Factors Associated with Pain Treatment Satisfaction Among Patients with Chronic Non-Cancer Pain and Substance Use

Introduction: A better understanding of pain treatment satisfaction in patients with chronic noncancer pain (CNCP) and substance use is needed, especially as opioid prescribing policies are changing. We sought to identify factors associated with pain treatment satisfaction in individuals with CNCP on recent opioid therapy and prior or active substance use. Methods: An exploratory cross-sectional analysis using baseline data from a cohort study of 300 adults with CNCP receiving > 20 morphine milligram equivalents of opioids for ≥ 3 of the preceding 12 months and prior or active substance use. Participants completed interviews, clinical assessments, urine drug screening, and medical chart review. Results: Participants were predominantly middle-aged (mean age 57.5 years), Black (44%), and cisgender men (60%). One-third (33%) had high, 28% moderate, and 39% low pain treatment satisfaction. Post-traumatic stress disorder (PTSD), tobacco use, past-year opioid discontinuation, and higher average pain scores were associated with lower satisfaction. HIV and prescription cannabis use were associated with higher satisfaction. Conclusions: The relationship between PTSD and tobacco use with lower satisfaction should be explored to augment pain outcomes. Higher satisfaction among individuals with HIV and prescription cannabis use presents potential research areas to guide CNCP management and reduce reliance on opioid therapies. ( J Am Board Fam Med 2021;34:1082–1095.) medications including tricyclic antidepressants (amitriptyline, desipramine), serotonin-norepinephrine reuptake inhibitors (duloxetine, venlafaxine), migraine medications (sumatriptan, fi oricet, midrin, ergotamine, topiramate), and antiseizure medications (valproic acid).