Distress Intolerance and Prescription Opioid Misuse Among Patients With Chronic Pain
Open accessAbstract
Unlabelled The risk for misuse of opioid medications is a significant challenge in the management of chronic pain. The identification of those who may be at greater risk for misusing opioids is needed to facilitate closer monitoring of high-risk subgroups, and may help to identify therapeutic targets for mitigating this risk. The aim of this study was to examine whether distress intolerance-the perceived or actual inability to manage negative emotional and somatic states-was associated with opioid misuse in those with chronic pain. A sample of 51 participants prescribed opioid analgesics for chronic back or neck pain were recruited for a 1-time laboratory study. Participants completed measures of distress intolerance and opioid misuse, and a quantitative sensory testing battery. Results suggested that distress intolerance was associated with opioid misuse, even controlling for pain severity and negative affect. Distress intolerance was not associated with pain severity, threshold, or tolerance, but was associated with self-reported anxiety and stress after noxious stimuli. This study found robust differences in distress intolerance between adults with chronic pain with and without opioid medication misuse. Distress intolerance may be a relevant marker of risk for opioid misuse among those with chronic pain.Perspective This study demonstrated that distress intolerance was associated with opioid misuse in adults with chronic pain who were prescribed opioids. Distress intolerance can be modified with treatment, and thus may be relevant not only for identification of risk for opioid misuse, but also for mitigation of this risk.
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Studies of non-cancer pain have identified psychiatric symptoms and coping skills deficits as risks for medication misuse and opioid use disorder.
“This is consistent with studies of non-cancer pain that have identified psychiatric symptoms and coping skills deficits as risks for medication misuse and opioid use disorder.810”
From Study protocol for a pilot randomised controlled trial of a virtually delivered behavioural intervention (ACTION) for adults with cancer at risk for opioid use disorder (2024) · cites this paper as [10]
The paper reports in its background that psychiatric severity and negative affect appear to increase the risk of opioid misuse in chronic pain patients. Its Results and Discussion associate distress intolerance—difficulty managing distress—with misuse, which lends support to the coping-deficit portion of the claim. But the study was cross-sectional, did not assess psychiatric disorders, and did not establish these factors as risks for developing opioid use disorder. (LLM, conf=0.86)
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- Authors
- McHugh, R. K., Weiss, R. D., Cornelius, M., Martel, M. O., Jamison, R. N., & Edwards, R. R.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- McHugh, R. Kathryn
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2016-07
- Volume
- 17
- Issue
- 7
- Pages
- 806-814
- ISSN
- 1526-5900 (ISSN-L)
- PMC
- PMC4925301
- OpenAlex
- W2313355562
- Cited by
- 91
- References
- 51
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 7 · 2023: 7 · 2022: 8 · 2021: 9 · 2020: 13 · 2019: 14 · 2018: 16 · 2017: 4 · 2016: 2
- FWCI
- 11.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG034982)
- National Institute on Drug Abuse (R03DA034102, K24DA022288, R21DA041020, UG1DA015831)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR064367)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- distress intolerance, prescription opioid misuse, chronic pain, chronic back pain, neck pain, opioid analgesics, anxiety, stress, quantitative sensory testing, pain intensity, risk indicators
- MeSH terms
- Adolescent, Adult, Aged, Analgesics, Opioid, Female, Humans, Hyperalgesia, Male, Middle Aged, Opioid-Related Disorders, Pain Measurement, Psychiatric Status Rating Scales, Psychophysics, Pain Threshold, Young Adult, Self Report, Catastrophization, Pain Perception, Chronic Pain, Prescription Drug Misuse
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