Sex Differences Among Opioid-Abusing Patients With Chronic Pain in a Clinical Trial

Abstract

Background The characteristics of patients with co-occurring chronic pain and prescription opioid abuse have not been well described, and even less is known about differences between men and women in this population. Objectives This study evaluated sex differences in the demographic, diagnostic, and behavioral attributes of patients with chronic pain and opioid abuse. Methods Data were collected via self-report and semi-structured clinical interviews from 162 patients (120 M, 42 W) who screened for a study investigating the abuse liability of prescription opioids. Results There were no differences between males and females in age, race, education, marital status or employment status. Participants had used prescription opioids for 5.4 ± 6.7 years. The majority of participants (60%) had low back pain in addition to opioid dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV). More women reported more arthritic pain than men, but otherwise there were no differences in types of pain. Pain exerted a greater effect in women on mood, walking ability, and social relations. Men reported more of certain aberrant behaviors including abuse of alcohol or illicit drugs, unauthorized dose increases, contact with street culture, and being arrested by police. Women were more depressed than men. Conclusions The demographic profile of opioid-abusing chronic pain patients presenting for treatment in a clinical trial was similar between sexes; however, some important differences were observed. Women reported more psychiatric co-morbidity and endorsed greater pain-related physical and social impairment. Men reported more aberrant behaviors. These differences suggest that men with chronic pain and opioid abuse/dependence may benefit by closer monitoring of aberrant behaviors while women may benefit from closer attention paid to physical and psychological effects of pain.

Gender and nonmedical prescription opioid use and DSM-5 nonmedical prescription opioid use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions – III

“…Stratification by gender, rare in previous studies, revealed new findings: 12-month and lifetime NMPOU was associated with major depressive disorder and persistent depression, and NMPOUD was associated with persistent depression (12-month and lifetime) and bipolar I disorder (lifetime), only among men. These findings contrast markedly with most general population surveys (Becker et al, 2008; Compton et al, 2005; Huang et al, 2006; Katz et al, 2013; Martins et al, 2009; 2012) and studies of pain patients (Campbell et al, 2010; Fillingim et al, 2003; Jamison et al, 2010; Manubay et al, 2015) and individuals in treatment for opioid use disorder (Back et al, 2011; Green et al, 2009; McHugh et al, 2013) in which affective psychopathology was much greater among women. Taken together, these findings underscore the need to diagnose and treat sex-specific comorbidities of NMPOU and NMPOUD.…”

“…Despite important sex differences in sociodemographic and clinical correlates of NMPOU and NMPOUD observed among chronic pain patients (Campbell et al, 2010; Fillingim et al, 2003; Jamison et al, 2010; Manubay et al, 2015) and individuals in substance abuse treatment (Back et al, 2011; Green et al, 2009; McHugh et al, 2013), little is known about sex-specific correlates of NMPOU and NMPOUD in the U.S. general population. This is especially true for NMPOUD since few national surveys have collected the information necessary to derive diagnoses of NMPOUD and the full range of its psychiatric comorbidities.…”

Alcohol and Pain: A Translational Review of Preclinical and Clinical Findings to Inform Future Treatment Strategies

“…Among younger adults, ages 25 to 45, there is experimental evidence that acute alcohol (approximate BAC = 0.065) may be associated with increased pain threshold among women, and that subjective response to alcohol may be more strongly associated with ratings of pain relief following alcohol administration among women (Hill et al, ). Yet, there is also evidence that men with chronic pain may be more at risk of AUD and depression, as well as report a stronger association between pain, depression, and alcohol use, as compared to women (Barry et al, ; Brown, ; Manubay et al, ). Also, in a sample of adults with chronic pain, pain‐related anxiety was positively associated with alcohol‐related consequences and symptoms of alcohol dependence among males, but not females (Zale et al, ).…”

Sex differences in prescription opioid use

“…Participants who met DSM-IV criteria for opioid dependence in the past 6 months (prescription opioids with or without heroin) were included in the descriptive statistics, t-tests, and chi-square analyses. The authors found 60% of the participants had back pain, women had greater psychiatric co-morbidity and endorsed greater pain compared to men, while men reported more antisocial behaviors such as police arrests compared to women (13). …”