Background & Aims

Misuse of opioids among patients with chronic pain who are prescribed long-term opioid therapy is a concern [1]. Several psychological factors are associated with increased risk of opioid misuse, including symptoms of anxiety and depression (i.e., negative affect), catastrophic thinking, and the subjective desire to consume opioids (i.e., opioid craving) [2, 3]. Although low pain acceptance has consistently been linked to negative pain-related outcomes [4], its association with opioid craving and opioid misuse has remained largely unexplored. Aims: The first objective of this study was to examine the association between pain acceptance and daily opioid craving among patients with chronic pain on long-term opioid therapy. The second objective was to examine whether the association between pain acceptance and opioid craving was mediated by patients’ day-to-day levels of negative affect and catastrophic thinking. The association between pain acceptance and opioid misuse was then examined.

Methods

In this longitudinal diary study, patients (n = 100) were recruited from a tertiary care pain clinic and from the community. Patients underwent a baseline assessment during which a host of sociodemographic, clinical, and psychological variables were assessed. This included assessment of pain acceptance. Patients were then asked to complete daily diaries for 14 consecutive days. Daily diaries assessed pain intensity levels, psychological variables (i.e., negative affect, catastrophizing), and opioid-related variables (i.e., opioid craving, opioid misuse).

Results

Multilevel analyses revealed a significant association between pain acceptance and opioid craving (p < .001), with lower levels of pain acceptance being associated with higher levels of opioid craving. A multilevel mediation analysis revealed that the association between pain acceptance and opioid craving was mediated by daily catastrophizing (p < .005). This mediation effect remained significant even when controlling for patients' daily pain intensity levels and negative affect (p < .005). Finally, analyses indicated that lower levels of pain acceptance were linked to more frequent opioid misuse behaviors (p < 0.05).

Conclusions

In line with previous work, we found that lower pain acceptance was associated with heightened daily reports of pain intensity, negative affect, and catastrophizing. One of the novel findings from our study was the association between low pain acceptance and daily opioid craving. Interestingly, results from a mediation analysis suggested that low pain acceptance might contribute to greater daily catastrophic thinking, which in turn might contribute to opioid craving. Although speculative, patients characterized by low levels of pain acceptance and elevated catastrophic thinking might struggle to cope with pain without the use of medication, which in turn might increase opioid craving. This falls in line with our finding that low pain acceptance, daily catastrophizing, and opioid craving were all associated with more frequent opioid misuse behaviours.

References

1. Vowles, K.E., et al., Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain, 2015. 156(4): p. 569-76.
2. Martel, M.O., A. Bruneau, and R.R. Edwards, Mind-body approaches targeting the psychological aspects of opioid use problems in patients with chronic pain: evidence and opportunities. Transl Res, 2021. 234: p. 114-128.
3. Rogers, A.H., et al., Association of opioid misuse with anxiety and depression: A systematic review of the literature. Clin Psychol Rev, 2021. 84: p. 101978.
4. McCracken, L.M. and K.E. Vowles, Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. Am Psychol, 2014. 69(2): p. 178-87.
5. Garland, E.L., Psychosocial intervention and the reward system in pain and opioid misuse: new opportunities and directions. Pain, 2020. 161(12): p. 2659-2666.

Presenting Author

Amanda Sirois

Poster Authors

Amanda Sirois

BSc

McGill University

Lead Author

Emmanuelle Coutu-Nadeau

BSc

McGill University

Lead Author

Maria Verner

MSc

McGill University Health Centre

Lead Author

Alice Bruneau

McGill University

Lead Author

Jordi Perez

MD

McGill University

Lead Author

Marc O Martel

PhD

McGill University

Lead Author

Topics

  • Treatment/Management: Pharmacology: Opioid