Pain Patient Stereotyping?

By Kyle Ramsey

Posted: 6/29/10

A new study proposes a series of risk factors for identifying primary-care patients with chronic pain who are most likely to abuse prescription medications and other drugs. However, there are some hazards inherent in applying such stereotypes in everyday clinical practice.

There is a controversy revolving around who should and should not receive pain medication for fear of dependency risks and other contributing factors. From a patient prospective, this study over which patients are more likely to abuse drugs has a clear-cut effect on these pain patients.

Which patients were most likely to be drug/substance abusers? 

In adjusted analyses, compared with those not having any current or past drug/substance use disorder, those with PDUD were 5 times more likely to report having spent time in jail, 3.4 times more likely to have a family history of SUD, and 3.6 times more likely to smoke cigarettes. Additionally, those with PDUD were 3.8 times more likely to have greater pain-related disability, and to be white, male, and/or have PTSD. Except for race, the same factors also predicted having another SUD, as compared with those without any drug/substance-use problem. Insurance coverage, employment, income, education, and age were not associated with drug/substance use disorders of any type in this sample.

According to lead author Jane M. Liebschutz, MD, MPH, FACP, quoted in a news article, "These data strongly suggest that physicians treating patients with pain should assess for substance use disorder prior to prescribing opioid analgesics. This research may help direct care, including treatment for substance use disorders, as primary care physicians may not be as aware of the overlap between pain and addictions. In particular, physicians may not think of assessing for time spent in jail, which was the largest predictor of having PDUD" [Medical News Today 2010].

This study simply reminds us to be wary of biased studies which could have detrimental effects on the future of pain medicine. SB. Leavitt, MA, PhD had this to add: “According to this research, any patient with chronic pain should be suspected of being likely to abuse prescribed medications and/or other drugs if they are a white male with severely disabling pain, spent time in jail, smokes cigarettes, has a family history of substance abuse, and/or suffers from post-traumatic stress disorder. Using commonly available assessment instruments, these factors can be readily identified and, presumably, the more factors evident in a patient the more strikes against him.”

Dr. Leavitt also suggested that there was a flaw in this line of research, saying, “First, the high 42% prevalence of prescription drug abuse and/or other substance-use disorders found in this study seems to characterize the particular and limited inner-city population examined but would doubtfully be typical of most primary care medical practices; so, its external validity must be questioned. Second, even if the factors predisposing to prescription drug abuse are valid, this sort of stereotyping (recently disparaged as “profiling”) could be misleading and, if inappropriately applied, could encourage mistreatment or undertreatment of patients with pain. In effect, this line of research — which was funded by the National Institute of Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism — raises “red flags” that may be somewhat arbitrary and it does not suggest any solutions for managing risk factors while still providing proper and adequate pharmacologic pain management.”

There is a definite problem with this type of research as it presents a decidedly biased view of pain patients that could, as Dr. Leavitt suggests, be misleading and attribute to future drug distribution practices. Indeed, this type of thinking is no better than any other type of prejudice. Thus, this article has a direct affect on Pain.com patients and should the voting lines be drawn from such research, there is a bleak future in store for pain sufferers.

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SOURCE: Pain-Topics