Negative Affect-Related Factors Have the Strongest Association with Prescription Opioid Misuse in a Cross-Sectional Cohort of Patients with Chronic Pain.
OBJECTIVE
Increased opioid prescription to relieve pain among patients with chronic pain is associated with increased risk for misuse, potentially leading to substance use disorders and overdose death. We aimed to characterize the relative importance and identify the most significant of several potential risk factors for the severity of self-reported prescribed opioid misuse behaviors.


METHODS
A sample of 1,193 patients (mean age ± SD = 50.72 ± 14.97 years, 64.04% female) with various chronic pain conditions completed a multidimensional registry assessing four pain severity measures and 14 physical, mental, and social health status factors using the National Institutes of Health's Patient-Reported Outcomes Measurement Information System (PROMIS). A validated PROMIS measure of medication misuse was completed by 692 patients who endorsed currently taking opioid medication. Patients taking opioid medications were compared across all measures with those who do not take opioid medications. Subsequently, a data-driven regression analysis was used to determine which measures best explained variability in severity of misuse. We hypothesized that negative affect-related factors, namely anxiety, anger, and/or depression, would be key predictors of misuse severity due to their crucial role in chronic pain and substance use disorders.


RESULTS
Patients taking opioid medications had significantly greater impairment across most measures. Above and beyond demographic variables, the only and most significant predictors of prescribed opioid misuse severity were as follows: anxiety (β = 0.15, P = 0.01), anger (β = 0.13, P = 0.02), Pain Intensity-worst (β = 0.09, P = 0.02), and depression (β = 0.13, P = 0.04).


CONCLUSIONS
Findings suggest that anxiety, anger, and depression are key factors associated with prescribed opioid misuse tendencies in patients with chronic pain and that they are potential targets for therapeutic intervention.
['Gilam|Gadi|G|', 'Sturgeon|John A|JA|', 'You|Dokyoung S|DS|', 'Wasan|Ajay D|AD|', 'Darnall|Beth D|BD|', 'Mackey|Sean C|SC|']
D000328:Adult D000339:Affect D000786:Anger D001007:Anxiety D059350:Chronic Pain D015331:Cohort Studies D003430:Cross-Sectional Studies D003863:Depression D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009293:Opioid-Related Disorders D063487:Prescription Drug Misuse
Chronic Pain Prescribed Opioids Misuse Anxiety Anger Depression CHOIR