![]() Trained research associates conducted in-person structured interviews with all participants. In addition, we examine the prevalence of alcohol and illicit drug use and prescription drug misuse for the purpose of self-medicating chronic pain in this population. The purpose of this study is to describe the prevalence of chronic pain and pain-related dysfunction among primary care patients who screen positive for drug use. This issue has particular importance in light of the recently published studies that demonstrated lack of efficacy of brief intervention for unhealthy drug use in primary care. If patients are self-medicating pain, then counseling interventions aimed at decreasing substance use, focused solely on the negative consequences of drug use, while not addressing pain symptoms, may be less effective. 11 – 13 The multi-site Prescription Opioid Addiction Treatment Study 14 found that 83 % of patients with chronic pain and prescription opioid dependence initially used opioids to treat chronic pain. ![]() While there are numerous reasons why individuals use substances, one theory is that individuals use psychoactive substances to “self-medicate” disturbing symptoms (e.g., posttraumatic stress). ![]() Because alcohol, 10 many illicit drugs (e.g., heroin, marijuana) and prescription opioids have analgesic properties, it is possible that patients are using these drugs to self-medicate pain. The prevalence and severity of chronic pain and pain-related dysfunction in patients who screen positive for the full spectrum (at-risk use to substance use disorders) of drug use (Illicit, prescription misuse) in primary care is unknown. However, other studies over the past decade have shown a wide range (3-26 %) of reported drug use in primary care. In one recent study, 7 10 % of patients in an urban primary care setting screened positive for drug use (illicit and prescription misuse). population has used an illicit drug, including nonmedical use of prescription drugs in the past month. 2 Cross-sectional surveys 3 – 5 among patients treated with medication assisted treatment (methadone, buprenorphine) report a prevalence of chronic pain ranging from 36 % to 61 %.Īccording to the 2013 National Survey on Drug Use and Health, 6 an estimated 9.4 % of the U.S. One survey reported that 52 % of treatment-seeking, opioid dependent veterans complained of moderate to severe chronic pain. 1 Chronic pain is particularly common among those with drug use disorders. Of the 168 eligible studies, 97/105 (57.7%) reported compliance in unique data sets (nonclinical=64/105, clinical=41/105 ).It is estimated that chronic pain currently affects approximately 100 million people in the US, and is one of the most common reasons patients seek medical care. ![]() The most common self-reported mEMA target was affect (primary target: 31/105, 29.5% data sets secondary target: 50/105, 47.6% data sets). The median duration of the mEMA protocol was 7 days (nonclinical=7, clinical=12). Most protocols used a single time-based (random or interval) prompt type (69/105, 65.7%) median prompt frequency was 5 per day. The median number of items per prompt was similar for nonclinical (8) and clinical data sets (10). More than half of the data sets reported mEMA training (84/105, 80%) and provision of participant incentives (66/105, 62.9%). Less than half of the data sets reported number of prompts delivered (22/105, 21%), answered (43/105, 41%), criterion for valid mEMA data (37/105, 35.2%), or response latency (38/105, 36.2%). Meta-analysis (nonclinical=41, clinical=27) estimated an overall compliance of 81.9% (95% CI 79.1-84.4), with no significant difference between nonclinical and clinical data sets or estimates before or after data exclusions. Compliance was associated with prompts per day and items per prompt for nonclinical data sets. Although widespread heterogeneity existed across analysis (I 2>90%), no compelling relationship was identified between key features of mEMA protocols representing burden and mEMA compliance.Įcological momentary assessment (EMA) is a survey method that allows collection of data on participant behaviors, affect, and perceptual experiences in real-time (momentary) and real-life environments (ecological).
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