Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, USA.
Department of Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Subst Abus. 2022;43(1):179-186. doi: 10.1080/08897077.2021.1903654. Epub 2021 Apr 2.
Chronic pain affects one-fifth of US adults. Reductions in opioid prescribing have been associated with increased non-prescription opioid use and, chronologically, increased stimulant (methamphetamine and cocaine) use. While non-prescription opioid use is commonly attributed to pain self-management, the role of stimulants in managing pain is unclear.
We analyzed baseline data from a longitudinal study of patients with chronic non-cancer pain in an urban safety-net healthcare system who had been prescribed an opioid for ≥3 of the last 12 months, and had a history of non-prescription opioid, cocaine, or amphetamine use ( = 300). We estimated the prevalence and identified correlates of stimulant use to treat pain among a subgroup of patients who reported past-year stimulant use ( = 105). Data sources included computer-assisted questionnaire (demographics, substance use, pain), clinical exam and procedures (pain, pain tolerance), and chart abstraction (opioid prescriptions). We conducted bivariate analyses to assess associations between demographics, pain characteristics, non-opioid therapies, substance use, opioid prescriptions, and self-reported symptoms, with reporting using stimulants to treat pain. Demographic variables and those with significant bivariate associations were included in a multivariable logistic regression model.
Fifty-two percent of participants with past-year stimulant use reported using stimulants in the past year to treat pain. Participants who used stimulants for pain reported slightly higher average pain in the past 3 months (median of 8 (IQR: 6-8) vs 7 (7-9) out of 10, = 0.049). In the multivariable analysis, female gender (AOR= 3.20, 95% CI: 1.06-9.63, = 0.039) and higher score on the neuropathic pain questionnaire (AOR = 1.34, 95% CI: 1.05-1.70, = 0.017) were associated with past-year stimulant use to treat pain.
Stimulants may be used for pain self-management, particularly for neuropathic pain and among women. Our findings suggest an underexplored motivation for stimulant use in an era of reduced access to prescribed opioids.
慢性疼痛影响了五分之一的美国成年人。阿片类药物处方的减少与非处方阿片类药物使用的增加有关，并且在时间上与兴奋剂（冰毒和可卡因）使用的增加有关。虽然非处方阿片类药物的使用通常归因于疼痛的自我管理，但兴奋剂在治疗疼痛方面的作用尚不清楚。
我们分析了在城市安全网医疗保健系统中患有慢性非癌症疼痛的患者的一项纵向研究的基线数据，这些患者在过去 12 个月中有≥3 个月的阿片类药物处方，并且有非处方阿片类药物、可卡因或安非他命使用史（n=300）。我们估计了在过去一年中报告使用过兴奋剂的患者亚组中（n=105），治疗疼痛时使用兴奋剂的患病率，并确定了其相关因素。数据来源包括计算机辅助问卷（人口统计学、物质使用、疼痛）、临床检查和程序（疼痛、疼痛耐受度）以及图表摘录（阿片类药物处方）。我们进行了单变量分析，以评估人口统计学特征、疼痛特征、非阿片类药物治疗、物质使用、阿片类药物处方和自我报告的症状与报告使用兴奋剂治疗疼痛之间的关联。将具有显著单变量关联的人口统计学变量和其他变量纳入多变量逻辑回归模型。
52%过去一年使用过兴奋剂的参与者报告在过去一年中使用兴奋剂来治疗疼痛。报告使用兴奋剂治疗疼痛的参与者在过去 3 个月中报告的平均疼痛稍高（中位数为 8（IQR：6-8）比 7（7-9），p=0.049）。在多变量分析中，女性（OR=3.20，95%CI：1.06-9.63，p=0.039）和神经病理性疼痛问卷得分较高（OR=1.34，95%CI：1.05-1.70，p=0.017）与过去一年使用兴奋剂治疗疼痛有关。
兴奋剂可能用于疼痛的自我管理，特别是用于治疗神经病理性疼痛和女性。我们的研究结果表明，在减少阿片类药物处方可获得性的时代，兴奋剂的使用可能存在一个未被充分探索的动机。
