Posttraumatic stress disorder and chronic pain are associated with opioid use disorder: Results from a 2012-2013 American nationally representative survey

Elena Bilevicius; Jordana L Sommer; Gordon J G Asmundson; Renée El-Gabalawy

doi:10.1016/j.drugalcdep.2018.04.005

Posttraumatic stress disorder and chronic pain are associated with opioid use disorder: Results from a 2012-2013 American nationally representative survey

Drug Alcohol Depend. 2018 Jul 1;188:119-125. doi: 10.1016/j.drugalcdep.2018.04.005. Epub 2018 May 7.

Authors

Elena Bilevicius¹, Jordana L Sommer¹, Gordon J G Asmundson², Renée El-Gabalawy³

Affiliations

¹ Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada; Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave, Winnipeg, MB, R3E 0Z2, Canada.
² Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
³ Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada; Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave, Winnipeg, MB, R3E 0Z2, Canada; Department of Clinical Health Psychology, University of Manitoba, PZ350-771 Bannatyne Ave, Winnipeg, MB, R3E 3N4, Canada. Electronic address: renee.el-gabalawy@umanitoba.ca.

PMID: 29775955
DOI: 10.1016/j.drugalcdep.2018.04.005

Abstract

Background: Chronic pain conditions and posttraumatic stress disorder (PTSD) commonly co-occur and are associated with opioid use disorder (OUD). The aims of this paper were to identify prevalence estimates of OUD among individuals with and without PTSD and assess independent and combined contributions of PTSD and chronic pain conditions on OUD in a nationally representative sample.

Methods: Data were extracted from 36,309 individuals from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. Past-year PTSD and OUD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 edition. Respondents reported physician-confirmed, past-year chronic pain conditions, categorized into musculoskeletal pain (e.g., arthritis), digestive pain (e.g., pancreatitis), and nerve pain (e.g., reflex sympathetic dystrophy). We examined the weighted prevalence of OUD among those with and without PTSD. Multiple logistic regressions examined the association between PTSD and chronic pain conditions on OUD.

Results: The prevalence of OUD was higher among those with PTSD than those without. Comorbid PTSD/musculoskeletal pain and PTSD/nerve pain conditions were associated with increased odds of OUD, compared to those with neither PTSD nor chronic pain conditions. Digestive pain conditions were not associated with OUD. Comorbid PTSD/musculoskeletal pain conditions demonstrated an additive relationship on OUD compared to musculoskeletal pain conditions and PTSD alone.

Conclusions: Results reveal that musculoskeletal pain and nerve pain conditions are associated with increased odds of OUD, but only musculoskeletal pain conditions display an additive relationship on OUD when combined with PTSD. These findings have implications for opioid management and screening among those with comorbid conditions.

Keywords: Chronic pain; Comorbidity; DSM-5; Musculoskeletal conditions; Opioid use disorder; Posttraumatic stress disorder.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Chronic Pain / diagnosis
Chronic Pain / epidemiology*
Chronic Pain / psychology
Comorbidity
Cross-Sectional Studies / trends
Female
Humans
Male
Middle Aged
Opioid-Related Disorders / diagnosis
Opioid-Related Disorders / epidemiology*
Opioid-Related Disorders / psychology
Prevalence
Stress Disorders, Post-Traumatic / diagnosis
Stress Disorders, Post-Traumatic / epidemiology*
Stress Disorders, Post-Traumatic / psychology
Surveys and Questionnaires*
United States / epidemiology