Severity and interference of chronic pain in methadone-maintained outpatients

Pain Med. 2014 Sep;15(9):1540-8. doi: 10.1111/pme.12430. Epub 2014 Apr 7.


Objectives: Patients with opioid use disorder maintained on methadone report more chronic pain than the general population. The current study characterized chronic pain in patients with opioid use disorder.

Design: A one-time self-report survey.

Setting: The Addiction Treatment Services methadone-maintenance clinic, located on the campus of Johns Hopkins Bayview Medical Center in Baltimore MD.

Subjects: A convenience sample of 227 methadone-maintained patients.

Methods: Participants completed a one-time self-report administration of the brief pain inventory (BPI) and a demographic survey; additional treatment variables were obtained directly from clinic records.

Results: Sixty percent of the sample endorsed chronic pain. Patients with pain were significantly older, had a higher mean methadone dose, and provided more benzodiazepine-positive urine samples. Pain was primarily located in the lower extremities (59%) and back (51%), and mean BPI severity and interference subscale scores were 5.7 and 5.4 out of 10, respectively. Logistic regressions indicated that age (P < 0.001) and methadone dose (P < 0.001) were significantly associated with having pain and that pain was a significant predictor of benzodiazepine use (P = 0.01). Only 13% (N = 18) of patients with pain were receiving pain management, and few were being treated with any nonopioid adjuvant analgesics. Yet patients who did receive treatment reported a mean 51% improvement in their pain, indicating they are not treatment refractory.

Conclusions: Results suggest there is a large discrepancy in the percent of patients who may need treatment for pain and those receiving treatment for pain and that more efforts should be made to provide standard pain management techniques to patients with opioid use disorder to reduce their overall level of pain and potentially improve their overall treatment outcomes.

Keywords: Chronic Pain; Methadone; Opioids.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Baltimore / epidemiology
  • Benzodiazepines / therapeutic use
  • Benzodiazepines / urine
  • Chronic Pain / drug therapy
  • Chronic Pain / epidemiology*
  • Chronic Pain / physiopathology
  • Cocaine / urine
  • Cocaine-Related Disorders / epidemiology
  • Cocaine-Related Disorders / urine
  • Comorbidity
  • Drug Tolerance
  • Female
  • Humans
  • Male
  • Methadone / administration & dosage
  • Methadone / therapeutic use*
  • Middle Aged
  • Opiate Substitution Treatment*
  • Opioid-Related Disorders / epidemiology
  • Opioid-Related Disorders / rehabilitation*
  • Outpatients / statistics & numerical data
  • Pain Measurement
  • Prevalence
  • Quality of Life
  • Sampling Studies
  • Self Report
  • Socioeconomic Factors


  • Benzodiazepines
  • Cocaine
  • Methadone