Advertisement

Risk of Pain Medication Misuse After Spinal Cord Injury: The Role of Substance Use, Personality, and Depression

  • Jillian M.R. Clark
    Affiliations
    College of Health Professions, Medical University of South Carolina, Charleston, South Carolina

    Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
    Search for articles by this author
  • Yue Cao
    Affiliations
    College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
    Search for articles by this author
  • James S. Krause
    Correspondence
    Address reprint requests to James S. Krause, PhD, College of Health Professions, Medical University of South Carolina, 77 President St, Suite C101, MSC 700, Charleston, SC 29425.
    Affiliations
    College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
    Search for articles by this author
Published:November 08, 2016DOI:https://doi.org/10.1016/j.jpain.2016.10.011

      Highlights

      • Of all participants, 17.6% reported risk of pain medication misuse.
      • Cigarette and cannabis use were associated with risk of pain medication misuse.
      • Greater depressive symptoms were associated with risk of pain medication misuse.
      • Impulsive and anxious traits were associated with risk of pain medication misuse.

      Abstract

      Our purpose was to identify risk of pain medication misuse (PMM) among participants with spinal cord injury (SCI) by examining associations with multiple sets of risk factors including demographic and injury characteristics, pain experiences, frequency of pain medication use, substance use, personality, and depressive symptoms. Risk of PMM was defined by a cutoff score ≥30 measured using the Pain Medication Questionnaire (PMQ) and examined in 1,619 adults with traumatic SCI of at least 1 year duration who reported at least 1 painful condition and use of prescription pain medication using a cross-sectional design. Results indicated 17.6% of participants had scores of ≥30 on the PMQ. After controlling for demographic, injury, and pain characteristics, logistic regression analysis showed that being a current smoker, recently using cannabis (behavioral factors), and multiple psychological factors were associated with risk of PMM, as indicated by scores on the PMQ. These included elevated depressive symptomatology and exhibiting impulsive or anxious personality traits. Because risk of PMM is indicated in individuals with SCI, prescribers should assess and monitor multiple risk factors for PMM including substance use behaviors and psychological indicators.

      Perspective

      This article identifies behavioral substance use and psychological factors associated with risk of PMM, measured using the PMQ, among those with SCI. Identification of these related variables will help health care professionals better prescribe and monitor pain medication use and/or misuse among individuals with SCI.

      Key words

      To read this article in full you will need to make a payment
      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Adams L.L.
        • Gatchel R.J.
        • Robinson R.C.
        • Polatin P.
        • Gajraj N.
        • Deschner M.
        • Noe C.
        Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients.
        J Pain Symptom Manage. 2004; 27: 440-459
        • Aluja A.
        • Rossier J.
        • Garcia L.F.
        • Angleitner A.
        • Kuhlman M.
        • Zuckerman M.
        A cross-cultural shortened form of the ZKPQ (ZKPQ-50-cc) adapted to English, French, German, and Spanish languages.
        Personal Indiv Diff. 2006; 41: 619-628
      1. CDC: BRFSS. Behavioral Risk Factor Surveillance System. Available at: http://www.cdc.gov/brfss/questionnaires/pdf-ques/2010brfss.pdf. Accessed August 22, 2012

      2. Cleeland CS: The Brief Pain Inventory: User Guide. Available at: https://www.mdanderson.org/documents/Departments-and-Divisions/Symptom-Research/BPI_UserGuide.pdf. Accessed May 27, 2016

        • Cleeland C.S.
        • Ryan K.M.
        Pain assessment: Global use of the Brief Pain Inventory.
        Ann Acad Med Singapore. 1994; 23: 129-138
        • Conway K.P.
        • Swendsen J.D.
        • Rounsaville B.J.
        • Merikangas K.R.
        Personality, drug of choice, and comorbid psychopathology among substance abusers.
        Drug Alcohol Depend. 2002; 65: 225-234
        • Craig A.
        • Tran Y.
        • Middleton J.
        Psychological morbidity and spinal cord injury: A systematic review.
        Spinal Cord. 2009; 47: 108-114
        • Donnelly C.
        • Eng J.J.
        Pain following spinal cord injury: The impact on community reintergration.
        Spinal Cord. 2005; 43: 278-282
        • Dowling L.S.
        • Gatchel R.J.
        • Adams L.L.
        • Stowell A.W.
        • Bernstein D.
        An evaluation of the predictive validity of the Pain Medication Questionnaire with a heterogeneous group of patients with chronic pain.
        J Opioid Manag. 2007; 3: 257-266
        • Edlund M.J.
        • Martin B.C.
        • Fan M.Y.
        • Devries A.
        • Braden J.B.
        • Sullivan M.D.
        Risks for opioid abuse and dependence among recipients of chronic opioid therapy: Results from the TROUP study.
        Drug Alcohol Depend. 2010; 112: 90-98
        • Ehde D.M.
        • Jensen M.P.
        • Engel J.M.
        • Turner J.A.
        • Hoffman A.J.
        • Cardenas D.D.
        Chronic pain secondary to disability: A review.
        Clin J Pain. 2003; 19: 3-17
        • Franques P.
        • Auriacombe M.
        • Piquemal E.
        • Verger M.
        • Brisseau-Gimenez S.
        • Grabot D.
        • Tignol J.
        Sensation seeking as a common factor in opioid dependent subjects and high risk sport practicing subjects. A cross sectional study.
        Drug Alcohol Depend. 2003; 69: 121-126
        • Graves D.E.
        • Bombardier C.H.
        Improving the efficiency of screening for major depression in people with spinal cord injury.
        J Spinal Cord Med. 2008; 31: 177-184
        • Heinemann A.W.
        • McGraw T.E.
        • Brandt M.J.
        • Roth E.
        • Dell’Oliver C.
        Prescription medication misuse among persons with spinal cord injuries.
        Int J Addict. 1992; 27: 301-316
        • Holmes C.P.
        • Gatchel R.J.
        • Adams L.L.
        • Stowell A.W.
        • Hatten A.
        • Noe C.
        • Lou L.
        An opioid screening instrument: Long-term evaluation of the utility of the Pain Medication Questionnaire.
        Pain Pract. 2006; 6: 74-88
      3. Humeniuk R, Henry-Edwards S, Ali R, Poznyak V, Monteiro M: The Alcohol Smoking and Substance Involvement Screening Test (ASSIST): Manual for Use in Primary Care. Available at: http://www.who.int/substance_abuse/activities/en/Draft_The_ASSIST_Guidelines.pdf. Accessed May 27, 2016

        • IBM Corp
        IBM SPSS Statistics for Windows.
        IBM Corp, Armonk, NY2012
        • Ives T.J.
        • Chelminski P.R.
        • Hammett-Stabler C.A.
        • Malone R.M.
        • Perhac J.S.
        • Potisek N.M.
        • Shilliday B.B.
        • DeWalt D.A.
        • Pignone M.P.
        Predictors of opioid misuse in patients with chronic pain: A prospective cohort study.
        BMC Health Serv Res. 2006; 6: 46
        • Jamison R.N.
        • Link C.L.
        • Marceau L.D.
        Do pain patients at high risk for substance misuse experience more pain? A longitudinal outcomes study.
        Pain Med. 2009; 10: 1084-1094
        • Jamison R.N.
        • Ross E.L.
        • Michna E.
        • Chen L.Q.
        • Holcomb C.
        • Wasan A.D.
        Substance misuse treatment for high-risk chronic pain patients on opioid therapy: A randomized trial.
        Pain. 2010; 150: 390-400
        • Jensen M.P.
        • Hoffman A.J.
        • Cardenas D.D.
        Chronic pain in individuals with spinal cord injury: A survey and longitudinal study.
        Spinal Cord. 2005; 43: 704-712
        • Kohout R.K.
        • Saunders L.L.
        • Krause J.S.
        The relationship between prescription medication use and ability to ambulate distances after spinal cord injury.
        Arch Phys Med Rehabil. 2011; 92: 1246-1249
        • Kornor H.
        • Nordvik H.
        Five-factor model personality traits in opioid dependence.
        BMC Psychiatry. 2007; 7: 37
        • Kosten T.A.
        • Ball S.A.
        • Rounsaville B.J.
        A sibling study of sensation seeking and opiate addiction.
        J Nerv Ment Dis. 1994; 182: 284-289
        • Krause J.S.
        • Carter R.E.
        • Pickelsimer E.
        Behavioral risk factors of mortality after spinal cord injury.
        Arch Phys Med Rehabil. 2009; 90: 95-101
        • Krause J.S.
        • Clark J.M.
        • Saunders L.L.
        Pain medication misuse among participants with spinal cord injury.
        Spinal Cord. 2015; 53: 630-635
        • Krause J.S.
        • Zhai Y.
        • Saunders L.L.
        • Carter R.E.
        Risk of mortality after spinal cord injury: An 8-year prospective study.
        Arch Phys Med Rehabil. 2009; 90: 1708-1715
        • Kroenke K.
        • Spitzer R.L.
        The PHQ-9: A new depression diagnostic and severity measure.
        Psychiatr Ann. 2002; 32: 509-515
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Liebschutz J.M.
        • Saitz R.
        • Weiss R.D.
        • Averbuch T.
        • Schwartz S.
        • Meltzer E.C.
        • Claggett-Borne E.
        • Cabral H.
        • Samet J.H.
        Clinical factors associated with prescription drug use disorder in urban primary care patients with chronic pain.
        J Pain. 2010; 11: 1047-1055
        • Manchikanti L.
        • Fellows B.
        • Ailinani H.
        • Pampati V.
        Therapeutic use, abuse, and nonmedical use of opioids: A ten-year perspective.
        Pain Phys. 2010; 13: 401-435
        • Morasco B.J.
        • Dobscha S.K.
        Prescription medication misuse and substance use disorder in VA primary care patients with chronic pain.
        Gen Hosp Psychiatry. 2008; 30: 93-99
        • Norrbrink Budh C.
        • Hultling C.
        • Lundeberg T.
        Quality of sleep in individuals with spinal cord injury: A comparison between patients with and without pain.
        Spinal Cord. 2005; 43: 85-95
        • Paulozzi L.J.
        • Jones C.M.
        • Mack K.A.
        • Rudd R.A.
        Vital signs: Overdoses of prescription opioid pain relievers – United States, 1999-2008.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 1477-1509
        • Putzke J.D.
        • Richards J.S.
        • Dowler R.N.
        The impact of pain in spinal cord injury: A case–control study.
        Rehabil Psychol. 2000; 45: 386-401
        • Reisfield G.M.
        • Wasan A.D.
        • Jamison R.N.
        The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: A review of the extant literature.
        Pain Med. 2009; 10: 1434-1441
        • Rintala D.H.
        • Hart K.A.
        • Priebe M.M.
        Predicting consistency of pain over a 10-year period in persons with spinal cord injury.
        J Rehabil Res Dev. 2004; 41: 75-88
        • Rohe D.E.
        • Krause J.S.
        The five-factor model of personality: Findings in males with spinal cord injury.
        Assessment. 1999; 6: 203-214
        • Saunders L.L.
        • Krause J.S.
        • Acuna J.
        Association of race, socioeconomic status, and health care access with pressure ulcers after spinal cord injury.
        Arch Phys Med Rehabil. 2012; 93: 972-977
        • Saunders L.L.
        • Krause J.S.
        • Carpenter M.J.
        • Saladin M.
        Risk behaviors related to cigarette smoking among persons with spinal cord injury.
        Nicotine Tob Res. 2014; 16: 224-230
        • Saunders L.L.
        • Krause J.S.
        • Saladin M.
        • Carpenter M.J.
        Prevalence of cigarette smoking and attempts to quit in a population-based cohort with spinal cord injury.
        Spinal Cord. 2015; 53: 641-655
        • Saunders L.L.
        • Krause J.S.
        • Selassie A.W.
        Association of health services with secondary conditions: Use of a population-based cohort of persons with SCI in South Carolina.
        Top Spinal Cord Inj Rehabil. 2010; 16: 30-39
        • Sehgal N.
        • Manchikanti L.
        • Smith H.S.
        Prescription opioid abuse in chronic pain: a review of opioid abuse predictors and strategies to curb opioid abuse.
        Pain Phys. 2012; 15: ES67-ES92
        • Siddall P.J.
        • McClelland J.M.
        • Rutkowski S.B.
        • Cousins M.J.
        A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury.
        Pain. 2003; 103: 249-257
        • Spielberger C.D.
        • Gorsuch R.L.
        • Lushene R.
        • Vagg P.R.
        • Jacobs G.A.
        Manual for the State-Trait Anxiety Inventory.
        Consulting Psychologists Press, Palo Alto, CA1983
        • Stephenson M.T.
        • Hoyle R.H.
        • Palmgreen P.
        • Slater M.D.
        Brief measures of sensation seeking for screening and large-scale surveys.
        Drug Alcohol Depend. 2003; 72: 279-286
        • Sullivan M.D.
        • Edlund M.J.
        • Fan M.Y.
        • Devries A.
        • Brennan Braden J.
        • Martin B.C.
        Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and medicaid insurance plans: The TROUP Study.
        Pain. 2010; 150: 332-339
        • Tate D.G.
        • Forchheimer M.
        • Krause J.S.
        • Meade M.A.
        • Bombardier C.H.
        Patterns of alcohol and substance use and abuse in persons with spinal cord injury risk factors and correlates.
        Arch Phys Med Rehabil. 2004; 85: 1837-1847
      4. US Department of Health and Human Services: Addressing Prescription Drug Abuse in the United States: Current Activities and Future Opportunities. Available at: http://www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_abuse_report_09.2013.pdf. Accessed May 27, 2016

        • Werhagen L.
        • Budh C.N.
        • Hultling C.
        • Molander C.
        Neuropathic pain after traumatic spinal cord injury–relations to gender, spinal level, completeness, and age at the time of injury.
        Spinal Cord. 2004; 42: 665-673
        • Wu L.T.
        • Ling W.
        • Burchett B.
        • Blazer D.G.
        • Shostak J.
        • Woody G.E.
        Gender and racial/ethnic differences in addiction severity, HIV risk, and quality of life among adults in opioid detoxification: Results from the National Drug Abuse Treatment Clinical Trials Network.
        Subst Abuse Rehabil. 2010; 13-22: 2010
        • Zuckerman M.
        • Kuhlman D.M.
        • Joireman J.
        • Teta P.
        • Kraft M.
        A comparison of three structural models for personality, The Big Three, The Big Five and The Alternate Five.
        J Pers Soc Psychol. 1993; 65: 757-768