Somatization is associated with non-adherence to opioid prescriptions

J Pain. 2011 May;12(5):573-80. doi: 10.1016/j.jpain.2010.11.002. Epub 2011 Feb 1.


Non-adherence to opioid prescriptions can decrease the safety and efficacy of opioid therapy. Identifying factors associated with over- and under-use of opioids in patients presenting with pain may improve prescribing and pain management. Patients presenting with pain often also present with somatization, and somatization is associated with both excessive use of and non-adherence to medications. This study examines the relationship between somatization and non-adherence (over- and under-use) to opioid prescriptions in the Veteran sample. One hundred and ninety-one Veterans who received an opioid prescription at a Veterans Affairs Palo Alto Health Care System in the prior year participated by completing a 1.5 hour semistructured interview which included assessments of depressive symptoms, somatization, medication side effects, and opioid pain medication usage. The percentage of patients non-adherent to opioid prescriptions increased as a function of somatization: Compared to no somatization, all levels of somatization were associated with higher rates of underuse, while severe somatization was associated with increased rates of overuse. Consistent with previous studies of medication non-adherence, increased depression and medication side effects were associated with decreased adherence to opioid prescriptions. However, in exploratory analyses, somatization mediated the relationship between depressive symptoms and opioid-use patterns as well as medication side effects and opioid use patterns.

Perspective: This article sought to explore the relationship between somatization and adherence to prescription opioid medications. Our findings suggest that pain management treatment plans may be optimized by addressing patient distress about physical symptoms when considering the use of prescription opioid medications.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Analgesics, Opioid / therapeutic use*
  • Analysis of Variance
  • Chi-Square Distribution
  • Female
  • Humans
  • Male
  • Medication Adherence / psychology*
  • Middle Aged
  • Pain / drug therapy*
  • Pain Measurement
  • Regression Analysis
  • Severity of Illness Index
  • Somatoform Disorders / psychology*
  • Surveys and Questionnaires
  • Veterans / psychology


  • Analgesics, Opioid