Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA.
Department of Health Law, Policy & Management, Boston University School of Public Health, Health, 715 Albany Street, Boston, MA 02118, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA.
Drug Alcohol Depend. 2024 Dec 1;265:112472. doi: 10.1016/j.drugalcdep.2024.112472. Epub 2024 Oct 24.
Chronic pain and non-prescribed substance use are associated with lower retention in opioid use disorder (OUD) treatment. We examined the associations of perceived capacity to tolerate uncomfortable physical sensations (discomfort intolerance and discomfort avoidance) and cannabis and alcohol use among persons with chronic pain receiving prescription buprenorphine for OUD.
This study utilizes baseline data from 163 persons with chronic pain receiving prescription buprenorphine for OUD enrolled in the Treating Opioid use, Persistent Pain, and Sadness (TOPPS) intervention trial. We used negative-binomial regression models, adjusted for age, education, gender, race/ethnicity, pain interference, depression, generalized anxiety disorder, and average cigarettes smoked/day to estimate the associations of discomfort tolerance and discomfort avoidance with frequency of cannabis and alcohol use.
Participants (n=163) were on average 45 years old (standard deviation=10.6) and predominantly White (86 %, n=141). Forty-one percent (n=66) used cannabis and 24 % (n=30) used alcohol use in the past 30 days. In adjusted models, discomfort intolerance was positively associated with days of cannabis use (IRR = 1.11, p =.016) and days of alcohol use (IRR = 1.14, p =.022). Discomfort avoidance was not associated with cannabis or alcohol use.
Individuals with chronic pain receiving prescribed buprenorphine for treatment of OUD with lower tolerance for physical discomfort may augment pain management with cannabis and alcohol. Given the intersections between substance use and retention in care for OUD, future work should extend this preliminary work by exploring these relationships over time and in experimental settings. Clinical Trial # NCT03698669.
慢性疼痛和非处方物质使用与阿片类药物使用障碍（OUD）治疗的保留率较低有关。我们研究了患有慢性疼痛并接受处方丁丙诺啡治疗 OUD 的患者中，感知忍受身体不适感觉的能力（不适耐受力和不适回避）与大麻和酒精使用之间的关联。
本研究利用了接受处方丁丙诺啡治疗 OUD 的 163 名患有慢性疼痛患者的基线数据，这些患者参加了治疗阿片类药物使用、持续性疼痛和悲伤（TOPPS）干预试验。我们使用负二项回归模型，调整了年龄、教育程度、性别、种族/民族、疼痛干扰、抑郁、广泛性焦虑症和平均每天吸烟量，以估计不适耐受力和不适回避与大麻和酒精使用频率的关联。
参与者（n=163）的平均年龄为 45 岁（标准差=10.6），主要为白人（86%，n=141）。41%（n=66）在过去 30 天内使用大麻，24%（n=30）使用酒精。在调整后的模型中，不适耐受力与大麻使用天数呈正相关（IRR=1.11，p=.016），与酒精使用天数呈正相关（IRR=1.14，p=.022）。不适回避与大麻或酒精使用无关。
接受处方丁丙诺啡治疗 OUD 的慢性疼痛患者，如果对身体不适的耐受力较低，可能会通过使用大麻和酒精来增强疼痛管理。鉴于物质使用与 OUD 治疗保留率之间的交集，未来的工作应该通过在时间和实验环境中探索这些关系来扩展这项初步工作。临床试验#NCT03698669。
