Stimulant use for self-management of pain among safety-net patients with chronic non-cancer pain.

TitleStimulant use for self-management of pain among safety-net patients with chronic non-cancer pain.
Publication TypeJournal Article
Year of Publication2022
AuthorsBeliveau, CM, McMahan, VM, Arenander, J, Angst, MS, Kushel, M, Torres, A, Santos, G-M, Coffin, PO
JournalSubst Abus
Volume43
Issue1
Pagination179-186
Date Published2022
ISSN1547-0164
KeywordsAdult, Analgesics, Opioid, Chronic Pain, Cocaine, Female, Humans, Longitudinal Studies, Neuralgia, Opioid-Related Disorders, Practice Patterns, Physicians', Self-Management, Substance-Related Disorders
Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

DOI10.1080/08897077.2021.1903654
Alternate JournalSubst Abus
PubMed ID33798030
PubMed Central IDPMC8791072
Grant ListK24 AG046372 / AG / NIA NIH HHS / United States
K24 DA042720 / DA / NIDA NIH HHS / United States
R01 DA040189 / DA / NIDA NIH HHS / United States
R25 DA028567 / DA / NIDA NIH HHS / United States