Psychological factors as predictors of opioid abuse and illicit drug use in chronic pain patients

Laxmaiah Manchikanti, MD; James Giordano, PhD; Mark V. Boswell, MD, PhD; Bert Fellows, MA; Rajeev Manchukonda, BDS; Vidyasagar Pampati, MSc

doi:10.5055/jom.2007.0045

Authors

Laxmaiah Manchikanti, MD
James Giordano, PhD
Mark V. Boswell, MD, PhD
Bert Fellows, MA
Rajeev Manchukonda, BDS
Vidyasagar Pampati, MSc

DOI:

https://doi.org/10.5055/jom.2007.0045

Keywords:

psychopathology, substance abuse, opioid abuse, illicit drug use, MCMI, P3, DSM-IV-TR, endopheno-type

Abstract

Background: Psychopathology (depression, anxiety, somatization disorder) and substance abuse (opioid mis-use and illicit drug use) are common in patients with chronic pain and present problems for public health and clinical management. Despite a body of literature describing various methods for identifying psychopathology, opioid misuse, and illicit drug use in chronic pain patients, the relationship between psychopathologies, substance abuse, and chronic pain has not been well characterized.
Methods: This report describes a total of500 consecutive pain patients prescribed and receiving stable doses of opioids. The patients were evaluated for psychopathology, opioid abuse, and illicit drug use during the course of regular pain management treatment. The relationships between psychopathology and drug abuse and/or illicit drug use in chronic pain patients were examined, and psychological evaluation for depression, anxiety, and somatization disorder was performed.
Results: Depression, anxiety, and somatization disorder were documented in 59, 64, and 30percent of chronic pain patients, respectively. Drug abuse was significantly higher in patients with depression as compared to patients without depression (12percent with depression versus 5percent without). Current illicit drug use was higher in women with depression (22 percent) than women without depression (14percent) and in men with or without depression (12percent). Current illicit drug use was also higher in men with somatization disorder (22 percent) than men without (9 percent).
Conclusion: This study demonstrated that the presence of psychological features of depression and somatization disorder may be markers of substance abuse diathesis in chronic pain patients.

Author Biographies

Laxmaiah Manchikanti, MD

Pain Management Center of Paducah, Paducah, Kentucky.

James Giordano, PhD

Division of Palliative Medicine and Center for Clinical Bioethics, Georgetown University Medical Center, Washington, D.C.

Mark V. Boswell, MD, PhD

Department of Anesthesiology and Messer Racz Pain Center, Texas Tech University Health Sciences Center, Lubbock, Texas.

Bert Fellows, MA

Pain Management Center of Paducah, Paducah, Kentucky.

Rajeev Manchukonda, BDS

Pain Management Center of Paducah, Paducah, Kentucky.

Vidyasagar Pampati, MSc

Pain Management Center of Paducah, Paducah, Kentucky.

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