Stimulant use for self-management of pain among safety-net patients with chronic non-cancer pain.
Post written by Cathleen Beliveau
The Cohort Study of Opioids, Pain, and Safety in an era of Changing Policy (COPING) study at the Center on Substance Use and Health follows a cohort of 300 people with chronic pain who had long-term opioid prescriptions. Research from this participant cohort was recently published in a paper that looks at illicit stimulant use, such as methamphetamine and cocaine, to treat pain.
As a Research Associate on the COPING study, I frequently heard participants say that they used stimulants as a way to manage their pain, and I was curious to see if there was any research on the subject. A literature search turned up just a few research articles, which seemed to show that stimulants could help relieve pain.
This paper, published in the New England Journal of Medicine by Forrest et al. in 1977, showed that when combined with an opioid (like morphine), dextroamphetamine (a stimulant similar to amphetamine) could enhance pain relief in post-operative patients.
This study by Pud et al. from 2017 showed that methylphenidate (a stimulant also known by the brand name Ritalin) by itself increased pain threshold and pain tolerance as measured by the cold pressor test. This means stimulants could increase someone’s ability to deal with, or decrease their sensitivity to, pain.
However, there were only a few articles that included any discussion of people who actually used illicit stimulants to treat their own pain. To better understand the motivations participants described, Vanessa McMahan, PhD, and I conducted an analysis on the baseline (enrollment) data from the COPING study to determine how many people reported using stimulants for pain.
Of the 300 people in the COPING study, 105 people reported using any illicit stimulant (like methamphetamine or cocaine) in the past year. Fifty-five of these people said they used stimulants to treat their pain in the past year and 50 said they did not. We also found that people with more symptoms of neuropathic pain, which is pain due to damage in the nervous system, and patients who reported female gender were more likely to use stimulants to treat their pain.
These are exciting results! We now have evidence that a substantial number of people use stimulants to treat their pain. No previous paper has specifically focused on people who use stimulants to treat chronic pain. This research brings up more questions than it answers – how often do people use stimulants for pain? How do stimulants relieve pain, and is this different for different people? Do people experience more pain relief when using in combination with opioids or without? How does this impact overdose risk? Are there any long-term effects (helpful or not) of using stimulants for pain? We don’t have any of these answers yet, but we hope to be able to study these questions in the future. In particular, we are thrilled to have the opportunity in research to listen to patient voices.
Beliveau CM, McMahan VM, Arenander J, Angst MS, Kushel M, Torres A, Santos GM, Coffin PO. Stimulant use for self-management of pain among safety-net patients with chronic non-cancer pain. Subst Abus. 2021 Apr 2:1-8.