Comparison of psychiatric comorbidity in treatment‐seeking, opioid‐dependent patients with versus without chronic pain

Abstract

Aim To compare psychiatric morbidity in treatment-seeking, opioid-dependent patients with versus without chronic pain. Design A retrospective comparative cohort design was used involving record linkage from routinely collected, nationally held data sets. Data were managed within a Scottish Government-certified Safe Haven. Setting and participants Participants comprised all patients of an NHS Substance Misuse Service in the East of Scotland (n = 467) who were in treatment during 2005 and had been in treatment for varying lengths of time. Their mean age at study inception was 35.0 years in the chronic pain group and 32.1 years; 68% of the chronic pain group and 74% of the no pain group were male. Measurements The outcomes were (a) psychiatric comorbidity assessed at study inception using the 28-item General Health Questionnaire and the Clinical Outcomes in Routine Evaluation-Outcome Measure and (b) receipt of at least one prescription for a psychiatric condition during a 5-year period following study inception. The independent variable was chronic pain measured at study inception using the Brief Pain Inventory-Short Form. Findings A total of 246 (52.7%) reported chronic pain and 221 (47.3%) did not. A higher proportion of patients with chronic pain had at least one psychiatric morbidity (62.4 versus 46.3%, P < 0.001). At the study inception, a higher proportion of patients with chronic pain were prescribed anxiolytics (49.0 versus 39.1%, P = 0.015) and antimanic drugs (9.9 compared with 4.9%, P = 0.015). Conclusions Patients of opioid treatment services in Scotland who report chronic pain may have a higher prevalence of psychiatric comorbidity than those who do not.

Evaluating the Relationship Between Depression and Pain Anxiety with Pain Catastrophizing in Patients with COVID-19

“…Catastrophizing is a negative cognitive-emotional process that includes components of magnification, helplessness, and rumination. The degree of catastrophizing is one of the most important predictors of pain treatment outcomes and a key variable in behavioral cognition approaches and fear-avoidance model (8). An individual's attitudes and beliefs, as well as sources and methods of coping with the pain, affect how s/he reports pain (9).…”

“…The most important effect of catastrophizing on chronic pain is that patients with pain receive an assessment of pain that may make them more alert to painful or threatening feelings and fear of experiencing painful feelings in the future (10). psychological symptoms that can contribute to the development of chronic pain, the persistence of pain symptoms, and response to medical treatment (8). Studies have shown that psychological variables such as attitudes, anxiety, and depression, instead of biomedical factors, should be considered both physically and psychologically.…”

Opioid dependence disorder and comorbid chronic pain: comparison of groups based on patient-attributed direction of the causal relationship between the two conditions

“…It may be that opioid-dependent patients with comorbid CP present with relatively more complex medical and psychiatric complications than those without pain -indeed our previous work has shown this in relation to psychiatric disorders. 18 Future research studies might consider including a third, comparator group -those with opioid use problems and no pain problems. This is the first study to examine both the patientattributed causal direction of ODD and CP and its association with health and clinical factors.…”

“…17 The present study used the 12-month threshold since, in a clinical population familiar with persistent, debilitating conditions, this was considered as the best indication of truly ‘chronic’ pain, an approach that has been used in other studies. 4 , 18 Those that reported having had pain for less than 12 months were excluded from the study since they were considered to form a small, relatively heterogeneous group. No participants were lost during the course of the study: as discussed below, since only anonymised data were used, participants were not required to consent to participation.…”

Commentary on Higgins et al. (2020): How are chronic pain, psychological distress and opioid dependence related?

“…Higgins et al . present a case–control study of psychiatric morbidity in Scottish National Health Service patients with and without chronic pain presenting for methadone treatment of opioid dependence . They find that the patients with chronic pain score consistently higher on self‐report measures of psychopathology and receive more psychotropic medications.…”