Predictors of painkiller dependence among people with pain in the general population

Pain Med. 2014 Apr;15(4):613-24. doi: 10.1111/pme.12263. Epub 2013 Oct 23.


Objectives: Self-medication with painkillers is widespread and increasing, and evidence about influences on painkiller dependence is needed to inform efforts to prevent and treat problem painkiller use.

Design: Online questionnaire survey.

Participants: People in the general population who had pain and used painkillers in the last month (N = 112).

Measurements: Pain frequency and intensity, use of over-the-counter and prescription painkillers, risk of substance abuse (Screener and Opioid Assessment for Patients with Pain [SOAPP] scale), depression, anxiety, stress, alexithymia, pain catastrophizing, pain anxiety, pain self-efficacy, pain acceptance, mindfulness, self-compassion, and painkiller dependence (Leeds Dependence Questionnaire).

Results: In multiple regression, the independent predictors of painkiller dependence were prescription painkiller use (β 0.21), SOAPP score (β 0.31), and pain acceptance (β -0.29). Prescription painkiller use mediated the influence of pain intensity. Alexithymia, anxiety, and pain acceptance all moderated the influence of pain.

Conclusions: The people most at risk of developing painkiller dependence are those who use prescription painkillers more frequently, who have a prior history of substance-related problems more generally, and who are less accepting of pain. Based on these findings, a preliminary model is presented with three types of influence on the development of painkiller dependence: 1) pain leading to painkiller use, 2) risk factors for substance-related problems irrespective of pain, and 3) psychological factors related to pain. The model could guide further research among the general population and high-risk groups, and acceptance-based interventions could be adapted and evaluated as methods to prevent and treat painkiller dependence.

Keywords: Addiction; Analgesics; Dependence; Medication; Pain.

MeSH terms

  • Adult
  • Affective Symptoms / epidemiology
  • Aged
  • Analgesics / therapeutic use
  • Analgesics, Opioid / therapeutic use*
  • Anxiety / epidemiology
  • Depression / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Opioid-Related Disorders / epidemiology*
  • Pain / drug therapy*
  • Risk Assessment
  • Risk Factors
  • Stress, Psychological / epidemiology
  • Substance-Related Disorders / epidemiology
  • Surveys and Questionnaires
  • Young Adult


  • Analgesics
  • Analgesics, Opioid