Pain in methadone patients: Time to address undertreatment and suicide risk (ANRS-Methaville trial)

Sandra Nordmann (1, 2) , Antoine Vilotitch (1, 2) , Caroline Lions (1, 2) , Laurent Michel (3, 4) , Marion Mora (1, 4) , Bruno Spire (1, 2) , Gwenaelle Maradan (2, 1) , Marc-Karim Bendiane (2, 1) , Alain Morel (5) , Perrine Roux (1, 2) , Patrizia Carrieri (1, 2)

1 SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
2 ORS PACA - Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille]
3 UMR_S 669 - Troubles du comportement alimentaire de l'adolescent
4 Centre Pierre Nicole [Paris]
5 Oppelia [Paris]

BACKGROUND: Pain in opioid-dependent patients is common but data measuring the course of pain (and its correlates) using validated scales in patients initiating methadone treatment are sparse. We aimed to assess pain and its interference in daily life, associated correlates, and undertreatment before and during methadone treatment. METHODS: This is a secondary analysis using longitudinal data of a randomized trial comparing two methadone initiation models. We assessed the effect of methadone initiation and other correlates on pain intensity and interference (using the Brief Pain Inventory) at months 0, 6 and 12 using a mixed multinomial logistic regression model. RESULTS: The study group comprised 168 patients who had data for either pain intensity or interference for at least one visit. Moderate to severe pain was reported in 12.9% of patients at M0, 5.4% at M6 and 7.3% at M12. Substantial interference with daily functioning was reported in 36.0% at M0, 14.5% at M6 and 17.1% at M12. Of the 98 visits where patients reported moderate to severe pain or substantial interference, 55.1% reported no treatment for pain relief, non-opioid analgesics were reported by 34.7%, opioid analgesics by 3.1% and both opioid and non-opioid analgesics by 7.1%. Methadone was associated with decreased pain intensity at 6 months (OR = 0.29, p = 0.04) and 12 months (OR = 0.30, p = 0.05) of follow-up and tended to be associated with substantial pain interference. Suicide risk was associated with both pain intensity and pain interference. CONCLUSIONS: Methadone in opioid-dependent patients can reduce pain. However, undertreatment of pain in methadone patients remains a major clinical concern. Patients with pain are at higher risk of suicide. Adequate screening and management of pain in this population is a priority and needs to be integrated into routine comprehensive care.

Domaines: Santé publique et épidémiologie; Toxicologie

Sandra Nordmann, Antoine Vilotitch, Caroline Lions, Laurent Michel, Marion Mora, et al.. Pain in methadone patients: Time to address undertreatment and suicide risk (ANRS-Methaville trial). PLoS ONE, 2017, 12 (5), pp.e0176288. ⟨10.1371/journal.pone.0176288⟩. ⟨inserm-01985280⟩