Substance abuse among patients with chronic back pain

BACKGROUND. Little is known about substance use and substance use disorders among primary care patients with chronic back pain. This study compared groups of patients with and without chronic back pain for the prevalence of substance use and substance use disorders. It also assessed the temporal relationship between the onset of chronic back pain and that of substance use disorders. METHODS. Adult patients aged 18 to 59 years who made three or more visits for back pain to a family practice clinic were eligible for the pain group. The comparison group consisted of a random sample of patients of the same ages who made appointments with the same clinic. A validated diagnostic interview about substance use disorders and other issues related to substance use was administered. RESULTS. Ninety-two percent of the patients in the chronic pain group reported severe pain, high disability, and severe to moderate limitation of activity. Two thirds (67%) of this group reported having continuous pain, and 21% experienced at least one episode of pain daily. Forty-four percent said their pain continously interfered with their activities, and 31% reported daily disruption of activity. There was little difference, however, in the adjusted rates of lifetime and current substance use disorders between the chronic pain and comparison groups. Lifetime prevalence rates were 54% for the pain group and 52% for the comparison group; current prevalence rates were 23% for both the pain and comparison groups. Substance abuse preceded the onset of pain by as much as 20 years for 77% of patients with chronic pain who had current substance use disorders and 63% of those who had lifetime substance use disorders. CONCLUSIONS. Chronic back pain did not connote special risk for current substance use disorders.