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Cited by 122Substance Abuse Treatment and OutcomesOpioid Use Disorder TreatmentHomelessness and Social Issues

The association of persistent pain with out-patient addiction treatment outcomes and service utilization

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Caldeiro, Ryan M., Malte, Carol A., Calsyn, Donald A., Baer, John S., Nichol, Paul, Kivlahan, Daniel R., Saxon, Andrew J.·2008·Addiction
DOI 10.1111/j.1360-0443.2008.02358.x
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Abstract

Aims To estimate the prevalence of persistent pain among veterans in out‐patient addiction treatment and examine associated addiction treatment outcomes and medical and psychiatric service use. Design, setting and participants Analysis of data from a prospective randomized controlled trial comparing on‐site versus referral primary care of veterans with substance dependence ( n = 582), excluding opioid dependence who had at least one follow‐up interview during the 12‐month study period in a Veterans Affairs (VA) out‐patient addiction treatment center. Measurements Pain status was classified as persistent (pain was rated moderate to very severe at all time‐points), low (pain was rated none to mild at all time‐points) or intermittent (all others). Main outcome measures were addiction treatment retention, addiction severity index (ASI) alcohol and drug composite scores, VA service utilization and treatment costs. Findings A total of 33.2% of veterans reported persistent pain and 47.3% reported intermittent pain. All groups benefited from addiction treatment, but veterans with persistent pain were in treatment for an estimated 35.1 fewer days [95% confidence interval (CI) = −64.1, −6.1, P = 0.018], less likely to be abstinent from alcohol or drugs at 12 months [odds ratio (OR) adj = 0.52; 95% CI = 0.30,0.89; P = 0.018], had worse ASI alcohol composite scores at 12 months (β adj = 0.09; 95% CI = 0.02,0.15; P = 0.007), were more likely to be medically hospitalized (OR adj = 2.70; 95% CI = 1.02,7.13; P = 0.046) and had higher total service costs compared to those with low pain ($17 766 versus $13 261, P = 0.012). Conclusions Persistent pain is common among veterans in out‐patient addiction treatment and is associated with poorer rates of abstinence, worse alcohol use severity and greater service utilization and costs than those with low pain.

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  • Physical pain is a significant predictor of alcohol use, heavy alcohol use, and relapse to drinking after a period of abstinence.

    “Perhaps more compelling, physical pain appears to be a significant predictor of alcohol use and heavy alcohol use and relapse to drinking after a period of abstinence (Larson et al., 2007;Caldeiro et al., 2008;Witkiewitz et al., 2015).”

    From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Caldeiro et al., 2008

    The Discussion and Substance use outcomes sections report that veterans with persistent pain had worse alcohol-use severity and were less likely to be abstinent from alcohol or drugs at 12 months than those with low pain. The paper does not report heavy alcohol use as a separate outcome or test relapse to drinking after a documented period of abstinence; its findings also concern persistent pain in veterans receiving outpatient addiction treatment, not physical pain generally. (LLM, conf=0.87)

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Research works printed but not linked: 3

  1. [14]14. Tu W., Zhou X. H. A Wald test comparing medical costs based on log-normal distributions with zero value costs. Stat Med 1999; 18: 2749-61.
  2. [19]19. Bonin M., Norton G. R., Frombach I., Asmundson G. J. G. PTSD in different treatment settings: a preliminary investi- gation of PTSD symptomatology in substance abuse and chronic pain patients. Depress Anxiety 2000; 11: 131-3.
  3. [26]26. Morrill J. A., Shrestha M., Grant R. W. Barriers to the treat- ment of hepatitis C. J Gen Intern Med 2005; 20: 754-8.

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Authors
Caldeiro, R. M., Malte, C. A., Calsyn, D. A., Baer, J. S., Nichol, P., Kivlahan, D. R., & Saxon, A. J.
Affiliations
  • University of Washington (US)
  • VA Puget Sound Health Care System (US)
Corresponding author
Caldeiro, Ryan M.
ORCID
Venue
Addiction
Publisher
Wiley
Published
2008-11-06
Volume
103
Issue
12
Pages
1996-2005
ISSN
  • 0965-2140 (ISSN-L)
  • 1360-0443
DOI
10.1111/j.1360-0443.2008.02358.x
OpenAlex
W2032644022
Cited by
122
References
28
Citations by year
2026: 6 · 2025: 9 · 2024: 11 · 2023: 4 · 2022: 5 · 2021: 6 · 2020: 9 · 2019: 8 · 2018: 10 · 2017: 8 · 2016: 10 · 2015: 11 · 2014: 7 · 2013: 4 · 2012: 4
FWCI
2.45
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Addiction (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • Health Services Research and Development
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
Keywords
chronic pain, veterans, outpatient addiction treatment, substance dependence, treatment retention, abstinence, alcohol use severity, health care utilization, hospitalization, treatment costs, primary care referral
MeSH terms
Adult, Female, Humans, Male, Middle Aged, Outpatient Clinics, Hospital, Pain, Pain Measurement, Patient Compliance, Prospective Studies, Veterans, Prevalence, Substance Abuse Treatment Centers, Treatment Outcome, Substance-Related Disorders

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