Top

BMC Psychiatry

Published in:

Open Access 01-12-2021 | Mood Disorders | Research

The effect of depressive symptoms on pain in a substance-using population with persistent pain: a cross-sectional cohort study

Authors: Pauline Voon, Jin Cheol Choi, Kanna Hayashi, M-J Milloy, Jane Buxton, Thomas Kerr

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

In light of the ongoing opioid overdose crisis, there is an urgent need for research on the impacts of mental health among people presenting with concurrent pain and substance use. This study examined the effect of depressive symptoms on pain severity and functional interference among people who use drugs (PWUD) during a community-wide overdose crisis.

Methods

From December 1st 2016 to December 31st 2018, 288 participants in two cohort studies of PWUD in Vancouver, Canada completed interviewer-administered questionnaires that included the Brief Pain Inventory and PROMIS Emotional Distress–Depression instruments. Generalized linear regression modelling (GLM) was used to examine the cross-sectional effect of depressive symptoms and other confounding factors on pain severity and interference.

Results

Moderate to severe depressive symptoms were significantly associated with greater pain-related functional interference (adjusted β = 1.24, 95% confidence interval [CI] = 0.33–2.15), but not significantly associated with greater average pain severity (adjusted β = 0.22, 95% CI = − 0.3 – 0.82), when controlling for confounding variables. Reported daily heroin use (adjusted β = 1.26, 95% CI = 0.47–2.05) and non-fatal overdose (adjusted β = 1.02, 95% CI = 0.08–1.96) were also significantly associated with greater pain-related functional interference.

Conclusions

In a substance-using population, greater pain-related functional interference was positively associated with depressive symptoms as well as overdose and daily heroin use. These findings emphasize the need to address the functional impact of pain, mental health comorbidity, and high-risk substance use that may contribute to overdose and other harms.

CDC. U.S. Centers for Disease Control and Prevention: Opioid Overdose: U.S. Washington, DC: Department of Health and Human Services; 2020. Available from: https://www.cdc.gov/drugoverdose/.

Hauser W, Schug S, Furlan AD. The opioid epidemic and national guidelines for opioid therapy for chronic noncancer pain: a perspective from different continents. Pain Rep. 2017;2(3):e599. https://doi.org/10.1097/PR9.0000000000000599.CrossRefPubMedPubMedCentral

Drug-related deaths in Scotland in 2018: National Records of Scotland; 2019. Available from: https://www.nrscotland.gov.uk/files//statistics/drug-related-deaths/2018/drug-related-deaths-18-pub.pdf. Accessed 26 Jan 2021.

Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372(9651):1733–45. https://doi.org/10.1016/S0140-6736(08)61311-2.CrossRefPubMed

Rose C, Shahanaghi A, Romero-Gonzalez M, Yarzebski J, Andre M, DiGirolamo GJ, et al. Mortality associated with opioid overdose: a review of clinical characteristics and health services received in the year prior to death. Psychiatr Serv. 2019;70(2):90–6. https://doi.org/10.1176/appi.ps.201800122.CrossRefPubMed

Dersh J, Polatin PB, Gatchel RJ. Chronic pain and psychopathology: research findings and theoretical considerations. Psychosom Med. 2002;64(5):773–86. https://doi.org/10.1097/01.psy.0000024232.11538.54.CrossRefPubMed

van Rijswijk SM, van Beek M, Schoof GM, Schene AH, Steegers M, Schellekens AF. Iatrogenic opioid use disorder, chronic pain and psychiatric comorbidity: a systematic review. Gen Hosp Psychiatry. 2019;59:37–50. https://doi.org/10.1016/j.genhosppsych.2019.04.008.CrossRefPubMed

Boscarino JA, Hoffman SN, Han JJ. Opioid-use disorder among patients on long-term opioid therapy: impact of final DSM-5 diagnostic criteria on prevalence and correlates. Subst Abus Rehabil. 2015;6:83–91. https://doi.org/10.2147/SAR.S85667.CrossRef

Boscarino JA, Rukstalis M, Hoffman SN, Han JJ, Erlich PM, Gerhard GS, et al. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction. 2010;105(10):1776–82. https://doi.org/10.1111/j.1360-0443.2010.03052.x.CrossRefPubMed

10.

Edlund MJ, Sullivan MD, Han X, Booth BM. Days with pain and substance use disorders: is there an association? Clin J Pain. 2013;29(8):689–95. https://doi.org/10.1097/AJP.0b013e318270fa77.CrossRefPubMedPubMedCentral

11.

Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015;162(4):276–86. https://doi.org/10.7326/M14-2559.CrossRefPubMed

12.

Turk DC, Swanson KS, Gatchel RJ. Predicting opioid misuse by chronic pain patients: a systematic review and literature synthesis. Clin J Pain. 2008;24(6):497–508. https://doi.org/10.1097/AJP.0b013e31816b1070.CrossRefPubMed

13.

Cragg A, Hau JP, Woo SA, Kitchen SA, Liu C, Doyle-Waters MM, et al. Risk factors for misuse of prescribed opioids: a systematic review and meta-analysis. Ann Emerg Med. 2019;74(5):634–46. https://doi.org/10.1016/j.annemergmed.2019.04.019.CrossRefPubMed

14.

Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433–45. https://doi.org/10.1001/archinte.163.20.2433.CrossRefPubMed

15.

Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain. 1997;13(2):116–37. https://doi.org/10.1097/00002508-199706000-00006.CrossRefPubMed

16.

Romano JM, Turner JA. Chronic pain and depression: does the evidence support a relationship? Psychol Bull. 1985;97(1):18–34. https://doi.org/10.1037/0033-2909.97.1.18.CrossRefPubMed

17.

Strathdee SA, Palepu A, Cornelisse PG, Yip B, O'Shaughnessy MV, Montaner JS, et al. Barriers to use of free antiretroviral therapy in injection drug users. Jama. 1998;280(6):547–9. https://doi.org/10.1001/jama.280.6.547.CrossRefPubMed

18.

Keller S, Bann CM, Dodd SL, Schein J, Mendoza TR, Cleeland CS. Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain. 2004;20(5):309–18. https://doi.org/10.1097/00002508-200409000-00005.CrossRefPubMed

19.

Breitbart W, Rosenfeld B, Passik S, Kaim M, Funesti-Esch J, Stein K. A comparison of pain report and adequacy of analgesic therapy in ambulatory AIDS patients with and without a history of substance abuse. Pain. 1997;72(1–2):235–43. https://doi.org/10.1016/S0304-3959(97)00039-0.CrossRefPubMed

20.

Passik SD, Kirsh KL, Donaghy KB, Portenoy RK. Pain and aberrant drug-related behaviors in medically ill patients with and without histories of substance abuse. Clin J Pain. 2006;22(2):173–81. https://doi.org/10.1097/01.ajp.0000161525.48245.aa.CrossRefPubMed

21.

Rosenblum A, Joseph H, Fong C, Kipnis S, Cleland C, Portenoy RK. Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. Jama. 2003;289(18):2370–8. https://doi.org/10.1001/jama.289.18.2370.CrossRefPubMed

22.

Pilkonis PA, Choi SW, Reise SP, Stover AM, Riley WT, Cella D, et al. Item banks for measuring emotional distress from the patient-reported outcomes measurement information system (PROMIS(R)): depression, anxiety, and anger. Assessment. 2011;18(3):263–83. https://doi.org/10.1177/1073191111411667.CrossRefPubMedPubMedCentral

23.

American Psychiatric Association. LEVEL 2, Depression, Adult (PROMIS Emotional Distress, Depression, Short Form). Available from: https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/assessment-measures . Accessed 26 Jan 2021.

24.

American Psychiatric Association. LEVEL 2, Anxiety, Adult (PROMIS Emotional Distress, Anxiety, Short Form). Available from: https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/assessment-measures . Accessed 26 Jan 2021.

25.

Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5) – Standard [Measurement instrument]. Available from: https://www.ptsd.va.gov/. Accessed 26 Jan 2021.

26.

Bovin MJ, Marx BP, Weathers FW, Gallagher MW, Rodriguez P, Schnurr PP, et al. Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in veterans. Psychol Assess. 2016;28(11):1379–91. https://doi.org/10.1037/pas0000254.CrossRefPubMed

27.

Voon P, Karamouzian M, Kerr T. Chronic pain and opioid misuse: a review of reviews. Subst Abuse Treat Prev Policy. 2017;12(1):36. https://doi.org/10.1186/s13011-017-0120-7.CrossRefPubMedPubMedCentral

28.

Morasco BJ, Gritzner S, Lewis L, Oldham R, Turk DC, Dobscha SK. Systematic review of prevalence, correlates, and treatment outcomes for chronic non-cancer pain in patients with comorbid substance use disorder. Pain. 2011;152(3):488–97. https://doi.org/10.1016/j.pain.2010.10.009.CrossRefPubMed

29.

Dennis BB, Bawor M, Naji L, Chan CK, Varenbut J, Paul J, et al. Impact of chronic pain on treatment prognosis for patients with opioid use disorder: a systematic review and meta-analysis. Subst Abuse. 2015;9:59–80. https://doi.org/10.4137/SART.S30120.CrossRefPubMedPubMedCentral

30.

John WS, Wu LT. Chronic non-cancer pain among adults with substance use disorders: prevalence, characteristics, and association with opioid overdose and healthcare utilization. Drug Alcohol Depend. 2020;209:107902. https://doi.org/10.1016/j.drugalcdep.2020.107902.CrossRefPubMedPubMedCentral

31.

Cleland CM, Bennett AS, Elliott L, Rosenblum A, Britton PC, Wolfson-Stofko B. Between- and within-person associations between opioid overdose risk and depression, suicidal ideation, pain severity, and pain interference. Drug Alcohol Depend. 2020;206:107734. https://doi.org/10.1016/j.drugalcdep.2019.107734.CrossRefPubMed

32.

Voon P, Wang L, Nosova E, Hayashi K, Milloy MJ, Wood E, et al. Pain and barriers to accessing health services among people who use drugs. Pain Manag Nurs. 2020;22(2):133–40.

33.

Voon P, Wang L, Nosova E, Hayashi K, Milloy MJ, Wood E, et al. Greater pain severity is associated with inability to access addiction treatment among a cohort of people who use drugs. J Pain Res. 2020;13:2443–9. https://doi.org/10.2147/JPR.S255438.CrossRefPubMedPubMedCentral

34.

Becker WC, Sullivan LE, Tetrault JM, Desai RA, Fiellin DA. Non-medical use, abuse and dependence on prescription opioids among U.S. adults: psychiatric, medical and substance use correlates. Drug Alcohol Depend. 2008;94(1–3):38–47. https://doi.org/10.1016/j.drugalcdep.2007.09.018.CrossRefPubMed

35.

Little RJA. A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc. 1988;83(404):1198–202. https://doi.org/10.1080/01621459.1988.10478722.CrossRef

36.

Bell BA, Kromrey JD, Ferron JM. Missing data and complex samples: The impact of listwise deletion vs. subpopulation analysis on statistical bias and hypothesis test results when data are MCAR and MAR. In: Proceedings of the Joint Statistical Meetings, Survey Research Methods Section, vol. 26; 2009. p. 759–4770.

37.

Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138(11):923–36. https://doi.org/10.1093/oxfordjournals.aje.a116813.CrossRefPubMed

38.

Lima VD, Geller J, Bangsberg DR, Patterson TL, Daniel M, Kerr T, et al. The effect of adherence on the association between depressive symptoms and mortality among HIV-infected individuals first initiating HAART. Aids. 2007;21(9):1175–83. https://doi.org/10.1097/QAD.0b013e32811ebf57.CrossRefPubMed

39.

Marshall BD, Kerr T, Shoveller JA, Patterson TL, Buxton JA, Wood E. Homelessness and unstable housing associated with an increased risk of HIV and STI transmission among street-involved youth. Health Place. 2009;15(3):753–60. https://doi.org/10.1016/j.healthplace.2008.12.005.CrossRefPubMedPubMedCentral

40.

Weng HY, Hsueh YH, Messam LL, Hertz-Picciotto I. Methods of covariate selection: directed acyclic graphs and the change-in-estimate procedure. Am J Epidemiol. 2009;169(10):1182–90. https://doi.org/10.1093/aje/kwp035.CrossRefPubMed

41.

Berna C, Leknes S, Holmes EA, Edwards RR, Goodwin GM, Tracey I. Induction of depressed mood disrupts emotion regulation neurocircuitry and enhances pain unpleasantness. Biol Psychiatry. 2010;67(11):1083–90. https://doi.org/10.1016/j.biopsych.2010.01.014.CrossRefPubMed

42.

Wiech K, Tracey I. The influence of negative emotions on pain: behavioral effects and neural mechanisms. Neuroimage. 2009;47(3):987–94. https://doi.org/10.1016/j.neuroimage.2009.05.059.CrossRefPubMed

43.

Haythornthwaite JA, Sieber WJ, Kerns RD. Depression and the chronic pain experience. Pain. 1991;46(2):177–84. https://doi.org/10.1016/0304-3959(91)90073-7.CrossRefPubMed

44.

Caudarella A, Dong H, Milloy MJ, Kerr T, Wood E, Hayashi K. Non-fatal overdose as a risk factor for subsequent fatal overdose among people who inject drugs. Drug Alcohol Depend. 2016;162:51–5. https://doi.org/10.1016/j.drugalcdep.2016.02.024.CrossRefPubMedPubMedCentral

45.

Johnson EM, Lanier WA, Merrill RM, Crook J, Porucznik CA, Rolfs RT, et al. Unintentional prescription opioid-related overdose deaths: description of decedents by next of kin or best contact, Utah, 2008-2009. J Gen Intern Med. 2013;28(4):522–9. https://doi.org/10.1007/s11606-012-2225-z.CrossRefPubMed

46.

Foley M, Schwab-Reese LM. Associations of state-level rates of depression and fatal opioid overdose in the United States, 2011-2015. Soc Psychiatry Psychiatr Epidemiol. 2019;54(1):131–4. https://doi.org/10.1007/s00127-018-1594-y.CrossRefPubMed

47.

Oquendo MA, Volkow ND. Suicide: a silent contributor to opioid-overdose deaths. N Engl J Med. 2018;378(17):1567–9. https://doi.org/10.1056/NEJMp1801417.CrossRefPubMed

48.

Sullivan MD. Who gets high-dose opioid therapy for chronic non-cancer pain? Pain. 2010;151(3):567–8. https://doi.org/10.1016/j.pain.2010.08.036.CrossRefPubMed

49.

Sullivan MD, Howe CQ. Opioid therapy for chronic pain in the United States: promises and perils. Pain. 2013;154(Suppl 1):S94–S100. https://doi.org/10.1016/j.pain.2013.09.009.CrossRefPubMedPubMedCentral

50.

Ballantyne JC. Opioids for the treatment of chronic pain: mistakes made, lessons learned, and future directions. Anesth Analg. 2017;125(5):1769–78. https://doi.org/10.1213/ANE.0000000000002500.CrossRefPubMed

51.

Inturrisi CE, Max MB, Foley KM, Schultz M, Shin SU, Houde RW. The pharmacokinetics of heroin in patients with chronic pain. N Engl J Med. 1984;310(19):1213–7. https://doi.org/10.1056/NEJM198405103101902.CrossRefPubMed

52.

Kuehn BM. SAMHSA: pain medication abuse a common path to heroin: experts say this pattern likely driving heroin resurgence. Jama. 2013;310(14):1433–4. https://doi.org/10.1001/jama.2013.278861.CrossRefPubMed

53.

Rieb LM, DeBeck K, Hayashi K, Wood E, Nosova E, Milloy MJ. Withdrawal-associated injury site pain prevalence and correlates among opioid-using people who inject drugs in Vancouver, Canada. Drug Alcohol Depend. 2020;216:108242. https://doi.org/10.1016/j.drugalcdep.2020.108242.CrossRefPubMed

54.

Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers - United States, 2002-2004 and 2008-2010. Drug Alcohol Depend. 2013;132(1–2):95–100. https://doi.org/10.1016/j.drugalcdep.2013.01.007.CrossRefPubMed

55.

Barry DT, Pilver C, Potenza MN, Desai RA. Prevalence and psychiatric correlates of pain interference among men and women in the general population. J Psychiatr Res. 2012;46(1):118–27. https://doi.org/10.1016/j.jpsychires.2011.09.004.CrossRefPubMed

56.

Baldwin N, Gray R, Goel A, Wood E, Buxton JA, Rieb LM. Fentanyl and heroin contained in seized illicit drugs and overdose-related deaths in British Columbia, Canada: an observational analysis. Drug Alcohol Depend. 2018;185:322–7. https://doi.org/10.1016/j.drugalcdep.2017.12.032.CrossRefPubMedPubMedCentral

Title: The effect of depressive symptoms on pain in a substance-using population with persistent pain: a cross-sectional cohort study
Authors: Pauline Voon
Jin Cheol Choi
Kanna Hayashi
M-J Milloy
Jane Buxton
Thomas Kerr
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Mood Disorders
Opioids
Opioids
Affective Disorder
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03424-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effect of depressive symptoms on pain in a substance-using population with persistent pain: a cross-sectional cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Social and structural factors associated with depression and suicidality among men who have sex with men and transgender women in Nepal

Posttraumatic stress disorder (PTSD) and depression severity in sexually assaulted women: hypothalamic-pituitary-adrenal (HPA) axis alterations

Job burnout and its impact on work ability in biosafety laboratory staff during the COVID-19 epidemic in Xinjiang

Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: a best-worst scaling choice experiment

Altered spontaneous neural activity in the precuneus, middle and superior frontal gyri, and hippocampus in college students with subclinical depression

An evaluation of eye movement desensitization and reprocessing therapy delivered remotely during the Covid–19 pandemic