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Opioid misuse linked to stress intolerance: study

Inability to manage negative emotional and somatic stress is associated with opioid misuse in adults with chronic pain, according to new research reported in The Journal of Pain, published by the American Pain Society,

August 9, 2016  By Newswise

Researchers from Harvard Medical School, Brigham and Women’s Hospital and McLean Hospital investigated if high distress intolerance would make patients with chronic pain more likely to misuse opioid analgesics. Previous research suggests those with chronic pain who misuse their opioids exhibit higher levels of distress in general, as well as heightened reactivity to that distress.

Distress intolerance is defined as the perceived or actual inability to cope with adverse somatic or emotional stress. This can be treated effectively with cognitive behavioral therapy. For their study, the authors hypothesized that participants with higher distress intolerance levels would be more likely to misuse their prescribed opioids. They also examined if stress intolerance was associated with high pain sensitivity.

The study evaluated 51 participants from the pain management clinic at Brigham and Women’s Hospital. Subjects completed questionnaires and self reports probing for pain severity, pain thresholds, distress intolerance and opioid misuse.

Results showed that self-reported distress intolerance was significantly associated with opioid misuse in the study sample. For every one-unit increase in the Distress Intolerance Index, the likelihood of being in the opioid misuse group was 12 per cent higher. Of the 51 study subjects, 31 met criteria for opioid misuse.


“This study found robust differences in distress intolerance between adults with chronic pain, with and without opioid medication misuse. Distress intolerance may be a relevant marker of risk for opioid misuse among those with chronic pain,” said R. Kathryn McHugh, lead author and clinical researcher at McLean Hospital in Belmont, Mass.

Distress intolerance, however, was not associated with greater pain sensitivity but was linked with higher pain-related anxiety. The authors noted that distress intolerance is targeted extensively in cognitive behavioral therapy and can be modified with treatment.

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