{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:07:29Z","timestamp":1787018849708,"version":"build-2736575974"},"reference-count":121,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2008,8,1]],"date-time":"2008-08-01T00:00:00Z","timestamp":1217548800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can J Psychiatry"],"published-print":{"date-parts":[[2008,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To review the problem of chronic pain in patients with substance use disorders, focusing on the prevalence of chronic pain in patients with substance dependence disorders, especially prescription opioid dependence, associated comorbidities, and the impact on drug abuse treatment response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>We identified relevant articles using PubMed from 1987 to 2008. Additional articles were obtained from the reference lists of key reviews of relevant topics. Studies were included if they investigated the relation between chronic pain and substance use disorders. Of particular interest were articles that proposed integrated treatment for both problems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The high prevalence of chronic pain syndromes was only recently explored in patients seeking treatment for drug abuse. The presence of chronic pain increases the risk of poor response to substance abuse treatment and an increased likelihood of multiple comorbidities that further add to the negative impact experienced by patients with substance dependence disorders. Substance abuse treatment programs offering integrated medical and psychiatric care for these comorbidities improve outcomes, with stepped care approaches offering the best treatment by tailoring the level of care to the individual patient's needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Substance abuse treatment programs should expand their services to address the comorbidities likely to pose barriers to successful drug rehabilitation. Given the high prevalence and negative impact of chronic pain, new pain management services should be integrated within the drug treatment program and adapted as patients demonstrate the need for more intensive treatment. If applied to the problem of chronic pain, a model substance abuse treatment program of integrated stepped care would improve outcomes for patients with both devastating disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectif:<\/jats:title>\n                    <jats:p>Examiner le probl\u00e8me de la douleur chronique chez les patients souffrant de troubles d'utilisation de substances, en mettant l'accent sur la pr\u00e9valence de la douleur chronique chez les patients souffrant de troubles de d\u00e9pendance aux substances, en particulier de d\u00e9pendance aux opiac\u00e9s sur ordonnance, les comorbidit\u00e9s associ\u00e9es, et l'effet sur la r\u00e9ponse au traitement de l'abus de drogues.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>M\u00e9thode:<\/jats:title>\n                    <jats:p>Nous avons relev\u00e9 les articles pertinents \u00e0 l'aide de PubMed, de 1987 \u00e0 2008. Les articles additionnels ont \u00e9t\u00e9 obtenus \u00e0 m\u00eame les bibliographies des \u00e9tudes cl\u00e9s de sujets pertinents. Les \u00e9tudes \u00e9taient incluses si elles exploraient la relation entre la douleur chronique et les troubles d'utilisation de substances. Les articles qui proposaient un traitement int\u00e9gr\u00e9 des deux probl\u00e8mes rev\u00eataient un int\u00e9r\u00eat particulier.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>R\u00e9sultats:<\/jats:title>\n                    <jats:p>La pr\u00e9valence \u00e9lev\u00e9e des syndromes de douleur chronique n'a \u00e9t\u00e9 explor\u00e9e que r\u00e9cemment chez les patients cherchant un traitement pour abus de drogues. La pr\u00e9sence de la douleur chronique accro\u00eet le risque d'une r\u00e9ponse m\u00e9diocre au traitement de l'abus de substances et accro\u00eet aussi la probabilit\u00e9 de comorbidit\u00e9s multiples qui ajoutent encore aux r\u00e9percussions n\u00e9gatives que connaissent les patients souffrant de troubles de d\u00e9pendance aux substances. Les programmes de traitement de l'abus de substances offrant des soins m\u00e9dicaux et psychiatriques int\u00e9gr\u00e9s pour ces comorbidit\u00e9s ont de meilleurs r\u00e9sultats, et les approches de soins par paliers offrent le meilleur traitement en personnalisant le niveau des soins selon les besoins individuels du patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Les programmes de traitement de l'abus de substances devraient d\u00e9velopper leurs services pour aborder les comorbidit\u00e9s aptes \u00e0 faire obstacle \u00e0 un r\u00e9tablissement r\u00e9ussi de l'usage de drogues. \u00c9tant donn\u00e9 la pr\u00e9valence \u00e9lev\u00e9e et les r\u00e9percussions n\u00e9gatives de la douleur chronique, de nouveaux services de soulagement de la douleur devraient \u00eatre int\u00e9gr\u00e9s au programme de traitement de l'abus de drogues, et adapt\u00e9s \u00e0 mesure que les patients d\u00e9montrent le besoin d'un traitement plus intensif Si on l'applique au probl\u00e8me de la douleur chronique, un programme mod\u00e8le de traitement de l'abus de substances comportant des soins par paliers int\u00e9gr\u00e9s am\u00e9liorerait les r\u00e9sultats pour les patients souffrant des deux troubles d\u00e9vastateurs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/070674370805300804","type":"journal-article","created":{"date-parts":[[2017,1,13]],"date-time":"2017-01-13T15:03:37Z","timestamp":1484319817000},"page":"496-508","source":"Crossref","is-referenced-by-count":41,"title":["Assessment and Management of Chronic Pain in Individuals Seeking Treatment for Opioid Dependence Disorder"],"prefix":"10.1177","volume":"53","author":[{"given":"Michael R","family":"Clark","sequence":"first","affiliation":[{"name":"Associate Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine; Director, Chronic 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