Neurological

Illegal use of stimulants to treat chronic pain in women with neuropathic pain

Stimulants like methamphetamine and cocaine are widely used to treat chronic pain without cancer, especially in people with neuropathic pain and in women. This is evident from research published in Substance Abuse.

Some clinical and in vivo studies across different types of pain suggest that stimulants may have analgesic properties. Qualitative studies have reported the prevalence of cocaine or methamphetamine use for pain management in people with HIV.

To assess the relationship between pain management and stimulant use in people with chronic pain, researchers conducted an exploratory analysis of the characteristics associated with reporting stimulant use in patients who were on COPING during a period of change. Pain and safety) participate policy) study. COPING is an ongoing cohort study investigating changes in pain, functional status and substance use in response to changes in the availability of prescribed opioids in patients with chronic pain without cancer.

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For the current study, the researchers used the available basic data. Stimulant use was defined as any reported use of methamphetamine or speed, cocaine or crack cocaine in the previous year. Of the 440 eligible participants, 300 took part in the current study (mean age 57 ± 8.2 years; 61% men; 45% Black or African American; 77% were homeless).

About 35% of COPING participants reported using stimulants illegally in the past year. 37% of them used cocaine or crack cocaine, 31% had methamphetamine (or speed) and 31% used both cocaine or crack cocaine and methamphetamine. Eight participants reported using nonprescription stimulants that they had not been prescribed in addition to nonprescription stimulants during the study period.

Of those who reported methamphetamine use, 35% used it less than once a month, 27% 1 to 3 days a month, 11% 1 to 2 days a week, 6% 3 to 4 days, 6% 5 to 6 days each Week and 15% used daily. Among those who reported cocaine or crack cocaine use, 29%, 24%, 22%, 13%, 6% and 7% did so over the same period.

Participants who reported using stimulants in the past year were generally slightly younger (mean age 56 ± 8.5 versus 58 ± 7.9) and more were HIV positive (54% versus 25%). The sex differed significantly, with a higher proportion of users in the past year being men (69% versus 56%) or transgender / other sex (5% versus 3%), while a lower proportion of women in the past year (27%) reported on consumption. vs 41%) compared to those who did not use stimulants.

A high proportion of participants who used stimulants said they had ever been homeless (86% versus 72%), but 92% of participants who used stimulants said they had been housed for most of the past year.

Just over half (52%) of those who reported using stimulants in the past year said they used stimulants to manage pain. Those who reported using stimulants to manage pain generally had a higher level of education (62% vs. 42%) and were ever homeless (93% vs. 78%) compared to participants who did not use stimulants Reported pain treatment. Those who reported stimulant use in connection with pain management also reported moderate or severe depression (49% versus 28%).

No difference in cold pain threshold or tolerance was found (median 7.48 and 13.2, respectively). No difference in use of neuropathic pain relievers or medical marijuana was found between the groups, but a higher proportion of participants who used stimulants to manage pain later reported prescribing other non-opioid pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (42% vs. 20%).

The results of a multivariable regression analysis indicated that the Douleur Neuropathique 4 (DN4) score and being a woman were significantly associated with the use of stimulants to manage pain. Each 1 point increase on the DN4 scale was associated with a 1.34-fold adjusted probability of reporting stimulant use to manage pain (95% CI, 1.05-1.70), while women had a 3, Had a 20-fold adjusted probability compared to men (95% CI, 1.06-9.63).

One of the limitations of the study is its lack of generalizability outside of patients in San Francisco Bay who have been prescribed opioids for chronic pain and who have used illicit substances in the past. the use of self-reported data concerning sensitive and illegal behavior that may have skewed the information available; and no measurement of concurrent or sequential opioid use.

Future studies, the researchers wrote, should “examine the use of poly-substances for non-medical reasons or for self-medication, and longitudinally examine patients to understand the temporal relationship between opioid responsibility and stimulant use for pain.”

“To the best of our knowledge, this is the first report to focus on the use of stimulants for pain self-management,” the researchers concluded. “Our findings provide an opportunity for providers to discuss the use of stimulants as a possible part of pain self-management routines with their patients.”

reference

Beliveau CM, McMahan VM, Arenander J. et al. Using stimulants to self-manage pain in safety net patients with chronic, non-cancer pain. Subst Abus. Published online April 2, 2021. doi: 10.1080 / 08897077.2021.1903654

This article originally appeared on Clinical Pain Advisor

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