Pain Predicts Opioid Use Disorder

Columbia University Medical Center researchers who wanted to explore the correlation between levels of pain and subsequent prescription opiate abuse in the noninstitutionalized U.S. population suggest that more painful conditions contribute to the risk of use disorders.

Published online July 22, 2016 in The American Journal of Psychiatry, the first-of-its-kind study found that patients with moderate to severe pain were 41% more like to develop prescription opioid use disorders than patients without this pain, regardless of other demographic and clinical factors.

For the study, the investigators used the National Epidemiologic Survey on Alcohol and Related Conditions to prospectively assess the interdependency of pain and prescription opioid use disorder among 34,000 adult participants at wave 1 and, three years later, at wave 2. In the study, “Pain was measured with a 5-point scale of pain-related interference in daily activities and dichotomized as “no pain” (no or little interference) or “pain” (moderate to extreme interference).”

Structured interviews (the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version) were used to assess prescription opioid use disorder. Other covariates included age, gender, anxiety or mood disorders, and family history of drug, alcohol, and behavioral problems.

Both at baseline and at 3-year follow-up, pain and prescription opioid use disorders were significantly associated with one another in the structural equation model. “However, whereas pain at baseline was also significantly associated with prescription opioid use disorder at follow-up, prescription opioid use disorder at baseline was not associated with pain at follow-up,” wrote the study authors. “These associations were independent of several background demographic and clinical characteristics.”

Study participants who reported pain and those with prescription opioid use disorders were also more likely than others to report recent substance use, mood, or anxiety disorders or have a family history of alcohol use disorder. Men and younger adults were also at increased risk of prescription opioid use disorders, confirming findings from previous research. Women and older adults were more likely to report pain, when compared with others.

“These findings indicate that adults who report moderate or more severe pain are at increased risk of becoming addicted to prescription opioids,” said senior author Mark Olfson, MD, MPH, a professor of psychiatry at Columbia University Medical Center. “In light of the national opioid abuse epidemic, these new results underscore the importance of developing effective, multimodal approaches to managing common painful medical conditions… In evaluating patients who present with pain, physicians should also be attentive to addiction risk factors such as age, sex and personal or family history of drug abuse. If opioids are prescribed, it is important for clinicians to monitor their patients carefully for warning signs of opioid addiction.”