inhibit treatment response to collaborative care interventions for chronic pain.

ClinicalTrials.gov: NCT03026790.