The Relationship between Higher Chronic Opioid Therapy Dose and Specific Personality Traits in Individuals with Chronic Pain
Maternal, Child & Mental Health
Use of opioids to treat chronic pain can be controversial given doses which exceed recommended guidelines. In a study of 218 patients with chronic pain, we found a relationship between opioid use and specific personality traits among individuals with chronic pain stratified by morphine equivalent doses (MEQ). Compared to individuals using no or low-dose opioids, those using high-dose opioids had higher scores on two obsessive maladaptive personality trait measures which was associated with greater levels of mood disorders, disability, and pain interference. There was no association with increased pain severity or substance misuse. Our findings support the notion that high-dose opioids are used more to deal with chronic pain limitations/interference than pain severity or substance use. Non-pharmacological methods should be considered among patients with chronic pain to increase coping such as cognitive behavioural therapy, pacing and acceptance instead of medical treatments alone.
Chronic pain is a frequently debilitating condition with high health care utilization, exacerbated by environmental, sociodemographic, and individual factors. Opioid analgesics have become controversial and problematic because of significant problems with physical dependency and an increase in associated misuse. Categorizing patients into groups, based on dose of opioids used and established pain management guidelines for dosing, we hypothesized that the groups would differ with respect to type of pharmacological therapy, pain intensity, and biopsychosocial characteristics. Individuals were recruited from a chronic pain clinic in Ontario, Canada. Morphine equivalent (MEQ) dose categories were selected based on Canadian Opioid Guidelines. Differences between four MEQ groups (0, 1-89, 90-199, > 200) were compared. Among 218 individuals (140 females; mean age 52.9±11.9 years), there were no significant differences between groups with respect to age, employment, education, living arrangement, time since injury, type of pain, use of non-opioids or cannabis use. Compared to individuals using no or lower-dose opioids, those using higher dose opioids had higher scores on two maladaptive personality traits (i.e., anxiety sensitivity and experiential avoidance) which was associated with poorer mood, greater pain interference, lower quality of life and dysfunctional coping but not greater pain intensity. These same maladaptive traits are stable personality traits seen in high-risk group whose level of obsessive traits significantly correlated with impaired mood and coping in chronic pain. There were no differences in substance misuse scores, which was not likely the primary driver of higher opioid doses. ain interference was more important than pain intensity in predicting/determining high dose opioid use.
McIntyre A, Mehta S, Vanderlaan D, Sequeira K, Loh E, Teasell R. (2021). The relationship between higher chronic opioid dose and specific personality traits in individuals with chronic pain. Pain Research and Management. https://doi.org/10.1155/2021/9946067
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