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      Greater Pain Severity is Associated with Inability to Access Addiction Treatment Among a Cohort of People Who Use Drugs

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          Abstract

          Aim

          Given that co-occurring pain is prevalent among people who use drugs (PWUD), we sought to explore the effect of pain severity on accessing addiction treatment.

          Methods

          Data were derived from two prospective cohort studies of PWUD in Vancouver, Canada from June 2014 to May 2016. Multivariable generalized linear mixed-effects multiple regression (GLMM) analyses were used to investigate the association between average pain severity and self-reported inability to access addiction treatment.

          Results

          Among 1348 PWUD, 136 (10.1%) reported being unable to access addiction treatment at least once over the study period. Individuals who reported being unable to access addiction treatment had a significantly higher median average pain severity score (median=5, IQR=0–7) compared to individuals reporting no inability to access addiction treatment (median=3, IQR=0–6, p=0.038). Greater pain severity was independently associated with higher odds of reporting inability to access addiction treatment (AOR: 1.75, 95%CI: 1.08–2.82 for mild-moderate vs no pain; AOR: 1.98, 95%CI: 1.27–3.09 for moderate-severe vs no pain).

          Conclusion

          PWUD with greater pain severity may be at higher risk of being unable to access addiction treatment, or vice versa. While further research is needed to confirm causal associations, these data suggest that there may be underlying pathways or mechanisms through which pain may be associated with access to addiction treatment for PWUD.

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          Most cited references 23

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          Grading the severity of chronic pain

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            Medication-assisted therapies--tackling the opioid-overdose epidemic.

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              Chronic pain and opioid misuse: a review of reviews

              Objective The crisis of prescription opioid (PO) related harms has focused attention toward identifying and treating high-risk populations. This review aims to synthesize systematic reviews on the epidemiology and clinical management of comorbid chronic pain and PO or other substance misuse. Methods A systematic database search was conducted to identify systematic reviews published between 2000 and 2016. Eligible studies were systematic reviews related to chronic non-cancer pain and PO or other substance misuse. Evidence from the included reviews was synthesized according to epidemiology and clinical management themes. Results Of 1908 identified articles, 18 systematic reviews were eligible for final inclusion. Two meta-analyses estimated the prevalence of chronic non-cancer pain in individuals using POs non-medically to be approximately 48% to 60%, which is substantially higher than the prevalence of chronic non-cancer pain in general population samples (11% to 19%). Five systematic reviews estimated the rates of PO or other opioid use in chronic pain populations with substantial variation in results (0.05% to 81%), likely due to widely varying definitions of dependence, substance use disorder, misuse, addiction, and abuse. Several clinical assessment and treatment approaches were identified, including: standardized assessment instruments; urine drug testing; medication counts; prescription drug monitoring programs; blood level monitoring; treatment agreements; opioid selection; dosing and dispensing strategies; and opioid agonist treatment. However, the reviews commonly noted serious limitations, inconsistencies, and imprecision of studies, and a lack of evidence on effectiveness or clinical utility for the majority of these strategies. Conclusion Overall, current systematic reviews have found a lack of high-quality evidence or consistent findings on the prevalence, risk factors, and optimal clinical assessment and treatment approaches related to concurrent chronic pain and substance misuse. Given the role of systematic reviews in guiding evidence-based medicine and health policy, there is an urgent need for high-quality primary research to guide future systematic reviews to address the escalating epidemic of harms related to chronic pain and substance misuse. Electronic supplementary material The online version of this article (doi:10.1186/s13011-017-0120-7) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                jpr
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                01 October 2020
                2020
                : 13
                : 2443-2449
                Affiliations
                [1 ]British Columbia Centre on Substance Use , Vancouver, BC V6Z 2A9, Canada
                [2 ]School of Population and Public Health, University of British Columbia , Vancouver, BC V6T 1Z3, Canada
                [3 ]British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital , Vancouver, BC V6Z 1Y6, Canada
                [4 ]Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute , Toronto, ON M5B 1T8, Canada
                [5 ]Faculty of Health Sciences, Simon Fraser University , Burnaby, BC V5A 1S6, Canada
                [6 ]Department of Medicine, University of British Columbia , Vancouver, BC V6Z 2A9, Canada
                Author notes
                Correspondence: Thomas Kerr Department of Medicine, University of British Columbia , 400-1045 Howe Street, Vancouver, BCV6Z 2A9, CanadaTel +1 778 945-7616Fax +1 604 428-5183 Email bccsu-tk@bccsu.ubc.ca
                Article
                255438
                10.2147/JPR.S255438
                7534843
                © 2020 Voon et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 1, Tables: 2, References: 28, Pages: 7
                Funding
                Funded by: US National Institutes of Health;
                Award ID: U01DA038886 and U01DA021525
                Funded by: Canadian Institutes of Health Research through the Canadian Research Initiative on Substance Misuse;
                Funded by: CIHR New Investigator Award;
                Award ID: MSH-141971
                Funded by: United States National Institutes of Health;
                Award ID: U01-DA0251525
                This study was supported by the US National Institutes of Health (U01DA038886 and U01DA021525) and the Canadian Institutes of Health Research through the Canadian Research Initiative on Substance Misuse (SMN–139148). This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine which supports Dr Evan Wood. Pauline Voon is supported through a Vanier Canada Graduate Scholarship from the Canadian Institutes of Health Research (CIHR) and a Doctoral Scholarship from The Pierre Elliott Trudeau Foundation. Dr Kanna Hayashi is supported by a CIHR New Investigator Award (MSH-141971), a Michael Smith Foundation for Health Research (MSFHR) Scholar Award, and the St Paul’s Foundation. M-J Milloy is supported by the United States National Institutes of Health (U01-DA0251525), a New Investigator award from the Canadian Institutes of Health Research, and a Scholar Award from the Michael Smith Foundation for Health Research.
                Categories
                Short Report

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