Opioid Consumption in Chronic Pain Patients: Role of Perceived Injustice and Other Psychological and Socioeconomic Factors

Abstract

Background: Chronic pain is a complex biopsychosocial phenomenon. Lifestyle, behavioral, socioeconomic, and psychosocial factors such as depression and perceived injustice are often associated with the development of chronic pain and vice versa. We sought to examine the interaction of these factors with opioid intake. Methods: At our institution, 164 patients with chronic pain undergoing an interdisciplinary assessment within a three-month period participated in the study and completed the Injustice Experience Questionnaire (IEQ). Data regarding opioid intake, pain levels, pain diagnosis, depression, anxiety, stress, quality of life, pain-related disability, habitual well-being, occupational status, and ongoing workers compensation litigation were extracted from the patients’ charts. Results: Approximately one-fourth of the patients used opioids. The IEQ total was significantly higher in patients using Schedule III opioids. Depression, but not the anxiety and stress scores, were significantly higher in patients using opioids. There were no significant differences regarding pain-related disability, habitual well-being, and the coded psychosocial diagnoses. In the patient group without opioids, the percentage of employed persons was significantly higher but there were no significant differences regarding work leave, pension application, or professional education. Conclusions: Opioid use appears to be more closely related to psychological factors and single social determinants of pain than to somatic factors.

Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors

“…In the elderly population (i.e., > 65 years of age), problematic opioid use and OUD have been increasingly observed, with both illicit and prescription opioids [45]. Risk factors for OUD development in this patient cohort include multimorbidity, long-term alcohol misuse, depression, or chronic pain disorder [45,46]. Along with the current therapy plans established from the data of younger adults, elderly patients respond well to opioid agonist therapy, while age is no obstacle to treatment [45].…”

“…Regardless of age, however, opioid misusage has been linked to psychological factors and single social determinants of pain rather than somatic factors [46].…”

The Key Role of Lifestyle Factors in Perpetuating Chronic Pain: Towards Precision Pain Medicine

“…One important study reports that graded exposure in vivo treatment in patients with chronic low back pain and complex regional pain syndrome type I was accompanied by reductions in fear that preceded pain relief [ 5 ]. Another original study reported that opioid use was more closely related to perceived injustice and depression, but not anxiety and stress in 164 patients with chronic pain [ 6 ]. In a study of patients post COVID-19 infection ( n = 567), more than 70% presented symptoms of central sensitisation [ 7 ].…”