Madden Erin F, Daulys Gintare, Tingey Benjamin, Frabis Felicia, Lagisetty Pooja, Kroth Philip J, Qeadan Fares
Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA.
Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
Pain Rep. 2025 Apr 18;10(3):e1261. doi: 10.1097/PR9.0000000000001261. eCollection 2025 Jun.
Pain management for patients with substance use disorders (SUDs) poses challenges, yet little is known about their pain severity perceptions. We conducted a mixed-methods study to understand numeric pain severity reporting among patients with SUD. We assessed how interactions between opioid prescribing and time, medications for opioid use disorder (MOUD), complementary medicine (CM), and outpatient SUD-related services (OS) predict differences in reported pain severity among patients with SUD.
We analyzed electronic health records (EHR) data, from 2003 to 2023, among the , which comprised 141 US health systems from 50 states. We used longitudinal patient-reported numeric rating scale pain severity scores in linear mixed effects regressions to predict mean pain severity scores. We also conducted 2 focus-groups, from 2022 to 2023, with patients with SUD and SUD-treating clinicians aiming to explore pain severity reporting.
Overall, predicted mean pain scores (95% confidence interval) were highest for patients with OUD (4.52 [4.51, 4.53]), lower for other patients with SUD (3.80 [3.79, 3.81]), and lowest for controls (3.28 [3.27, 3.29]) across all opioid prescription doses and durations. Complementary medicine use was associated with lower pain scores for all patients prescribed opioids. Pain scores were also lower for patients with OUD and SUD prescribed opioids and using OS, and for patients with OUD treated with MOUD and prescribed higher dose opioids. Focus-groups revealed pain reporting is influenced by anticipated clinician disbelief, treatment changes, and stigma.
These findings highlight the need to address pain within addiction treatment and further examine effective pain management interventions for this complex patient population.
物质使用障碍（SUDs）患者的疼痛管理面临挑战，但对他们对疼痛严重程度的认知却知之甚少。我们开展了一项混合方法研究，以了解SUD患者的数字疼痛严重程度报告情况。我们评估了阿片类药物处方与时间、阿片类药物使用障碍药物（MOUD）、补充医学（CM）以及门诊SUD相关服务（OS）之间的相互作用如何预测SUD患者报告的疼痛严重程度差异。
我们分析了2003年至2023年期间来自美国50个州141个医疗系统的电子健康记录（EHR）数据。我们在线性混合效应回归中使用患者报告的纵向数字评分量表疼痛严重程度得分来预测平均疼痛严重程度得分。我们还在2022年至2023年期间对SUD患者和治疗SUD的临床医生进行了2次焦点小组讨论，旨在探讨疼痛严重程度报告情况。
总体而言，在所有阿片类药物处方剂量和疗程中，阿片类药物使用障碍（OUD）患者的预测平均疼痛评分（95%置信区间）最高（4.52 [4.51, 4.53]），其他SUD患者较低（3.80 [3.79, 3.81]），对照组最低（3.28 [3.27, 3.29]）。使用补充医学与所有开具阿片类药物的患者疼痛评分较低相关。开具阿片类药物并使用OS的OUD和SUD患者，以及接受MOUD治疗并开具较高剂量阿片类药物的OUD患者，疼痛评分也较低。焦点小组讨论显示，疼痛报告受到临床医生预期的怀疑、治疗变化和耻辱感的影响。
这些发现凸显了在成瘾治疗中解决疼痛问题的必要性，并进一步研究针对这一复杂患者群体的有效疼痛管理干预措施。
