The association between trauma exposure and prescription opioid use duration in non-cancer pain

Abstract

<h3>Context:</h3> The relationship between trauma exposure and opioid misuse has been investigated extensively. However, less is known about the association between traumatic stress and chronic prescription opioid use in patients with non-cancer pain. As opioid prescribing remains a common strategy for pain management, understanding risk factors for prolonged use of these medications is important to mitigate risks and harms to the patient. <h3>Objective:</h3> To determine whether chronic pain patients with vs. without trauma exposure have a greater risk for longer prescription opioid use duration. <h3>Study Design:</h3> Cross-sectional. <h3>Dataset:</h3> Preliminary survey data obtained from ongoing baseline assessment of longitudinal study. <h3>Population Studied:</h3> The first 489 patients who completed the baseline survey by 03/2021 were included if they had been using prescription opioids for 30-90 days and had not used opioids for at least 3 months prior to the current episode of use. <h3>Outcome measures and instruments:</h3> opioid duration, trauma obtained from Life Events Checklist-5, PTSD by the Primary Care PTSD Screen for DSM-5. <h3>Results:</h3> Patients were on average 52.3 (SD±12.4) years of age, 66.5% female and 67% white race. 62.8% reported trauma history, and compared to those without trauma, they were significantly (p&lt;0.05) younger, female, and had more pain sites, higher pain interference, as well as depression, anxiety, and smoking histories. Unadjusted analysis revealed trauma vs. no trauma was associated with &gt;90 day opioid use (OR=1.37; CI:0.94-1.99). After adjusting for age, gender, race, number of pain sites, pain severity, pain interference, anxiety, depression, substance use disorder history, and smoking, the association remained (OR=1.42; CI: 0.96-2.10). No significant association was found between positive PC-PTSD-5 screen and opioid use duration in patients with trauma history. <h3>Conclusions:</h3> Patients with trauma history have a greater risk for prolonged prescription opioid use. This relationship appears to be independent of PTSD symptoms. Exposure to traumatic stress should be considered among other risk factors, such as depression, that are correlated with chronic prescription opioid use. This study highlights the need for trauma-informed, patient-centered pain management.