Background & Aims

Opioid misuse, that is, taking opioids differently than prescribed, including overuse, is common in people with chronic non-cancer pain (CNCP). In addition, there is evidence that suffering from post-traumatic stress disorder (PTSD) increases the risk of developing opioid misuse after contact with this medication. It has been suggested that transdiagnostic vulnerability variables may underline this. In this line, impulsivity has been related to both opioid misuse (Vest et al., 2016) and PTSD (Netto et al., 2016). Also, anxiety sensitivity has been shown to be associated with opioid misuse, increased PTSD symptoms, and greater perceived pain (Lies et al., 2017; Rogers et al., 2019). The study aimed to examine a hypothetical model of the joint contribution of impulsivity, and anxiety sensitivity to PTSD symptoms and pain intensity. Also, both PTSD symptoms and pain intensity are expected to be associated with opioid misuse.

Methods

The study sample comprised 221 people (165 women and 56 men) with CNCP, receiving opioid treatment and who have suffered trauma throughout their lives. A hypothetical model was tested via structural equation modelling. Maximum likelihood estimation and the robust estimation method were used for the analyses, following the recommendations of Byrne (2010).

Results

The final empirical model showed a good fit to the data. The impulsivity had a direct positive path to PTSD. Anxiety sensitivity shown two statistically significant positive paths coefficients: one to PTSD and one to pain intensity. Also, anxiety sensitivity and PTSD (but not pain intensity) had a direct path to opioid misuse.

Conclusions

The findings provide evidence that PTSD and anxiety sensitivity are two variables that could directly increase opioid misuse. However, pain intensity could not be related to this misuse. These results could indicate that people with chronic pain resort to misusing opioids not to reduce their perceived pain intensity but to calm the psychological discomfort derived from PTSD or sensations associated with the experience of anxiety.

References

Vest, N., Reynolds, C. J., & Tragesser, S. L. (2016). Impulsivity and risk for prescription opioid misuse in a chronic pain patient sample. Addictive behaviors, 60, 184-190.
Fogle, B. M., Kabel, K., Shepherd, J. M., et al. (2023). Posttraumatic stress and distress tolerance in relation to opioid misuse and dependence among trauma-exposed adults with chronic pain. Experimental and clinical psychopharmacology, 31(5), 953–962.
Lies, J., Lau, S. T., Jones, et al., (2017). Predictors and moderators of post-traumatic stress disorder: An investigation of anxiety sensitivity and resilience in individuals with chronic pain. Annals of the Academy of Medicine, 46(3), 102–110.
Rogers, A. H., M.A, Kauffman, B. Y., M.A, Bakhshaie, J., M.D, et al. (2019). Anxiety sensitivity and opioid misuse among opioid-using adults with chronic pain. The American journal of drug and alcohol abuse, 45(5), 470–478.
Byrne, B. (2010). Structural equation modelling with AMOS. L.E.A.

Presenting Author

Elena R. Serrano-Ibáñez

Poster Authors

Elena R. Serrano-Ibáñez

MD, PhD

Universidad de Málaga

Lead Author

E-mail

Victoria Barrado-Moreno

University of Malaga

Lead Author

E-mail

Carmen Ramírez-Maestre

PhD

Universidad de Málaga, IBIMA Plataforma BIONAND, Malaga, Spain

Lead Author

E-mail

Alicia Eva López-Martínez

Universidad de Málaga, IBIMA Plataforma BIONAND, Malaga, Spain

Lead Author

E-mail

José Manuel González-Mesa

Hospital Clínico Universitario Virgen de la Victoria, Malaga, Spain

Lead Author

E-mail

Milagros Rivera Pérez

Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain

Lead Author

E-mail

Jose Antonio Reinaldo Lapuerta

Hospital Costa del Sol, Marbella, Spain

Lead Author

E-mail

M. Teresa Asenjo

Centro de Salud Cruz de Humilladero, Málaga, Spain

Lead Author

E-mail

Pedro Vega Montes

Centro de Salud El Consul, Málaga, España

Lead Author

E-mail

Topics

  • Mechanisms: Psychosocial and Biopsychosocial