TY - JOUR
KW - Adolescent
KW - Adult
KW - Aged
KW - Analgesics, Opioid/administration & dosage/adverse effects/therapeutic use
KW - Female
KW - Humans
KW - Inappropriate Prescribing/adverse effects
KW - Male
KW - Methadone/administration & dosage/adverse effects/therapeutic use
KW - Middle Aged
KW - Opiate Substitution Treatment/adverse effects
KW - Pain/diagnosis/drug therapy/etiology
KW - Suicide/prevention & control
AU - S. Nordmann
AU - A. Vilotitch
AU - C. Lions
AU - L. Michel
AU - M. Mora
AU - B. Spire
AU - G. Maradan
AU - M. K. Bendiane
AU - A. Morel
AU - P. Roux
AU - P. Carrieri
AU - ANRS Methaville Study Group
A1 - 
AB - BACKGROUND: Pain in opioid-dependent patients is common but data measuring the course of pain (and its correlates) using validated scales in patients initiating methadone treatment are sparse. We aimed to assess pain and its interference in daily life, associated correlates, and undertreatment before and during methadone treatment. METHODS: This is a secondary analysis using longitudinal data of a randomized trial comparing two methadone initiation models. We assessed the effect of methadone initiation and other correlates on pain intensity and interference (using the Brief Pain Inventory) at months 0, 6 and 12 using a mixed multinomial logistic regression model. RESULTS: The study group comprised 168 patients who had data for either pain intensity or interference for at least one visit. Moderate to severe pain was reported in 12.9% of patients at M0, 5.4% at M6 and 7.3% at M12. Substantial interference with daily functioning was reported in 36.0% at M0, 14.5% at M6 and 17.1% at M12. Of the 98 visits where patients reported moderate to severe pain or substantial interference, 55.1% reported no treatment for pain relief, non-opioid analgesics were reported by 34.7%, opioid analgesics by 3.1% and both opioid and non-opioid analgesics by 7.1%. Methadone was associated with decreased pain intensity at 6 months (OR = 0.29, p = 0.04) and 12 months (OR = 0.30, p = 0.05) of follow-up and tended to be associated with substantial pain interference. Suicide risk was associated with both pain intensity and pain interference. CONCLUSIONS: Methadone in opioid-dependent patients can reduce pain. However, undertreatment of pain in methadone patients remains a major clinical concern. Patients with pain are at higher risk of suicide. Adequate screening and management of pain in this population is a priority and needs to be integrated into routine comprehensive care.
AD - Aix Marseille Universite, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Sante & Traitement de l'Information Medicale, Marseille, France.; ORS PACA, Observatoire Regional de la Sante Provence-Alpes-Cote d'Azur, Marseille, France.; Aix Marseille Universite, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Sante & Traitement de l'Information Medicale, Marseille, France.; ORS PACA, Observatoire Regional de la Sante Provence-Alpes-Cote d'Azur, Marseille, France.; Aix Marseille Universite, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Sante & Traitement de l'Information Medicale, Marseille, France.; ORS PACA, Observatoire Regional de la Sante Provence-Alpes-Cote d'Azur, Marseille, France.; INSERM, UMR-S 669, Paris, France.; Universite Paris-Sud and Universite Paris Descartes, UMR-S 669, Paris, France.; Centre Pierre Nicole, Paris, France.; Aix Marseille Universite, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Sante & Traitement de l'Information Medicale, Marseille, France.; ORS PACA, Observatoire Regional de la Sante Provence-Alpes-Cote d'Azur, Marseille, France.; Aix Marseille Universite, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Sante & Traitement de l'Information Medicale, Marseille, France.; ORS PACA, Observatoire Regional de la Sante Provence-Alpes-Cote d'Azur, Marseille, France.; Aix Marseille Universite, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Sante & Traitement de l'Information Medicale, Marseille, France.; ORS PACA, Observatoire Regional de la Sante Provence-Alpes-Cote d'Azur, Marseille, France.; Aix Marseille Universite, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Sante & Traitement de l'Information Medicale, Marseille, France.; ORS PACA, Observatoire Regional de la Sante Provence-Alpes-Cote d'Azur, Marseille, France.; Oppelia, Paris, France.; Aix Marseille Universite, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Sante & Traitemen(TRUNCATED)
BT - PloS one
C5 - Opioids & Substance Use
CP - 5
CY - United States
DO - 10.1371/journal.pone.0176288
IS - 5
JF - PloS one
M1 - Journal Article
N2 - BACKGROUND: Pain in opioid-dependent patients is common but data measuring the course of pain (and its correlates) using validated scales in patients initiating methadone treatment are sparse. We aimed to assess pain and its interference in daily life, associated correlates, and undertreatment before and during methadone treatment. METHODS: This is a secondary analysis using longitudinal data of a randomized trial comparing two methadone initiation models. We assessed the effect of methadone initiation and other correlates on pain intensity and interference (using the Brief Pain Inventory) at months 0, 6 and 12 using a mixed multinomial logistic regression model. RESULTS: The study group comprised 168 patients who had data for either pain intensity or interference for at least one visit. Moderate to severe pain was reported in 12.9% of patients at M0, 5.4% at M6 and 7.3% at M12. Substantial interference with daily functioning was reported in 36.0% at M0, 14.5% at M6 and 17.1% at M12. Of the 98 visits where patients reported moderate to severe pain or substantial interference, 55.1% reported no treatment for pain relief, non-opioid analgesics were reported by 34.7%, opioid analgesics by 3.1% and both opioid and non-opioid analgesics by 7.1%. Methadone was associated with decreased pain intensity at 6 months (OR = 0.29, p = 0.04) and 12 months (OR = 0.30, p = 0.05) of follow-up and tended to be associated with substantial pain interference. Suicide risk was associated with both pain intensity and pain interference. CONCLUSIONS: Methadone in opioid-dependent patients can reduce pain. However, undertreatment of pain in methadone patients remains a major clinical concern. Patients with pain are at higher risk of suicide. Adequate screening and management of pain in this population is a priority and needs to be integrated into routine comprehensive care.
PP - United States
PY - 2017
SN - 1932-6203; 1932-6203
T1 - Pain in methadone patients: Time to address undertreatment and suicide risk (ANRS-Methaville trial)
T2 - PloS one
TI - Pain in methadone patients: Time to address undertreatment and suicide risk (ANRS-Methaville trial)
U1 - Opioids & Substance Use
U2 - 28520735
U3 - 10.1371/journal.pone.0176288
VL - 12
VO - 1932-6203; 1932-6203
Y1 - 2017
Y2 - May 17
ER -