A Brief Screen for Classifying Pain Severity in Patients with Opioid Dependence

Pain is prevalent among people with opioid dependence, and its association with psychosocial stressors (e.g., depression) may threaten clinical gains achieved through substance abuse treatment. A rationale exists, therefore, for screening treatment-seeking patients with opioid dependence for potentially destabilizing pain.

Researchers in this study examined the effectiveness of a streamlined pain screening instrument among people with opioid dependence who sought inpatient opioid detoxification in Massachusetts. Following admission, 110 adults completed a brief questionnaire, including the Brief Pain Inventory–Short Form, to assess physical pain during the last week.

• Ninety-one percent of patients reported some pain during the previous week. Forty-three percent reported chronic pain (lasting ≥6 months), and 70% of those with chronic pain rated their pain as “severe” (≥7 on a scale of 1 to 10).
• Patients with severe chronic pain, versus patients with less severe or no pain, had worse depressive symptoms and were more likely to be receiving occupational disability benefits.

Comments:

Severe chronic pain was common among people with opioid dependence seeking inpatient detoxification and was associated with conditions (depressive symptoms, disability) that complicate recovery from drug dependence.

Limitations of this study include the high-acuity patient population (seeking inpatient treatment) and lack of detail about the timing of pain assessment, sequencing of screening steps, and potential for opioid withdrawal symptoms to be reported as pain. Nonetheless, this study suggests that assessing pain severity among patients in opioid dependence treatment could help clinicians identify which of their patients might benefit from pain-related intervention. Additional research is needed to define the impact of simple pain screening algorithms on clinical outcomes among people in treatment for opioid dependence.

Marc N. Gourevitch, MD, MPH

Reference:

Potter JS, Shiffman SJ, Weiss RD. Chronic pain severity in opioid-dependent patients. Am J Drug Alcohol Abuse. 2008;34(1):101–107.