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

LaRowe, Lisa R.; Powers, Jessica M.; Garey, Lorra; Rogers, Andrew H.; Zvolensky, Michael J.

doi:10.1016/j.drugalcdep.2020.108171

Cited by 27 publications

(19 citation statements)

References 53 publications

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“… 7 Despite the dangers of concurrent use of alcohol and opioids, the authors found only one study that was designed to examine co-use of these substances in the context of pain. 111 Consistent with findings from studies of either substance alone, pain-related anxiety was associated with greater likelihood of misuse of both substances concurrently in an online sample of adults with chronic pain. One potential explanation for this finding is that people with higher levels of pain-related anxiety may view concurrent use as a way to extend or supplement analgesic effects of both substances.…”

Section: Discussionsupporting

confidence: 74%

“…In an online sample of 1,812 adults with chronic low back pain, 12% endorsed use of both alcohol and prescription opioids (co-use) and 3% met cut-offs for both hazardous drinking and opioid misuse in the past month (i.e., concurrent use). 111 Pain-related anxiety was individually associated with hazardous alcohol use, opioid misuse, and likelihood of alcohol and opioid co-use. Moreover, every 1-point increase in pain-related anxiety was associated with a 4% increase in likelihood of concurrent hazardous drinking and opioid misuse.…”

Section: Resultsmentioning

confidence: 98%

“… 92 The review also observed consistent evidence across several studies that pain-related anxiety and pain catastrophizing are associated with alcohol and opioid use among people with chronic pain. 73 , 96 , 102 , 111 Maladaptive cognitive-affective responses to pain may activate escape/avoidance processes, leading to use of alcohol and/or opioids. These observations are in line with conceptual models of pain and substance use and further support consideration of pain-related cognitions as potentially key transdiagnostic vulnerability factors for alcohol and opioid use.…”

Section: Discussionmentioning

confidence: 99%

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Cognitive-Affective Transdiagnostic Factors Associated With Vulnerability to Alcohol and Prescription Opioid Use in the Context of Pain

Zale

Powers

Ditre

2021

ARCR

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The use of alcohol and prescription opioids is common among people in pain and poses significant public health burdens. This review identifies factors associated with motivation to use alcohol and prescription opioids in the context of pain. Pain-relevant, cognitive-affective, transdiagnostic vulnerability factors—expectancies/motives, pain catastrophizing, pain-related anxiety, distress intolerance, anxiety sensitivity, and perceived interrelations—were selected from theoretical conceptualizations of pain and substance use. Searches conducted in PubMed, PsycINFO, and Embase returned 25 studies that examined associations between identified variables of interest and the use of alcohol and prescription opioids in the context of pain. Consistent with a larger literature on pain and substance use, the studies included in this review demonstrated that people with chronic pain are motivated to use alcohol and opioids in response to negative affect and hold expectancies/motives for coping with pain. Vulnerabilities that engender difficulty managing aversive internal states (distress intolerance and anxiety sensitivity) and maladaptive responses to pain (pain-related anxiety and pain catastrophizing) also were implicated in motivation for alcohol and opioid use. Although one study found that pain-related anxiety was associated with co-use of alcohol and opioids, no studies examined simultaneous use. Future research directions that can explicate causal associations, identify patterns of alcohol and opioid co-use, clarify the role of pain in cessation processes, and inform treatment development are discussed.

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Section: Discussionsupporting

confidence: 74%

Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cognitive-Affective Transdiagnostic Factors Associated With Vulnerability to Alcohol and Prescription Opioid Use in the Context of Pain

Zale

Powers

Ditre

2021

ARCR

View full text Add to dashboard Cite

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“…Pain-related anxiety affects patients' pain perception. Patients have the potential to catastrophize pain [ 35 ], increase the associated negative experience, and intensify their willingness to seek medical care [ 36 ]. A low to moderate negative correlation was found between state-trait anxiety scale and PPT, and no significant correlation was observed for lower extremity muscles.…”

Section: Discussionmentioning

confidence: 99%

Differences and Correlations of Anxiety, Sleep Quality, and Pressure-Pain Threshold between Patients with Chronic Low Back Pain and Asymptomatic People

Wang

et al. 2022

Pain Research and Management

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Background. Chronic low back pain (CLBP) is a clinically common and expensive disease. Patients frequently take sick leaves because of pain and dysfunction, and their unpleasant life and work experiences cause psychological depression and anxiety and affect their quality of life. Sleep disturbance is a common problem among patients with low back pain (LBP) with more than 50% complaining about poor sleep quality. This study aimed to explore the correlations between anxiety, sleep quality, and pressure-pain threshold (PPT) and their differences between patients with CLBP and asymptomatic people. Methods. Forty patients with CLBP and 40 asymptomatic people were recruited. Relevant data, including State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, and PPT, were individually and independently collected by blinded physiotherapists with a practicing certificate and then statistically analyzed. An independent sample t-test was used to determine the intergroup differences between patients with CLBP and asymptomatic populations. Pearson correlation coefficient was employed for correlation analysis. Results. The CLBP group had significantly higher anxiety scores (41.64 ± 9.88 vs. 36.69 ± 8.31; t = −2.496, p = 0.015 ) than the asymptomatic group. A significant difference was found in the total score of the Pittsburgh Sleep Quality Index (6.41 ± 2.43 vs. 5.09 ± 2.18; t = −2.628, p = 0.010 ) but not in the trait anxiety (44.00 ± 7.83 vs. 42.67 ± 9.51; t = −0.695, p = 0.489 ) of the two groups. State−Trait Anxiety Inventory showed a low to moderate negative correlation with PPT. No remarkable correlation was observed between Pittsburgh Sleep Quality Index and PPT. Conclusions. Patients with CLBP showed considerably worse state anxiety and sleep quality than asymptomatic people; however, no substantial difference in PPT was found between the two groups. The results suggest that in clinical practice, the focus should include pain and related social and psychological factors. CLBP treatment could be considered from multiple perspectives and disciplines.This trial is registered with Chinese Clinical Trial Registry (Trial registration: ChiCTR-TRC-13003701).

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“…In other studies, gabapentin has been described as a predictive factor of substance use disorders and there are data linking coprescribing of opioids or the incidence of chronic pain with an increase in morbidity and mortality. 18 , 19 , 20 As such, opioids (combined with muscle relaxants given the low use [n=18]) were included. In the univariate analyses, opioid or muscle relaxant exposures were not associated with either 30-day alcohol-readmissions or multiple alcohol-related readmissions within 1 year of the index hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Medications and Patient Factors Associated With Increased Readmission for Alcohol-Related Diagnoses

Osborne

Horsman

Mara

et al. 2022

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective To investigate medication factors and patient characteristics associated with readmissions following alcohol-related hospitalizations. Patients and Methods Adult patients admitted from September 1, 2016, through August 31, 2019, who had an alcohol-related hospitalization were identified through electronic health records. Patient characteristics and medications of interest administered during hospitalization or prescribed at discharge were identified. Medications of interest included US Food and Drug Administration–approved medications for alcohol use disorder, benzodiazepines, barbiturates, gabapentin, opioids, and muscle relaxants. The primary outcome was to identify medications and patient factors associated with 30-day alcohol-related readmission. Secondary outcomes included medications and patient characteristics associated with multiple alcohol-related readmissions within a year from the index admission (ie, two or more readmissions) and factors associated with 30-day all-cause readmission. Results Characteristics of the 932 patients included in this study associated with a 30-day alcohol-related readmission included younger age, severity of alcohol withdrawal, history of psychiatric disorder, marital status, and the number of prior alcohol-related admission in the previous year. Benzodiazepine or barbiturate use during hospitalization or upon discharge was associated with 30-day alcohol-related readmission ( P =.006). Gabapentin administration during hospitalization or upon discharge was not associated with 30-day alcohol-related readmission ( P =.079). Conclusion The findings reinforce current literature identifying patient-specific factors associated with 30-day readmissions. Gabapentin use was not associated with readmissions; however, there was an association with benzodiazepine/barbiturate use.

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

Cited by 27 publications

References 53 publications

Cognitive-Affective Transdiagnostic Factors Associated With Vulnerability to Alcohol and Prescription Opioid Use in the Context of Pain

Cognitive-Affective Transdiagnostic Factors Associated With Vulnerability to Alcohol and Prescription Opioid Use in the Context of Pain

Differences and Correlations of Anxiety, Sleep Quality, and Pressure-Pain Threshold between Patients with Chronic Low Back Pain and Asymptomatic People

Medications and Patient Factors Associated With Increased Readmission for Alcohol-Related Diagnoses

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