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Associations Between Adolescent Chronic Pain and Prescription Opioid Misuse in Adulthood

  • Cornelius B. Groenewald
    Correspondence
    Address reprint requests to Cornelius B. Groenewald, MB, ChB, Departments of Anesthesiology and Pain Medicine, Seattle Children's Hospital, M/S MB.11.500.3, 4800 Sand Point Way NE, Seattle, WA 98105.
    Affiliations
    Departments of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington
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  • Emily F. Law
    Affiliations
    Departments of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington
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  • Emma Fisher
    Affiliations
    Department for Health, University of Bath, Claverton Down, Bath, UK
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  • Sarah E. Beals-Erickson
    Affiliations
    Division of Developmental and Behavioral Sciences, Children's Mercy Hospital and University of Missouri–Kansas City, Kansas City, Missouri
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  • Tonya M. Palermo
    Affiliations
    Departments of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington

    Pediatrics, University of Washington School of Medicine, Seattle, Washington

    Psychiatry, University of Washington School of Medicine, Seattle, Washington

    Division of Developmental and Behavioral Sciences, Children's Mercy Hospital and University of Missouri–Kansas City, Kansas City, Missouri
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Published:August 08, 2018DOI:https://doi.org/10.1016/j.jpain.2018.07.007

      Highlights

      • Adolescent chronic pain was associated with future opioid misuse.
      • Trauma exposure and substance use increased opioid misuse risk among those with pain.
      • Depressive and anxiety symptoms were not associated with opioid misuse.

      Abstract

      Prescription opioid misuse is a serious public health concern, yet antecedent factors are poorly described. Using data from the National Longitudinal Study of Adolescent to Adult Health (N = 14,784), we examined the longitudinal relationship between a history of adolescent chronic pain and the odds of misusing prescription opioids in adulthood. The primary predictor variable was chronic pain status during adolescence. The primary outcome variables were prescription opioid misuse during early adulthood and adulthood. Multivariate models controlled for known risk factors of opioid misuse, including sociodemographics (sex, race, and ethnicity), adolescent mental health symptoms (anxiety, depression), adolescent self-reported physical health status, adolescent substance use/abuse, childhood trauma, and adult legitimate opioid use. We found that adults with a history of adolescent chronic pain were more likely to misuse opioids than those without history of chronic pain, even after controlling for other known risk factors. Further, we found that among individuals with history of adolescent chronic pain that race (white), other substance use, and exposure to trauma were risk factors for later opioid misuse. Longitudinal associations between adolescent chronic pain and subsequent adult prescription opioid misuse highlight the need for early targeted screening and prevention efforts that may reduce later opioid misuse.
      Perspective: Using a large, nationally representative sample, we found that chronic pain during adolescence was an independent risk factor for opioid misuse in adulthood, over and above other known risk factors. Furthermore, among those individuals with adolescent chronic pain, substance use, exposure to trauma, and race were associated with opioid misuse.

      Key words

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