Health care experiences when pain and substance use disorder coexist: "just because i'm an addict doesn't mean i don't have pain".

OBJECTIVE: To report the health care experiences of 34 individuals with coexisting substance use disorder (SUD) and chronic pain.
DESIGN: Narrative inquiry qualitative study of 90-minute interviews.
SETTING: Midwest metropolitan methadone clinic.
SUBJECTS: All individuals had SUD and were treated for SUD with methadone. They all self-identified as having pain longer than 6 months.
METHODS: This qualitative design allowed exploration of how participants made sense of events related to living with SUD and chronic pain. Narrative inquiry gives a consistent story from the participants' perspective, and researchers can perform additional analysis using the storyline. Thematic analysis occurred of their health care experiences.
RESULTS: Results revealed that participants 1) spoke about how they used deception to obtain opioids when their drug cravings were out of control; 2) were disturbed by health care providers having little understanding or ability to help them with their painful condition; 3) felt they wanted to abuse opioids again when receiving poor treatment by the health care team; 4) related what went well in their health care to help them maintain their sobriety; and 5) recommended improvements on health care interventions that included effective treatment of pain.
CONCLUSIONS: Coexisting chronic pain and SUD create unique health care needs by mutually activating and potentiating the other. There are very few comparable studies exploring the experiences of individuals when pain and SUD coexist. The health care team can better develop treatment plans and test interventions sensitive to their unique needs when they understand the experiences of this population. Wiley Periodicals, Inc.