Exploring the Psychometric Properties of the Current Opioid Misuse Measure Among Adults With Chronic Pain and Opioid Use

Posttraumatic Stress and Opioid Use and Pain among Individuals with Probable Posttraumatic Stress Disorder and Self-Reported Chronic Pain: The Role of Health Literacy

BACKGROUND

Chronic pain and opioid misuse are a prevalent comorbidity with deleterious health outcomes. Growing work indicates that posttraumatic stress disorder (PTSD) can increase the risk for chronic pain and opioid misuse and dependence. However, there is little understanding of social determinants of health (SDoH) that may account for interrelations of PTSD with chronic pain and opioid misuse and dependence. Health literacy is one relevant SDoH construct, reflecting the ability to gather, process, and comprehend health-related information required to engage in a healthcare setting.

OBJECTIVE

The purpose of the present cross-sectional study was to examine the indirect effect of health literacy in the association between PTSD and opioid misuse, opioid dependence, pain intensity, and pain disability.

METHOD

The sample included 142 adults (Mage = 35.2, SD = 9.9; 67.4% female; 70.1% White/Caucasian) with self-reported chronic pain and probable PTSD who were using opioid medication.

RESULTS

Results demonstrated that PTSD symptom severity had a small indirect effect on opioid misuse and opioid dependence via health literacy; no indirect effects were evident for pain intensity and disability.

CONCLUSION

The present investigation provides evidence that health literacy may serve as an important explanatory factor in associations between PTSD symptom severity and opioid misuse and dependence among adults with co-occurring probable PTSD and chronic pain.

The prevalence of prescription opioid use and misuse among emergency department patients in The Netherlands

RATIONALE

Prescription opioid use and misuse have increased rapidly in many Western countries in the past decade. Patients (mis)using opioids are at risk of presenting to the emergency department (ED) with opioid-related problems. European data concerning prescription opioid (mis)use among the ED population is lacking.

AIMS AND OBJECTIVES

This study aims to determine prevalence of prescription opioid use, misuse, and opioid use disorder (OUD) among Dutch ED patients. Secondary objectives were to explore factors associated with prescription opioid misuse and the number of patients discharged with a new opioid prescription.

METHODS

In a cross-sectional multicenter study at three hospitals in the Netherlands, adult ED patients were screened for current prescription opioid use. Opioid users filled out questionnaires regarding opioid (mis)use, and underwent a structured interview to assess OUD criteria. The primary outcomes were prevalence rates of (1) current prescription opioid use, (2) prescription opioid misuse (based on a Current Opioid Misuse Measure [COMM] score > 8), (3) OUD, based on DSM-5 criteria. Independent T-tests, Pearson χ2 and Fisher's Exact tests were used to analyse differences in characteristics between groups.

RESULTS

A total of 997 patients were screened, of which 15% (n = 150) used prescription opioids. Out of 93 patients assessed, 22.6% (n = 21) showed signs of prescription opioid misuse, and 9.8% (n = 9, 95% CI: 4.5-17.8) fulfilled criteria for OUD. A medical history of psychiatric disorder was significantly more common in patients with prescription opioid misuse and OUD.

CONCLUSION

This study shows that prescription opioid use is relatively common in ED patients in the Netherlands, compared to the overall population. Over one fifth of these patients shows signs of opioid misuse or OUD. Awareness among ED personnel about the high prevalence of prescription opioid (mis)use in their population is critical for signalling opioid-related problems.

Opioid coping motives and pain intensity among adults with chronic low back pain: associations with mood, pain reactivity, and opioid misuse

Chronic low back pain (CLBP) is a significant public health problem that is associated with opioid misuse and use disorder. Despite limited evidence for the efficacy of opioids in the management of chronic pain, they continue to be prescribed and people with CLBP are at increased risk for misuse. Identifying individual difference factors involved in opioid misuse, such as pain intensity as well as reasons for using opioids (also known as motives), may provide pertinent clinical information to reduce opioid misuse among this vulnerable population. Therefore, the aims of the current study were to examine the relationships between opioid motives-to cope with pain-related distress and pain intensity, in terms of anxiety, depression, pain catastrophizing, pain-related anxiety, and opioid misuse among 300 (Mage= 45.69, SD = 11.17, 69% female) adults with CLBP currently using opioids. Results from the current study suggest that both pain intensity and motives to cope with pain-related distress with opioids were associated with all criterion variables, but the magnitude of variance explained by coping motives was larger than pain intensity in terms of opioid misuse. The present findings provide initial empirical evidence for the importance of motives to cope with pain-related distress with opioids and pain intensity in efforts to better understand opioid misuse and related clinical correlates among adults with CLBP.

Posttraumatic stress and pain-related anxiety among trauma-exposed adults with chronic pain in terms of opioid misuse and dependence

Trauma-exposure and posttraumatic stress symptoms increase risk for opioid-related problems in the context of chronic pain. Yet, there has been little exploration of moderators of the posttraumatic stress-opioid misuse association. Pain-related anxiety, defined as worry about pain and the negative consequences of pain, has shown relations to both posttraumatic stress symptoms and opioid misuse, and it may moderate the association between posttraumatic stress symptoms and opioid misuse, as well as dependence. The current study examined the moderating role of pain-related anxiety on the relationship between posttraumatic stress symptoms and opioid misuse and dependence among 292 (71.6 % female, M_age = 38.03 years, SD = 10.93) trauma exposed adults with chronic pain. Results indicated that pain-related anxiety significantly moderated the observed relations, such that compared to those with low pain-related anxiety, the relationship between posttraumatic stress symptoms and opioid misuse and dependence was stronger for those with elevated pain-related anxiety. These results highlight the importance of assessing and targeting pain-related anxiety among this trauma-exposed segment of the chronic pain population with elevated posttraumatic stress symptoms.

Initial Validation of the Intentions to Co-Use Alcohol and Opioids Scale

Co-use of alcohol and prescription opioid medication increases risk for harmful and potentially fatal health effects (e.g., overdose). Behavioral intentions (i.e., the immediate antecedent of corresponding behavior according to the Theory of Planned Behavior) are important in prediction of substance use, and a valid measure assessing intentions to co-use alcohol and opioids is needed to identify individuals at-risk for harmful substance use. The goal of the current study was to develop and conduct the psychometric validation of a six-item Intentions to Co-Use Alcohol and Opioids (ICAO) scale. Participants included 261 (Mage = 38; 64% male) past-month drinkers with a current opioid prescription and chronic musculoskeletal pain who completed a targeted online survey. Confirmatory factor analysis indicated that a single-factor structure provided good model fit (Bollen-Stine bootstrap p = .121). Moreover, the ICAO demonstrated high internal consistency (α = .96) and was correlated with measures of alcohol and opioid use/co-use. These findings provide support for the single-factor structure, reliability, and concurrent/convergent validity of the ICAO among individuals who endorse alcohol use, opioid use, and chronic musculoskeletal pain. The ICAO may offer clinical utility as a tool to identify individuals at greater risk of potentially fatal co-use of alcohol and opioid medications.

Indirect Effects of Negative Mood on Opioid Misuse and Dependence via Anxiety Sensitivity Subfacets: Evidence from Adults Reporting Chronic Pain

Background: Opioid misuse in the context of pain management exacts a significant public health burden. Past work has established linkages between negative mood (i.e., symptoms of anxiety and depression) and opioid misuse/dependence, yet the mechanisms underlying these associations have received little scientific investigation. Anxiety sensitivity (AS), the fear of the negative consequences of internal states, may be relevant to better understanding negative mood-opioid relations among adults with chronic pain. Methods: Simultaneous indirect effects of negative mood on opioid misuse and opioid dependence via lower-order factors of AS (physical, cognitive, and social concerns) were examined cross-sectionally in the present study. The study sample consisted of 428 adults (74.1% female, Mage = 38.27 years, SD = 11.06) who self-reported current moderate to severe chronic pain and opioid use for chronic pain. Results: Results indicated that negative mood was (in part) indirectly related to opioid misuse (in part) via AS physical and cognitive concerns and was (in part) indirectly related to opioid dependence via AS cognitive concerns only. No significant indirect effects via social concerns were observed. Discussion and Conclusions: Findings suggest the importance of further exploring the role of anxiety sensitivity cognitive and physical concerns in terms of opioid misuse and dependence among adults with chronic pain.

Opioid and cannabis co-use: The role of opioid use to cope with negative affect

INTRODUCTION

The opioid epidemic is a significant public health concern, particularly among adults with chronic pain. There are high rates of cannabis co-use among these individuals and co-use is related to worse opioid-related outcomes. Yet, little work has examined mechanisms underlying this relationship. In line with affective processing models of substance use, it is possible that those who use multiple substances do so in a maladaptive attempt to cope with psychological distress.

METHOD

We tested whether, among adults with chronic lower back pain (CLBP), the relation between co-use and more severe opioid-related problems would occur via the serial effects of negative affect (anxiety, depression) and more coping motivated opioid use.

RESULTS

After controlling for pain severity and relevant demographics, co-use remained related to more anxiety, depression, and opioid-related problems (but not more opioid use). Further, co-use was indirectly related to more opioid-related problems via the serial effect of negative affect (anxiety, depression) and coping motives. Alternative model testing found co-use was not indirectly related to anxiety or depression via serial effects of opioid problems and coping.

CONCLUSIONS

Results highlight the important role negative affect may play in opioid problems among individuals with CLBP who co-use opioid and cannabis.

Chronic pain acceptance: Relations to opioid misuse and pain management motives among individuals with chronic low back pain

The opioid epidemic is a significant public health concern, and opioid consumption rates and opioid-related deaths are on the rise. Chronic pain acceptance, or willingness to experience pain and pain-related distress, is one pain-related psychological mechanism that may reduce maladaptive attempts to avoid or control pain using opioids among individuals with chronic lower back pain (CLBP). However, little work has examined chronic pain acceptance as it relates to opioid use and motives for use among adults with CLBP. The current investigation sought to explore the effects of chronic pain acceptance on opioid misuse and motives for opioid use (i.e., pain management and coping motives) among adults with CLBP. Participants were 291 adults (69.1 % female, Mage = 45.77 years, SD = 11.22) self-reporting current mild to severe CLBP and current opioid use who were recruited via an online survey. Results indicated that higher acceptance of pain was related to lower levels of opioid misuse and lower motivation to use opioids to cope with pain. Contrary to hypotheses, chronic pain acceptance did not predict motivation to use opioids to cope with emotional distress (i.e., coping motives). The current findings provide support for chronic pain acceptance as a potential protective mechanism in terms of opioid misuse and motivation to use opioids to manage pain.

Reward drive moderates the effect of depression-related cognitive mechanisms on risk of prescription opioid misuse among patients with chronic non-cancer pain

Depression, a prognostic factor for prescription opioid misuse commonly occurs in people with chronic non-cancer pain (CNCP). However, the mechanisms linking depression and prescription opioid misuse remain unclear. This study examined the potential mediating role of pain catastrophizing in the association between depressive symptoms and prescription opioid misuse risk, and impulsivity traits as possible moderators of these relationships. Individuals (N = 198; 77% women) with CNCP using prescription opioids participated in a cross-sectional online survey with validated measures of depression, pain catastrophizing, rash impulsiveness, reward drive, anxiety, pain severity and prescription opioid misuse. Meditation analyses with percentile-based bootstrapping examined pathways to prescription opioid use, controlling for age, sex, pain severity, and anxiety symptoms. Partial moderated mediation of the indirect effect of depressive symptoms on prescription opioid misuse risk through pain catastrophizing by rash impulsiveness and reward drive were estimated. Pain catastrophizing mediated depressive symptoms and prescription opioid misuse risk. Indirect effects were stronger when moderate to high levels of reward drive were included in the model. Findings suggest the risk of prescription opioid misuse in those experiencing depressive symptoms and pain catastrophizing is particularly higher for those higher in reward drive. Treatments targeting these mechanisms may reduce opioid misuse risk. PERSPECTIVE: This article identifies reward drive as a potentially important factor increasing the effects of depression-related cognitive mechanisms on risk of prescription opioid misuse in those with CNCP. These findings could assist in personalizing clinical CNCP management to reduce the risks associated with opioid misuse.

Spanish Validation of the COMM Scale to Assess the Misuse of Prescription Opioids in Patients with Chronic Noncancer Pain

The Current Opioid Misuse Measure (COMM) is a questionnaire used to identify and monitor chronic pain patients on opioid therapy who may be misusing their prescription opioids. The aim of the present study was to adapt the questionnaire for its use in Spanish-speaking populations. A total of 171 individuals (131 women and 40 men) with nononcological chronic pain participated in this cross-sectional study. The most frequent pain diagnoses in the sample were fibromyalgia, herniated disc, and rheumatoid arthritis. Systematic sampling was used. All individuals were interviewed at their clinic between March 2018 and February 2020. The dimensionality of the COMM-SV items was evaluated using an optimal implementation of parallel analysis (PA) and an exploratory factor analysis. Internal consistency, test-retest reliability, and criterion and convergent validity were calculated. The COMM-SV comprises five factors: problematic interpersonal behaviour, searching for more medication than prescribed, medication misuse and self-injurious thoughts, emergency use, and memory and attention problems. It has good reliability and adequate test-retest stability. The results support its criterion and convergent validity. Given the increasing use and abuse of opioids, a valid and reliable instrument is needed in Spanish settings to identify patients with chronic pain who present aberrant behaviour related to the use of these medications. The COMM-SV enables Spanish clinicians to do that.

Fatigue Severity among Adults with Chronic Low Back Pain: Relations to Opioid Use and Hazardous Alcohol Use

BACKGROUND

Chronic low back pain is the second leading cause of disability in the United States and is related to greater risk of opioid misuse. Research suggests that severe fatigue may be a relevant factor for better understanding the greater rates of opioid and misuse among adults with chronic low back pain. Therefore, the current study sought to examine differences in opioid misuse, risk for opioid use disorder, and hazardous alcohol use in two different groups: one group with clinically significant fatigue, and one group without clinically significant fatigue.

METHODS

Participants were recruited utilizing a validated online survey management system that yielded 1,681 adults (70.0% female, 81.1% White, M _age = 44.5 years, SD = 11.88) with current mild to severe chronic low back pain. One-way analysis of covariance (ANCOVA) models were conducted to examine group differences.

RESULTS

Among adults with chronic low back pain, those with clinically significant fatigue reported significantly greater opioid misuse and risk for opioid use disorder compared to those without clinically significant fatigue. These results were evident after controlling for pain severity and interference. The results for hazardous alcohol use were not significantly different between groups.

CONCLUSIONS

Clinically significant fatigue is a distinguishing characteristic among adults with chronic low back pain in terms of opioid misuse and risk for opioid use disorder. Potential clinical implications of such findings suggest that it may be important for clinicians to assess fatigue levels to better manage opioid misuse potential among adults with chronic low back pain.

Validation of the Opioid Overdose Risk Behavior Scale, version 2 (ORBS-2)

OBJECTIVE

To examine the factor structure of a revised and expanded opioid overdose risk behavior scale and assess its associations with known overdose indicators and other clinical constructs.

BACKGROUND

Opioid-related overdose remains high in the U.S. We lack strong instrumentation for assessing behavioral risk factors. We revised and expanded the opioid overdose risk behavior scale (ORBS-1) for use among a broader range of people who use opioids.

SETTING & SAMPLING FRAME

Using respondent-driven sampling we recruited adults (18+) reporting current unprescribed opioid use and New York City residence.

METHOD

Participants (N = 575) completed the ORBS-1, ORBS-2, and a variety of clinical measures and then completed the ORBS-2 and overdose risk outcomes across monthly follow-up assessments over a 13-month period.

RESULTS

Principal components analysis was used to identify six ORBS-2 subscales, Prescription Opioid Misuse, Risky Non-Injection Use, Injection Drug Use, Concurrent Opioid and Benzodiazepine Use, Concurrent Opioid and Alcohol Use, and Multiple-Drug Polysubstance Use. All subscales showed moderate non-parametric correlations with the ORBS-1 and with corresponding clinical constructs. Five of the subscales were significantly (p < .01) positively associated with self-reported non-fatal overdose. Of note, the Risky Non-Injection Use subscale was the most strongly associated with past-month overdose indicators.

CONCLUSIONS

Psychometrics for the opioid overdose risk behavior subscales identified suggest the ongoing utility of risk behavioral instrumentation for epidemiological research and clinical practice focused on risk communication and minimization. Use of the entire ORBS-2 measure can provide insight into the proximal/behavioral factors of greatest concern to reduce overdose mortality.

Exploring transdiagnostic processes for chronic pain and opioid misuse among two studies of adults with chronic pain

Chronic pain is a significant public health problem associated with functional impairment, increased medical expenditures, and opioid misuse. Recent work has suggested that certain transdiagnostic psychosocial factors may be more important than pain intensity to better understand pain and opioid outcomes. Specifically, pain-related anxiety, anxiety sensitivity, emotion dysregulation, and distress tolerance have all been uniquely associated with both pain and opioid outcomes across a range of samples. Yet, no work has examined how these transdiagnostic constructs relate to pain and opioid misuse when accounting for the other constructs. Therefore, the current study employed two independent sample of adults with chronic pain to examine (1) the construct independence of each of these factors using exploratory structural equation modelling (ESEM) and (2) how each of these constructs relates to pain and opioid outcomes in latent structural models. Results from Study 1 provided empirical support for construct independence of the transdiagnostic constructs. Findings from Study 2 indicated that pain-related anxiety was most strongly related to pain intensity, interference, and pain-related negative affect, anxiety sensitivity with opioid misuse, and emotion dysregulation with all studied criterion variables. The current results highlight the importance of assessing and targeting transdiagnostic constructs among adults with pain.

The Moderating Role of Fatigue Sensitivity in the Relation between Depression and Alcohol and Opioid Misuse among Adults with Chronic Low Back Pain

OBJECTIVE

Chronic low back pain is the second leading cause of disability in the United States and is frequently related to increased risk of opioid and alcohol misuse. Depression is associated with poor substance use outcomes among persons with chronic low back pain. Theoretically, the influence of depression on opioid and alcohol misuse among those with chronic low back pain may vary as a function of fatigue sensitivity.

METHOD

To empirically test this theorized model, the current study examined fatigue sensitivity as a moderator for the relation between depression and opioid and alcohol misuse among 291 adults (69.1% female, M _age = 45.77 years, SD = 11.22) with chronic low back pain currently using opioids.

RESULTS

Results suggested that fatigue sensitivity moderated the effect of depression on opioid misuse (β=0.60, p= .001, 95%CI [0.02, 0.06]) and alcohol misuse (β=0.45, p= .025, 95%CI [0.002, 0.03]). Examination of simple slopes revealed that the association between depression and opioid and alcohol misuse was statistically significant for those with higher levels of fatigue sensitivity, but not lower levels of fatigue sensitivity.

CONCLUSIONS

Overall, the current investigation provides initial empirical support for the moderating role of fatigue sensitivity in the relation between depression and alcohol and opioid misuse among adults with chronic low back pain.

Pain-related anxiety, sex, and co-use of alcohol and prescription opioids among adults with chronic low back pain

BACKGROUND

Both alcohol and prescription opioid use/misuse are highly prevalent among individuals with chronic pain. Co-use of alcohol and prescription opioids is also common, despite contraindications due to increased risk of negative health effects and mortality. There is evidence that pain-related anxiety (i.e., the tendency to respond to pain with anxiety or fear) may be associated with heavier drinking and prescription opioid use/co-use, and that these associations may be especially salient among men.

METHODS

This study is the first examination of pain-related anxiety in relation to hazardous alcohol use, prescription opioid use/misuse, and alcohol-opioid co-use. Participants included 1812 adults with chronic low back pain (69 % female, Mage = 43.95) who completed an online survey assessing health behaviors.

RESULTS

Pain-related anxiety was positively associated with indices of alcohol (i.e., alcohol-related consequences) and opioid use (i.e., prescription opioid use/misuse, daily opioid consumption). Of note, sex moderated associations between pain-related anxiety and both alcohol-related consequences and prescription opioid misuse. In addition to being associated with alcohol and prescription opioid use, independently, pain-related anxiety was also associated with greater likelihood of endorsing co-use of alcohol and opioids and engaging in concurrent hazardous drinking and prescription opioid misuse.

CONCLUSIONS

These findings contribute to a growing literature suggesting that pain-related anxiety is an important transdiagnostic factor in pain and alcohol and prescription opioid use/co-use, perhaps especially among males.