ArticleJournal of general internal medicine2009
Providers' experiences treating chronic pain among opioid-dependent drug users.
Article in Journal of general internal medicine, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
53 citing papers in PubMed, 91 citations in OpenAlex.
- A pilot study assessing acceptability and feasibility of hatha yoga for chronic pain in people receiving opioid agonist therapy for opioid use disorder.Journal of substance abuse treatment · 2019Trial
- Willingness to use microbicides among females who use unregulated drugs in Vancouver, Canada.AIDS care · 2026Article
- Characterizing the Use of Healthcare Access Supports Among People Who Use Drugs in Vancouver, Canada, 2017 to 2020: A Cohort Study.Substance use & addiction journal · 2024Article
- Association of Opioid Use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrospective Cohort Analysis.Journal of general internal medicine · 2024Article
- Pain and withdrawal are common among patients receiving medications for opioid use disorder and associated with pain catastrophizing, negative affect, and poor sleep.Experimental and clinical psychopharmacology · 2024Article
- Denial of prescription pain medication among people who use drugs in Vancouver, Canada.Harm reduction journal · 2024Article
- Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD.JAMA network open · 2023Article
- Emergency department experiences of people who use drugs who left or were discharged from hospital against medical advice.PloS one · 2023Article
- Testing the Decision Support Tool for Responsible Pain Management for Headache and Facial Pain Diagnosis with Opioid-Risk-Stratified Treatment.SN comprehensive clinical medicine · 2023Article
- External resilience in the context of drug use and socio-structural vulnerabilities: a qualitative exploration among women who use drugs and sell sex in Baltimore, Maryland.Harm reduction journal · 2022Article
- Ageing and older people who use illicit opioids, cocaine or methamphetamine: a scoping review and literature map.Addiction (Abingdon, England) · 2022Article
- Association of chronic non-cancer pain status and buprenorphine treatment retention among individuals with opioid use disorder: Results from electronic health record data.Drug and alcohol dependence reports · 2022Article
- Impact of Current Pain Status on Low-Barrier Buprenorphine Treatment Response Among Patients with Opioid Use Disorder.Pain medicine (Malden, Mass.) · 2021Article
- "It's Helped Me a Lot, Just Like to Stay Alive": a Qualitative Analysis of Outcomes of a Novel Hydromorphone Tablet Distribution Program in Vancouver, Canada.Journal of urban health : bulletin of the New York Academy of Medicine · 2021Article
- Characterizing Health Care Access among Cisgender Female Sex Workers with Substance Use Histories in Baltimore, Maryland.Journal of health care for the poor and underserved · 2021Article
- Prevalence and Characteristics of Chronic Pain in Buprenorphine and Methadone-Maintained Patients.Frontiers in psychiatry · 2021Article
- High prevalence of unmet healthcare need among people who use illicit drugs in a Canadian setting with publicly-funded interdisciplinary primary care clinics.Substance abuse · 2021Article
- Motivations to initiate injectable hydromorphone and diacetylmorphine treatment: A qualitative study of patient experiences in Vancouver, Canada.The International journal on drug policy · 2020Article
- Chronic non-cancer pain among adults with substance use disorders: Prevalence, characteristics, and association with opioid overdose and healthcare utilization.Drug and alcohol dependence · 2020Article
- Confronting challenges to opioid risk mitigation in the U.S. health system: Recommendations from a panel of national experts.PloS one · 2020Article
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
backgroundSuccessful management of chronic pain with opioid medications requires balancing opioid dependence and addiction with pain relief and restoration of function. Evaluating these risks and benefits is difficult among patients with chronic pain and pre-existing addiction, and the ambiguity is increased for patients on methadone maintenance therapy for opioid dependence. Providers treating both chronic pain and addiction routinely make diagnostic and therapeutic decisions, but decision-making strategies in this context have not been well described.
objectiveOur objective was twofold. We sought first to explore providers' perceptions of ambiguity, and then to examine their strategies for making diagnostic and treatment decisions to manage chronic pain among patients on methadone maintenance therapy.
designQualitative semi-structured interviews. SETTING AND
participantsWe interviewed health-care providers delivering integrated medical care and substance abuse treatment to patients in a methadone maintenance program.
resultsProviders treating pain and co-morbid addiction described ambiguity in all diagnostic and therapeutic decisions. To cope with this inherent ambiguity, most providers adopted one of two decision-making frameworks, which determined clinical behavior. One framework prioritized addiction treatment by emphasizing the destructive consequences of abusing illicit drugs or prescription medications; the other prioritized pain management by focusing on the destructive consequences of untreated pain. Identification with a decision-making framework shaped providers' experiences, including their treatment goals, perceptions of treatment risks, pain management strategies, and tolerance of ambiguity. Adherence to one of these two frameworks led to wide variation in pain management practices, which created tension among providers.
conclusionsProviders delivering integrated medical care and substance abuse treatment to patients in a methadone maintenance program found tremendous ambiguity in the management of chronic pain. Most providers adopted one of the two divergent heuristic frameworks we identified, which resulted in significant variations in pain management. To reduce variation and determine best practices, studies should examine clinically relevant endpoints, including pain, illicit drug use, prescription drug abuse, and functional status. Until then, providers managing chronic pain in patients with co-morbid addiction should attempt to reduce tension by acknowledging ambiguity and engaging in open discourse.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.