1. Stimulant use for Self-Management of Pain among Safety-Net Patients with Chronic Non-Cancer Pain
- Author
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Beliveau, Cathleen M, McMahan, Vanessa M, Arenander, Justine, Angst, Martin S, Kushel, Margot, Torres, Andrea, Santos, Glenn-Milo, and Coffin, Phillip O
- Subjects
Clinical and Health Psychology ,Health Services and Systems ,Public Health ,Health Sciences ,Psychology ,Drug Abuse (NIDA only) ,Pain Research ,Clinical Research ,Brain Disorders ,Neurosciences ,Substance Misuse ,Chronic Pain ,Prescription Drug Abuse ,Good Health and Well Being ,Adult ,Analgesics ,Opioid ,Cocaine ,Female ,Humans ,Longitudinal Studies ,Neuralgia ,Opioid-Related Disorders ,Practice Patterns ,Physicians' ,Self-Management ,Substance-Related Disorders ,Chronic pain ,pain management ,stimulants ,methamphetamine ,cocaine ,safety-net clinic ,Public Health and Health Services ,Substance Abuse ,Health services and systems ,Public health ,Clinical and health psychology - Abstract
BackgroundChronic 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.MethodsWe 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 (N = 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 (N = 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.ResultsFifty-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, p = 0.049). In the multivariable analysis, female gender (AOR= 3.20, 95% CI: 1.06-9.63, p = 0.039) and higher score on the Douleur Neuropathique 4 neuropathic pain questionnaire (AOR = 1.34, 95% CI: 1.05-1.70, p = 0.017) were associated with past-year stimulant use to treat pain.ConclusionStimulants 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.
- Published
- 2022