Study Highlights Challenges with Opioid Prescriptions for Chronic Pain

The Role of Pain Behavior: Examining the Link Between Perceived Injustice and Perception in Patients

The challenge to prescribers seeking to manage their patients’ chronic pain while addressing the risk for opioid related adverse events has escalated with the increasing use of opioid therapy over the last 2 decades. A recent study by a team that included PAINWeek faculty member Beth Darnall, PhD, sought to address one of these areas of risk, the association between perceptions of injustice and likelihood for pain medication use. Perception of injustice is defined as an appraisal regarding the severity and irreparability of loss associated with pain, blame, and a sense of unfairness. Patients may express such sentiments as “it all seems so unfair”, “nothing will ever be the same”, and “I can’t believe this happened to me”. The study sought to examine and separate the impact of pain intensity, symptoms of depression, and pain behavior as mediators of perception of injustice and the propensity for opioid use in patients with chronic pain.  The findings were published last week in the Journal of Pain Research.

The cross-sectional study examined 344 patients with chronic pain who completed assessments of perceived injustice, pain intensity, depressive symptoms, pain behavior, and opioid prescription. The study results supported previous observations of a significant association between perceived injustice and opioid prescription. In evaluating the possible mechanisms for this connection, the research concluded that pain behavior, and not pain intensity or depressive symptoms, was the more powerful mediator of the association. Pain behavior includes movement alterations or expressive displays that, it was hypothesized, might lead prescribers to infer higher levels of pain and to consider more aggressive modalities of pain management. The authors state that future research should employ a longitudinal design to further clarify the relationships among pain behavior, perceived injustice, and rates of opioid prescription.

A news story about the findings with link to access the journal article, may be read here.

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