Highlights
- •Pain catastrophizing mediated depressive symptoms and prescription opioid misuse risk.
- •Indirect effects were stronger at higher levels of reward drive, regardless of rash impulsiveness.
- •Impulsivity traits may assist in identifying those at risk of prescription opioid misuse.
Abstract
Depression, a prognostic factor for prescription opioid misuse commonly occurs in
people with chronic non-cancer pain (CNCP). However, the mechanisms linking depression
and prescription opioid misuse remain unclear. This study examined the potential mediating
role of pain catastrophizing in the association between depressive symptoms and prescription
opioid misuse risk, and impulsivity traits as possible moderators of these relationships.
Individuals (N = 198; 77% women) with CNCP using prescription opioids participated in a cross-sectional
online survey with validated measures of depression, pain catastrophizing, rash impulsiveness,
reward drive, anxiety, pain severity and prescription opioid misuse. Meditation analyses
with percentile-based bootstrapping examined pathways to prescription opioid use,
controlling for age, sex, pain severity, and anxiety symptoms. Partial moderated mediation
of the indirect effect of depressive symptoms on prescription opioid misuse risk through
pain catastrophizing by rash impulsiveness and reward drive were estimated. Pain catastrophizing
mediated depressive symptoms and prescription opioid misuse risk. Indirect effects
were stronger when moderate to high levels of reward drive were included in the model.
Findings suggest the risk of prescription opioid misuse in those experiencing depressive
symptoms and pain catastrophizing is particularly higher for those higher in reward
drive. Treatments targeting these mechanisms may reduce opioid misuse risk.
Perspective
This article identifies reward drive as a potentially important factor increasing
the effects of depression-related cognitive mechanisms on risk of prescription opioid
misuse in those with CNCP. These findings could assist in personalizing clinical CNCP
management to reduce the risks associated with opioid misuse.
Key Words
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Article info
Publication history
Published online: November 24, 2022
Accepted:
November 20,
2022
Received in revised form:
November 13,
2022
Received:
July 25,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Internal university funds to Dr. Elphinston were used for the thank you gift (prize draw of $100 gift vouchers). Dr. Elphinston is supported by a Research Stimulus Fellowship grant administered by The University of Queensland and an Advance Queensland Women's Research Assistance Program grant administered by the Queensland Government Department of Innovation, Tourism Industry Development. Associate Professor Gullo is supported by a Medical Research Future Fund Translating Research into Practice (TRIP) Fellowship (1167986).
Conflict of Interest: The authors have no conflict of interests to declare.
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© 2022 by United States Association for the Study of Pain, Inc.
