Opioid Pain Medication Prescription for Chronic Pain in Primary Care Centers: The Roles of Pain Acceptance, Pain Intensity, Depressive Symptoms, Pain Catastrophizing, Sex, and Age

Abstract

Background: Psychological factors of patients may influence physicians’ decisions on prescribing opioid analgesics. However, few studies have sought to identify these factors. The present study had a double objective: (1) To identify the individual factors that differentiate patients who had been prescribed opioids for the management of chronic back pain from those who had not been prescribed opioids and (2) to determine which factors make significant and independent contributions to the prediction of opioid prescribing. Methods: A total of 675 patients from four primary care centers were included in the sample. Variables included sex, age, pain intensity, depressive symptoms, pain catastrophizing, and pain acceptance. Results: Although no differences were found between men and women, participants with chronic noncancer pain who were prescribed opioids were older, reported higher levels of pain intensity and depressive symptoms, and reported lower levels of pain-acceptance. An independent association was found between pain intensity and depressive symptoms and opioid prescribing. Conclusions: The findings suggest that patient factors influence physicians’ decisions on prescribing opioids. It may be useful for primary care physicians to be aware of the potential of these factors to bias their treatment decisions.

Mood and Anxiety Symptoms in Persons Taking Prescription Opioids: A Systematic Review with Meta-Analyses of Longitudinal Studies

“…The experience and intensity of pain have independently been associated with the incidence of depression and anxiety [ 44 ], and the number of pain locations and increased duration of pain have been associated with the course of depressive and anxiety symptoms [ 45 ]. Pain is also the precursor for the prescription of opiates, with pain intensity a predictor of initial opioid prescribing for chronic pain in primary care settings and of the prevalence and incidence of prescription opioid use disorder [ 46 , 47 ]. Given these independent associations, it is likely that the experience of pain and the characteristics of that experience (i.e., duration, intensity, location, and number of locations) could be contributing to the associations we observed been opiate use and mental health outcomes.…”

Early Life Stress and Risks for Opioid Misuse: Review of Data Supporting Neurobiological Underpinnings

“…Predictors of prolonged opioid use in patients with musculoskeletal problems include past or current substance use problems, higher initially prescribed doses, mood disorders, and depression [ 71 , 85 , 86 ]. Among chronic pain patients, predictors of misuse include anxiety, anger, pain intensity, and depression [ 87 , 88 , 89 ] as well as measures of distress intolerance [ 90 ], pain catastrophizing [ 91 ], and difficulties in emotion regulation [ 92 ].…”

Racial and Ethnic Disparities in Opioid Prescriptions in Benign and Malignant Pancreatic Disease in the United States

“…33 However, opioid use differences by sex vary based on care setting and disease. [36][37][38][39] There are several strengths to this study. The NAMCS database is ideal for studying racial and ethnic disparities because of the intentional oversampling of minority patients.…”

“…This finding is inconsistent with overall trends toward higher rates of opioid prescriptions for adult female patients compared with male patients in the United States 33 . However, opioid use differences by sex vary based on care setting and disease 36–39 …”