Social support and the association between post-traumatic stress disorder and risk for long-term prescription opioid use

Author:

Sullivan Mark D.1ORCID,Wilson Lauren2,Amick Matthew2,Miller-Matero Lisa R.3,Chrusciel Timothy245,Salas Joanne24,Zabel Celeste3,Lustman Patrick J.6,Ahmedani Brian3,Carpenter Ryan W.7,Scherrer Jeffrey F.248

Affiliation:

1. Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, United States

2. Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States

3. Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, United States

4. Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States

5. Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, United States

6. Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States

7. Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, United States

8. Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, United States

Abstract

Abstract Post-traumatic stress disorder (PTSD) is common in patients with chronic pain, adversely affects chronic pain outcomes, and is associated with opioid use and adverse opioid outcomes. Social support is a robust predictor of PTSD incidence and course as well as chronic pain outcome. We determined whether the association between PTSD and persistent opioid use was modified by emotional support in a cohort of patients receiving opioids for noncancer pain. Eligible participants were ≥18 years and had completed a new period of prescription opioid use lasting 30 to 90 days. Bivariate associations between cohort characteristics and each key variable was assessed using χ2 tests for categorical variables and t-tests for continuous variables. Interaction between PTSD and emotional support was assessed by a priori stratification on low vs high emotional support. Participants (n = 808) were 53.6 (SD ± 11.6) years of age, 69.8% female, 69.6% White, and 26.4% African American. Overall, 17.2% had probable PTSD. High emotional support was significantly (P < 0.0001) more common among those without probable PTSD. Prescription opioid use at 6-month follow-up was significantly (P = 0.0368) more common among patients with vs without probable PTSD. In fully adjusted models, PTSD was no longer associated with opioid use at 6-month follow-up among participants with high emotional support. Among those with lower emotional support, PTSD was significantly associated with opioid use at 6-month follow-up in unadjusted (odds ratio = 2.40; 95% confidence interval: 1.24-4.64) and adjusted models (odds ratio = 2.39; 95% confidence interval: 1.14-4.99). Results point to the hypothesis that improvement of emotional support in vulnerable patients with chronic pain and PTSD may help reduce sustained opioid use.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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