Borderline Personality Disorder Features and Risk for Prescription Opioid Misuse in a Chronic Pain Sample: Roles for Identity Disturbances and Impulsivity

Although borderline personality disorder (BPD) is associated with both chronic pain and substance abuse, little research examines how BPD features in chronic pain patients may constitute a risk factor for misuse of prescription opioids, and no prior research has examined which particular component(s) of BPD might put chronic pain patients at risk—an oversight that undermines prevention and treatment of such problematic opioid use. In a cross-sectional study of patients in treatment for chronic pain (N = 147), BPD features were associated with several measures of prescription opioid misuse, even controlling for pain severity and interference. Specifically, the identity disturbances and self-harmful impulsivity facets of BPD were most consistently associated with opioid misuse, and exploratory analyses suggested that these factors may be interactive in their effects. Together, these results suggest that BPD features—especially unstable identity and self-harmful impulsivity—play a unique role in problematic prescription opioid use in chronic pain settings.

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Prevalence of Borderline Personality Disorder Symptoms Among Chronic-Pain Patients

PsycEXTRA Dataset ◽

10.1037/e637912009-001 ◽

2009 ◽

Author(s):

Chelsea A. Delparte ◽

Regan Shercliffe ◽

Tom Robinson

Keyword(s):

Chronic Pain ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Chronic Pain Patients ◽

Pain Patients

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Anhedonia in chronic pain and prescription opioid misuse

Psychological Medicine ◽

10.1017/s0033291719002010 ◽

2019 ◽

Vol 50 (12) ◽

pp. 1977-1988 ◽

Cited By ~ 5

Author(s):

Eric L. Garland ◽

Martin Trøstheim ◽

Marie Eikemo ◽

Gernot Ernst ◽

Siri Leknes

Keyword(s):

Chronic Pain ◽

Large Scale ◽

Reward Processing ◽

Pain Severity ◽

Prescription Opioid ◽

Opioid Misuse ◽

Opioid Use ◽

Study Results ◽

Chronic Pain Patients ◽

Pain Patients

AbstractBackgroundBoth acute and chronic pain can disrupt reward processing. Moreover, prolonged prescription opioid use and depressed mood are common in chronic pain samples. Despite the prevalence of these risk factors for anhedonia, little is known about anhedonia in chronic pain populations.MethodsWe conducted a large-scale, systematic study of anhedonia in chronic pain, focusing on its relationship with opioid use/misuse, pain severity, and depression. Chronic pain patients across four distinct samples (N = 488) completed the Snaith–Hamilton Pleasure Scale (SHAPS), measures of opioid use, pain severity and depression, as well as the Current Opioid Misuse Measure (COMM). We used a meta-analytic approach to determine reference levels of anhedonia in healthy samples spanning a variety of countries and diverse age groups, extracting SHAPS scores from 58 published studies totaling 2664 psychiatrically healthy participants.ResultsCompared to healthy samples, chronic pain patients showed higher levels of anhedonia, with ~25% of patients scoring above the standard anhedonia cut-off. This difference was not primarily driven by depression levels, which explained less than 25% of variance in anhedonia scores. Neither opioid use duration, dose, nor pain severity alone was significantly associated with anhedonia. Yet, there was a clear effect of opioid misuse, with opioid misusers (COMM ⩾13) reporting greater anhedonia than non-misusers. Opioid misuse remained a significant predictor of anhedonia even after controlling for pain severity, depression and opioid dose.ConclusionsStudy results suggest that both chronic pain and opioid misuse contribute to anhedonia, which may, in turn, drive further pain and misuse.

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Establishing the content validity of the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ) among chronic pain patients

Current Medical Research and Opinion ◽

10.1080/03007995.2020.1865891 ◽

2020 ◽

pp. 1-1

Author(s):

Karin S. Coyne ◽

Alexandra I. Barsdorf ◽

Anne Brooks ◽

Jean-Yves Mazèire ◽

Renee F. Pierson ◽

...

Keyword(s):

Chronic Pain ◽

Content Validity ◽

Prescription Opioid ◽

Opioid Misuse ◽

Chronic Pain Patients ◽

Prescription Opioid Misuse ◽

Pain Patients

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Anhedonia in chronic pain and prescription opioid misuse

10.31234/osf.io/ghrdb ◽

2019 ◽

Author(s):

Eric Garland ◽

Martin Trøstheim ◽

Marie Eikemo ◽

Gernot Ernst ◽

Siri Leknes

Keyword(s):

Chronic Pain ◽

Large Scale ◽

Age Groups ◽

Reward Processing ◽

Pain Severity ◽

Prescription Opioid ◽

Opioid Misuse ◽

Opioid Use ◽

Chronic Pain Patients ◽

Pain Patients

BACKGROUND:Both acute and chronic pain can disrupt reward processing. Moreover, prolonged prescription opioid use and depressed mood are common in chronic pain samples. Despite the prevalence of these risk factors for anhedonia, little is known about anhedonia in chronic pain populations.METHODS:We conducted a large-scale, systematic study of anhedonia in chronic pain, focusing on its relationship with opioid use/misuse, pain severity, and depression. Chronic pain patients across four distinct samples (N = 488) completed the Snaith-Hamilton Pleasure Scale (SHAPS), measures of opioid use, pain severity and depression, as well as the Current Opioid Misuse Measure (COMM). We used a meta-analytic approach to determine reference levels of anhedonia in healthy samples spanning a variety of countries and diverse age groups, extracting SHAPS scores from 58 published studies totaling 2664 psychiatrically healthy participants.RESULTS:Compared to healthy samples, chronic pain patients showed higher levels of anhedonia, with ~25% of patients scoring above the standard anhedonia cut-off. This difference was not primarily driven by depression levels, which explained less than 25% of variance in anhedonia scores. Neither opioid use duration, dose, nor pain severity alone was significantly associated with anhedonia. Yet, there was a clear effect of opioid misuse, with opioid misusers (COMM ⩾13) reporting greater anhedonia than non-misusers. Opioid misuse remained a significant predictor of anhedonia even after controlling for pain severity, depression and opioid dose.CONCLUSIONS:Study results suggest that both chronic pain and opioid misuse contribute to anhedonia, which may, in turn, drive further pain and misuse.

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Concurrent and lagged associations of prescription opioid use with pain and negative affect in the daily lives of chronic pain patients.

10.31234/osf.io/nypb4 ◽

2019 ◽

Author(s):

Ryan Carpenter ◽

Sean Patrick Lane ◽

Stephen Bruehl ◽

Timothy J Trull

Keyword(s):

Chronic Pain ◽

Negative Affect ◽

Multilevel Models ◽

Negative Reinforcement ◽

Prescription Opioid ◽

Opioid Misuse ◽

Opioid Use ◽

Opioid Dose ◽

Chronic Pain Patients ◽

Pain Patients

Objective: Prescribed opioids for chronic pain management contribute significantly to the opioid crisis. There is a need to understand the real-world benefits that, despite risks, lead chronic pain patients to persist in opioid use. Negative reinforcement models of addiction posit that individuals use substances to reduce aversive states but have seldom been applied to prescribed opioids. Using ecological momentary assessment, we examined reciprocal associations between opioid use and physical pain, for which opioids are prescribed, and negative affect (NA), for which they are not. Method: Chronic low back pain patients on long-term opioid therapy (n = 34) without significant past-year opioid misuse reported multiple times daily via smartphone over 2 weeks (nobservations = 2,285). We hypothesized that pain and NA would be positively associated with subsequent opioid use, and that use would be negatively associated with subsequent pain and NA. Results: Time-lagged multilevel models indicated that participants were more likely to use opioids and in larger doses following elevated pain and NA. There was also an interaction of concurrent pain and NA on opioid dose. In turn, participants reported reduced pain and NA following larger doses. Additionally, individuals at high risk for opioid misuse, compared with low risk, took larger doses following pain, but also experienced smaller subsequent pain and NA reductions. Conclusions: Opioid use was bidirectionally associated with pain and NA. Findings fit negative reinforcement models associated with risk of developing opioid use disorder. Educating patients and providers about negative reinforcement may help reduce opioid use and opioid-associated risks. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

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Disability and Borderline Personality Disorder in Chronic Pain Patients

Pain Research and Management ◽

10.1155/2010/952816 ◽

2010 ◽

Vol 15 (6) ◽

pp. 369-370 ◽

Cited By ~ 4

Author(s):

Randy A Sansone ◽

J David Sinclair ◽

Michael W Wiederman

Keyword(s):

Chronic Pain ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Pain Specialist ◽

Significant Difference ◽

Chronic Pain Patients ◽

History Of ◽

The Relationship ◽

Pain Patients

BACKGROUND AND OBJECTIVE: Few studies have examined the relationship between disability and borderline personality symptomatology, and, among those that have, findings have been inconsistent. In the present study, the relationship between medical disability and borderline personality symptomatology was examined in a sample of chronic pain patients.METHODS: In a consecutive insured sample of male and female chronic pain patients (n=117), who were being initially evaluated by an outpatient pain specialist, the criterion of having “ever been on medical disability” and features of borderline personality disorder were examined using the borderline personality scale of the Personality Diagnostic Questionnaire-4.RESULTS: While 35% of participants acknowledged having ever been on medical disability, there was no statistically significant difference between those with a history versus those without a history of medical disability with regard to the prevalence of borderline personality symptomatology.CONCLUSIONS: Findings suggest that among chronic pain patients, there may be no meaningful relationship between having ever been on medical disability and borderline personality symptomatology.

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