A Prospective Evaluation of Psychotherapeutic and Illicit Drug Use in Patients Presenting with Chronic Pain at the Time of Initial Evaluation

Background: Reports of chronic pain and associated opioid use, abuse, and fatalities continueto increase at an alarming rate, not only in the United States but also across the globe. In lightof the many resultant fatalities, multiple authors and authorities have cautioned against theexcessive use of opioids. Consequently, the Food and Drug Administration, Drug EnforcementAdministration, and multiple state authorities have been proposing and implementing a plethoraof regulations to curb opioid overuse and abuse. In the majority of cases, pain physicians havebeen portrayed as the perpetrators responsible for escalating use and abuse and resultantfatalities.Objectives: To assess the patterns of psychotherapeutic drug use and illicit drug use at thetime of initial evaluation.Study Design: A prospective evaluation.Setting: A private, specialty referral interventional pain management clinic in the United States.Methods: Participants were all new patients presenting to interventional pain managementevaluated by one physician. Inclusion criteria was patients over 18 years of age with chronicspinal pain of at least one year duration.Results: The results of this evaluation indicate that 94% of patients were on long-term opioidsprior to presenting to interventional pain management. Illicit drug use is also common, althoughit has declined significantly. While a large proportion of individuals (45.7%) have used illicitdrugs at some point in the past, current illicit drug use is present in only 7.9% of patients, bothpast and current use are similar to that of the general population. More importantly, a significantproportion of patients have been on opioids (high doses of more than 40 mg equivalents ofmorphine 48.8%) on a long-term basis, initiated and maintained by primary care physicians,prior to presenting to interventional pain management. Further, 35% were on benzodiazepines,and 9.2% on carisoprodol prior to presenting to interventional pain management.Limitations: The limitations of this evaluation include that it is a prospective, single centerevaluation by one physician that is partially dependent on subjective recall of the patient.Conclusion: This study shows an overwhelming majority of patients were initiated andmaintained with opioids in managing chronic noncancer pain. They were frequently on highdoses over a long period of time with multiple drug combinations prescribed by primary carephysicians.Key Words: Chronic pain, persistent pain, noncancer pain, controlled substances, substanceabuse, prescription drug abuse, opioids, prescriptions, urine drug testing, fatalities, regulations