To review the problem of chronic pain in patients with substance use disorders, focusing on the prevalence of chronic pain in patients with substance dependence disorders, especially prescription opioid dependence, associated comorbidities, and the impact on drug abuse treatment response.
Method:
We identified relevant articles using PubMed from 1987 to 2008. Additional articles were obtained from the reference lists of key reviews of relevant topics. Studies were included if they investigated the relation between chronic pain and substance use disorders. Of particular interest were articles that proposed integrated treatment for both problems.
Results:
The high prevalence of chronic pain syndromes was only recently explored in patients seeking treatment for drug abuse. The presence of chronic pain increases the risk of poor response to substance abuse treatment and an increased likelihood of multiple comorbidities that further add to the negative impact experienced by patients with substance dependence disorders. Substance abuse treatment programs offering integrated medical and psychiatric care for these comorbidities improve outcomes, with stepped care approaches offering the best treatment by tailoring the level of care to the individual patient's needs.
Conclusions:
Substance abuse treatment programs should expand their services to address the comorbidities likely to pose barriers to successful drug rehabilitation. Given the high prevalence and negative impact of chronic pain, new pain management services should be integrated within the drug treatment program and adapted as patients demonstrate the need for more intensive treatment. If applied to the problem of chronic pain, a model substance abuse treatment program of integrated stepped care would improve outcomes for patients with both devastating disorders.
Objectif:
Examiner le problème de la douleur chronique chez les patients souffrant de troubles d'utilisation de substances, en mettant l'accent sur la prévalence de la douleur chronique chez les patients souffrant de troubles de dépendance aux substances, en particulier de dépendance aux opiacés sur ordonnance, les comorbidités associées, et l'effet sur la réponse au traitement de l'abus de drogues.
Méthode:
Nous avons relevé les articles pertinents à l'aide de PubMed, de 1987 à 2008. Les articles additionnels ont été obtenus à même les bibliographies des études clés de sujets pertinents. Les études étaient incluses si elles exploraient la relation entre la douleur chronique et les troubles d'utilisation de substances. Les articles qui proposaient un traitement intégré des deux problèmes revêtaient un intérêt particulier.
Résultats:
La prévalence élevée des syndromes de douleur chronique n'a été explorée que récemment chez les patients cherchant un traitement pour abus de drogues. La présence de la douleur chronique accroît le risque d'une réponse médiocre au traitement de l'abus de substances et accroît aussi la probabilité de comorbidités multiples qui ajoutent encore aux répercussions négatives que connaissent les patients souffrant de troubles de dépendance aux substances. Les programmes de traitement de l'abus de substances offrant des soins médicaux et psychiatriques intégrés pour ces comorbidités ont de meilleurs résultats, et les approches de soins par paliers offrent le meilleur traitement en personnalisant le niveau des soins selon les besoins individuels du patient.
Conclusions:
Les programmes de traitement de l'abus de substances devraient développer leurs services pour aborder les comorbidités aptes à faire obstacle à un rétablissement réussi de l'usage de drogues. Étant donné la prévalence élevée et les répercussions négatives de la douleur chronique, de nouveaux services de soulagement de la douleur devraient être intégrés au programme de traitement de l'abus de drogues, et adaptés à mesure que les patients démontrent le besoin d'un traitement plus intensif Si on l'applique au problème de la douleur chronique, un programme modèle de traitement de l'abus de substances comportant des soins par paliers intégrés améliorerait les résultats pour les patients souffrant des deux troubles dévastateurs.
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