Anxiety, depression, and opioid misuse among adults with chronic pain: the role of emotion dysregulation

Abstract

The opioid epidemic is a significant public health concern in the United States, particularly among adults with chronic pain. Considerable research suggests that people with mental health problems, including anxiety and depression, may experience more opioid-related problems in the context of chronic pain. Yet, little work has examined potential mechanisms underyling these relations. Emotion dysregulation is one mechanistic factor that may link anxiety and depression and opioid-related problems among persons with chronic pain. Therefore, the current study examined the explanatory role of emotion dysregulation in the cross-sectional relationship between anxiety and depression problems and current opioid misuse and severity of opioid dependence among 431 adults with chronic pain who reported currently using opioid medications (74% female, M_age=38.32 years, SD = 11.11). Results indicated that emotion dysregulation explained, in part, the relationship between anxiety and depression symptoms and opioid-related problems. These findings highlight the need to further consider the role of emotion dysregulation among adults with chronic pain who use prescription opioids and experience symptoms of anxiety or depression. Future prospective research will be needed to further establish emotion dysregulation as a mechanism in anxiety/depression-opioid misuse/dependence processes.

Keywords: Anxiety; Chronic pain; Depression; Emotion dysregulation; Opioid.

Fig. 1

Conceptual model. (a) path = effects of X on M; (b) path = effects of M on Y; (c) path = total effect of X on Y; (c′) path = direct effect of X on Yi controlling for M; Path a is consistent in all models; therefore, it presented only in model 1. Path c is the total model effect, and c′ is the direct effect of the predictor on the outcome, controlling for the mediator. Age, sex, education, income, and pain intensity were included as covariates. DERS-16 = Difficulties in Emotion Regulation Scale-16 (Bjureberg et al., 2016); PHQ4 = Patient Health Quesionaire-4 (Löwe et al., 2010); COMM = Current Opioid Misuse Measure (Butler et al., 2007); SDS = Severity of Dependence Scale (Gossop et al., 1995; Iraurgi Castillo et al., 2010)