Inability to manage negative emotional and somatic stress is associated with opioid misuse in adults with chronic pain, according to a study published in the Journal of Pain.
Previous research suggests those with chronic pain who misuse their opioids exhibit higher levels of distress in general, as well as heightened reactivity to that distress.
Kathryn McHugh, PhD, McLean Hospital, Belmont, Massachusetts, and colleagues investigated if high distress intolerance would make patients with chronic pain more likely to misuse opioid analgesics.
Distress intolerance was defined as the perceived or actual inability to cope with adverse somatic or emotional stress.
The study evaluated 51 participants from the pain management clinic at Brigham and Women’s Hospital, Boston, Massachusetts. Subjects completed questionnaires and self-reports probing for pain severity, pain thresholds, distress intolerance, and opioid misuse.
Results showed that self-reported distress intolerance was significantly associated with opioid misuse. For every 1-unit increase in the Distress Intolerance Index, the likelihood of being in the opioid misuse group was 12% higher. Of the 51 study subjects, 31 met criteria for opioid misuse.
“This study found robust differences in distress intolerance between adults with chronic pain, with and without opioid medication misuse,” said Dr. McHugh. “Distress intolerance may be a relevant marker of risk for opioid misuse among those with chronic pain.”
However, distress intolerance was not associated with greater pain sensitivity but was linked with higher pain-related anxiety.
The authors noted that distress intolerance is targeted extensively in cognitive behavioural therapy and can be modified with treatment.