Co-occuring Chronic Pain and Opioid Addiction

The prevalence of addictive disorders among chronic pain patients is difficult to determine (Covington and Kotz 2003). One 1992 literature review found only seven studies that utilized acceptable diagnostic criteria and reported that estimates of substance use disorders among chronic pain patients ranged from 3.2% – 18.9% (Fishbain, Rosomoff, & Rosomoff, 1992).

A Swedish study of 414 chronic pain patients reported that 32.8% were diagnosed with a substance use disorder (Hoffmann, Olofsson, Salen, & Wickstrom, 1995). In two US studies, 43 to 45% of chronic pain patients reported aberrant drug-related behavior; the proportion with diagnosable substance use disorder is unknown (Katz et al., 2003; Passik et al., 2004).

All these studies evaluated patients referred to pain clinics and may overstate the prevalence of substance abuse in the overall population with chronic pain.

A relatively high prevalence of substance abuse disorders among persons with chronic pain can also be inferred by the high co-occurrence of these two disorders.

There have been several reports that the prevalence of chronic pain among persons with opioid and other substance use disorders is substantially higher than the pain prevalence found in the general population (Breitbart, et al., 1996; Brennan, Schutte, & Moos, 2005; Jamison, Kauffman, & Katz, 2000; Rosenblum et al., 2003; Sheu, et al., 2008).

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