Stimulant use for self-management of pain among safety-net patients with chronic non-cancer pain

Abstract

Background

Chronic pain affects one-fifth of US adults. Reductions in opioid prescribing have been associated with increased non-prescription opioid use and, chronologically, increased stimulant (methamphetamine and cocaine) use. While non-prescription opioid use is commonly attributed to pain self-management, the role of stimulants in managing pain is unclear.

Methods

We analyzed baseline data from a longitudinal study of patients with chronic non-cancer pain in an urban safety-net healthcare system who had been prescribed an opioid for ≥3 of the last 12 months, and had a history of non-prescription opioid, cocaine, or amphetamine use (N = 300). We estimated the prevalence and identified correlates of stimulant use to treat pain among a subgroup of patients who reported past-year stimulant use (N = 105). Data sources included computer-assisted questionnaire (demographics, substance use, pain), clinical exam and procedures (pain, pain tolerance), and chart abstraction (opioid prescriptions). We conducted bivariate analyses to assess associations between demographics, pain characteristics, non-opioid therapies, substance use, opioid prescriptions, and self-reported symptoms, with reporting using stimulants to treat pain. Demographic variables and those with significant bivariate associations were included in a multivariable logistic regression model.

Results

Fifty-two percent of participants with past-year stimulant use reported using stimulants in the past year to treat pain. Participants who used stimulants for pain reported slightly higher average pain in the past 3 months (median of 8 (IQR: 6–8) vs 7 (7–9) out of 10, p = 0.049). In the multivariable analysis, female gender (AOR= 3.20, 95% CI: 1.06–9.63, p = 0.039) and higher score on the Douleur Neuropathique 4 neuropathic pain questionnaire (AOR = 1.34, 95% CI: 1.05–1.70, p = 0.017) were associated with past-year stimulant use to treat pain.

Conclusion

Stimulants may be used for pain self-management, particularly for neuropathic pain and among women. Our findings suggest an underexplored motivation for stimulant use in an era of reduced access to prescribed opioids.

Keywords:

• Chronic pain
• pain management
• stimulants
• methamphetamine
• cocaine
• safety-net clinic

Acknowledgments

The authors would like to thank Nimah Haq, Rita Bagnulo, Wiley Kornbluh, Deeqa Mohamed, and Amy Rodriguez for their work on the COPING study, and the participants for sharing their time and experiences.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributors

CMB conceived of manuscript concept and led manuscript development, with input from all authors. VMM conducted the data analysis and contributed to manuscript writing. JA coordinated the study and oversaw data collection. CMB and AT conducted study visits and collected study data. MSA, MK, GS, and POC provided expert consultation. POC conceived of and oversees the COPING study.

Additional information

Funding

This work was supported by National Institutes of Health grants 5R01DA040189 and K24DA042720.