In an era when people are increasingly using pain medication to manage chronic pain, there’s a growing body of research that suggests there may be a relationship between pain clinics and pain medication use.
It’s not clear whether this link exists for all patients, or whether the link is stronger in certain patients.
But a growing number of studies have found that patients with chronic pain often use more pain medication than their peers with no existing symptoms, and that they are at greater risk for developing other conditions.
In particular, the National Institutes of Health’s Pain Center has found that pain clinics are more likely to prescribe opioids, including the opiate hydrocodone, compared to pain clinics with no patients.
Opioid prescriptions are now common in pain clinics, with more than half of patients using at least one opioid over the past five years.
“There’s definitely an association between pain clinic use and pain medications,” says Amy Smith, an associate professor of medicine at Harvard Medical School who was not involved in the Pain Center study.
In a survey of 9,000 U.S. adults conducted by Pain Center in 2017, nearly 80 per cent of the respondents had taken pain medication.
Other studies have suggested that pain patients are less likely to use pain medications than non-pain patients.
In fact, the majority of pain clinic patients are opioid dependent.
“I would argue that pain clinic access may be the single greatest risk factor for opioid dependence in the United States,” says Paul Reisman, a professor of psychiatry at the University of Texas at Austin.
“This is a very large group of patients, who are getting treatment with very little benefit.”
Pain clinic patients may be less likely than the general population to receive opioids from a primary care provider, and are less able to access treatment in a community setting, Smith says.
And patients who are opioid-dependent may not be able to find pain medication from a doctor who is familiar with pain management.
A 2016 study of pain clinics found that fewer than 20 per cent used opioids in general practice and pain clinics.
There were more opioid-related hospitalizations and emergency department visits among pain clinic residents than the rest of the population, and patients in pain clinic settings had higher levels of medication use compared to patients in non-specialty facilities.
There is some evidence that pain care clinics may be more effective than other settings in helping patients with a chronic pain condition manage their condition, and therefore may be better at reducing the use of opioids.
Smith says pain clinics may also be more responsive to patient requests for medical care, with some patients choosing to visit a pain clinic because they are more willing to take their medications.
But she cautions that it’s not yet clear whether there is an association at all between pain care clinic use or pain medication misuse.
“It’s possible that some patients are being treated with less medication because they’re using a pain care provider or clinic less often than others,” Smith says, “but I don’t know that this is a causal relationship.”
Pain clinics may still be a useful resource for people who have no existing conditions, but are vulnerable to developing new conditions, she says.
“People are very reluctant to admit that they have a chronic condition and they are very resistant to admit to taking medications,” she says, adding that it may be that some pain clinics will be able help those who may not have existing conditions to access care.
In 2016, a large survey of pain care providers by the Pain Centre found that more than one-third of patients reported that they had received opioid treatment in the past year, but only 10 per cent had used opioids for the first time.
Pain care providers also report a higher proportion of patients who had used opioid analgesics for the past 12 months compared to non-physician patients, suggesting that patients who have been prescribed opioids in the last 12 months are at higher risk for addiction, Smith adds.
Pain clinics have an ethical obligation to provide pain care to their patients, and the National Institute of Health is actively monitoring the situation, says Smith.
“As pain care is becoming increasingly common, there is a growing awareness of the ethical obligations of pain providers,” she adds.
“Physicians need to take responsibility for their patients and the patients need to be responsible for their doctors.”