Comorbid Post-Traumatic Stress Disorder, Pain, and Opiate Addiction

Ketchen, Bethany; Eilender, Pamela; Fareed, Ayman

doi:10.1007/978-3-319-08359-9_28

Cited by 2 publications

(6 citation statements)

References 53 publications

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“…This has been highlighted in other studies. 18,39,40 Individuals with musculoskeletal pain conditions and PTSD, may have a higher burden of trauma-associations and pain-memories which could create a bigger reward deficit and later higher euphoric effects with opioids. It is hypothesised that the reward deficit and the euphoric effects with opioids may be significant contributors to the development of OUD.…”

Section: Discussionmentioning

confidence: 99%

“…It is hypothesised that the reward deficit and the euphoric effects with opioids may be significant contributors to the development of OUD. 35,39,40 Neuro-imaging studies demonstrate that individuals with PTSD show changes in brain function in regions of the hippocampus, anterior cingulate cortex, and medial prefrontal cortex in the form of increased levels of noradrenaline and decreased levels of dopamine, both of which prime the individual towards heightened opioid related cues and subsequent development of OUD. 39 Further studies are needed to examine the impact and modifiers of this correlate on development of OUD among individuals with CNCP and PTSD.…”

Section: Discussionmentioning

confidence: 99%

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Is post-traumatic stress disorder a risk factor for development of opioid use disorder among individuals with chronic non-cancer pain? A systematic review

Kendurkar,

Wilson,

Sunderland

et al. 2023

British Journal of Pain

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Introduction There is emerging evidence that posttraumatic-stress disorder may have mediating effects in development of chronic-non-cancer-pain and opioid-use-disorder independently, but its impact on the development of opioid-use-disorder in people with chronic-non-cancer pain is still unclear. Objectives (i) Estimate the risk of opioid-use-disorder among individuals with chronic-non-cancer-pain and posttraumatic-stress disorder, relative to those with chronic-non-cancer-pain only, and (ii) identify potential correlates of opioid-use-disorder among people with chronic-non-cancer-pain and posttraumatic-stress disorder. Methods This systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Longitudinal, epidemiological, cohort, follow-up, retrospective, prospective and cross-sectional studies reporting measures of variance on the likelihood of developing opioid-use-disorder with posttraumatic-stress disorder among individuals with chronic-non-cancer-pain were identified from six-electronic databases (Medline, Embase, Evidence-based Medicine reviews, PsycINFO, Scopus and Web of Science) until December 2022. Results Three out of the four studies, which met the selection criteria for this analysis reported statistically significant positive association between risk of developing opioid-use-disorder with posttraumatic-stress disorder among chronic-non-cancer-pain cohort (unadjusted Relative-Risk range: 1.51–5.27) but this association was not evident in the fourth study (adjusted Relative-Risk: 0.96; statistically non-significant), when adjusted for sociodemographic variables. The increased risk was noted particularly with females and chronic musculoskeletal pain conditions. Conclusions Posttraumatic-stress disorder can increase the risk of development of opioid-use-disorder among people with chronic-non-cancer-pain and a better understanding of this relationship will help to predict and prevent the development of opioid-use-disorder and may also help in reducing the disability and burden associated with chronic-non-cancer-pain. Perspective This review quantifies the risk of developing opioid-use-disorder in the context of posttraumatic-stress disorder among individuals with chronic-non-cancer-pain. Awareness and subsequent practice change will reduce the increasing global burden associated with the chronic-non-cancer-pain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Is post-traumatic stress disorder a risk factor for development of opioid use disorder among individuals with chronic non-cancer pain? A systematic review

Kendurkar,

Wilson,

Sunderland

et al. 2023

British Journal of Pain

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“…There is little research on opioid medication misuse in people with comorbid PTSD and chronic pain: nevertheless, it has been suggested that both disorders may share a vulnerability pathway (Ketchen et al, 2016). Currently, there is a sizable literature in support of shared pathways between chronic pain and PTSD.…”

mentioning

confidence: 99%

“…Unfortunately, there is evidence of opioid misuse in chronic pain patients (Han et al, 2017; Vowles et al, 2015). In addition, previous studies have suggested that more than 60% of individuals with chronic pain and opioid dependence meet criteria for a mood disorder and that this group is more likely to be prescribed opiates for pain management than those without a diagnosed mental health disorder (Ketchen et al, 2016; McHugh et al, 2016). Moreover, opioid use disorder is more common in chronic noncancer pain patients with posttraumatic stress symptoms (PTSD; Ditre et al, 2019; López-Martínez et al, 2019).…”

mentioning

confidence: 99%

“…People with comorbid PTSD and chronic pain report high levels of intense pain and affective distress and rely more heavily on medication to manage both pain and psychological distress (Ketchen et al, 2016). Chronic pain can be considered a stressor that contributes to substance use as a means of coping, thus hindering the use of other more adaptive strategies and contributing to the maintenance of both pain and addiction (Ditre et al, 2019).…”

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confidence: 99%

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Does pain catastrophizing and distress intolerance mediate the relationship between PTSD and prescribed opioid misuse in people with chronic noncancer pain?

López‐Martínez¹,

Sainero-Tirado²,

Esteve³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: There is an ongoing debate on the use of long-term high-dose medically prescribed opioid analgesics for patients with chronic noncancer pain. Such use is elevated when there is comorbid pain and PTSD, which is quite prevalent. Therefore, it is relevant to investigate the psychological variables that may explain opioid misuse in this population. The purpose of this study was to examine the interaction effect of PTSD severity, distress intolerance, and pain catastrophizing on prescribed opioid misuse in chronic noncancer pain patients. Method: A total of 168 participants (M age = 60 years, 74% women) were assessed regarding opioid medication, pain intensity, traumatic psychological events, PTSD, distress intolerance, pain catastrophizing, and current opioid misuse. Results: Groups were formed according to the level of PTSD severity (no symptoms, moderate symptoms, and severe symptoms). Significant differences were found between the groups in pain intensity, catastrophizing, distress intolerance, and opioid misuse. The severe-symptoms group had the highest scores on all variables. There were no between-group differences in the prescribed medication. Mediation analysis showed that the relationship between PTSD severity and opioid misuse was completely and independently mediated by distress intolerance and pain catastrophizing. Conclusions: Distress intciolerance and pain catastrophizing may be theoretically and clinically relevant constructs in understanding the motivation for opioid misuse in people with concurrent chronic noncancer pain and PTSD.

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Comorbid Post-Traumatic Stress Disorder, Pain, and Opiate Addiction

Cited by 2 publications

References 53 publications

Is post-traumatic stress disorder a risk factor for development of opioid use disorder among individuals with chronic non-cancer pain? A systematic review

Is post-traumatic stress disorder a risk factor for development of opioid use disorder among individuals with chronic non-cancer pain? A systematic review

Does pain catastrophizing and distress intolerance mediate the relationship between PTSD and prescribed opioid misuse in people with chronic noncancer pain?

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