Leslie W. Suen, MD; Vanessa M. McMahan, PhD; Christopher Rowe, PhD; Sumeet Bhardwaj, MD; Kelly Knight, PhD; Margot B. Kushel, MD; Glenn-Milo Santos, PhD; Phillip Coffin, MD
Corresponding Author: Leslie Suen, MD; UCSF National Clinician Scholars Program - Philip R. Lee Institute of Health Policy Studies. Email: Leslie.Suen@ucsf.edu
Section: Original Research
Publication: 11/11/2021
Introduction: A better understanding of pain treatment satisfaction in individuals with chronic non-cancer 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 prospective cohort study of 300 adults with CNCP receiving >20 morphine milligram equivalents (MME) of opioids for >3 of the preceding twelve months and prior or active substance use. We recruited from the San Francisco Health Network (SFHN), a network of clinics serving publicly insured and uninsured patients in San Francisco. 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) (AOR 0.6, 95%CI 0.3-0.9), tobacco use (AOR 0.6, 95%CI 0.4-0.9), past-year opioid discontinuation (AOR 0.4, 95%CI 0.2-0.9), and higher average pain scores (AOR 0.9, 95%CI 0.8-1.0) were associated with lower satisfaction. HIV (AOR 1.6, 95% CI 1.0-2.7) and prescription cannabis use (AOR 1.7, 95% CI 1.0-2.7) 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 present potential research areas to guide CNCP management and reduce reliance on opioid therapies.