By R Carter
Originally Published in April 2018, this report revisited again, shows the level of deliberate misdirection by those who claim to be rational and objective researchers. At a time when the medical community was feeling the presure to provide answers for something they clearly did not understand, the short path to the exit was to blame opioid prescribing for chronic pain. It’s now 2020 and looking back, we can see the folly and dishonesty in such claims as opioid overdose deaths have yet to level off. Even in the face of data showing significant reductions in opioid prescribing, opioid deaths continue and drug abuse in general is now shifted away from opioids towards methanphetamine and other stimulants.
After reading this report, I was enraged. Not only was the purported test biased towards labeling chronic pain patients as more prone to opioid misuse, but it also lacked any scientific and rational objectivity for making the claims. Equating generalized stress as a tool for measuring the probability of opioid misuse, by limiting it to individuals already taking opioids for pain management, would no different than asking a mouse if they were tempted to chew off their tail because it was caught in a trap. Such questions have no place in honest, rational and objective measurements of risk for opioid misuse.
Again such conclusions forward the bias assumption that anyone taking opioids for pain management have little to no judgment or self-control and that under the slightest levels of stress, are more likely to begin abusing medication.
Such suggestions are like throwing gasoline on an already burning building with opioid hysteria still running rampant across our nation. They also disregard more than fifty years of well-documented studies and clinical experience that the addiction rate for those taking opioids for chronic pain is less than the national average of 0.6%, that’s one-tenth of one percent, per 100,000 patients for the nation in general but only 0.15% for chronic pain patients. Despite the Harvard credentials of these researchers, their science and conclusions are no better than me or you interpreting cave wall drawings.
Fear of Distress Signals Risk for Opioid Misuse in Chronic Pain Patients
- Among patients with chronic pain, those who reported less ability to tolerate physical or emotional distress were more likely to misuse opioid analgesics.
- Neither pain severity nor pain sensitivity was associated with the risk of opioid misuse.
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Drs. R. Kathryn McHugh and Roger D. Weiss from Harvard Medical School and colleagues administered the Distress Intolerance Index (DII) to a group of patients who were receiving prescription opioid treatment for chronic neck or back pain. Respondents to the DII report how strongly they identify with 10 statements expressing fear and anxiety at the prospect of physical or emotional distress. Of 51 patients in the study, the 31 who met diagnostic criteria for prescription opioid misuse scored higher on the instrument than the 20 who did not (see Figure). Among those who misused opioids, higher DII scores were associated with more severe misuse.
Dr. McHugh says, “These data from the DII as well as from some of our other work suggest that a brief measure of self-reported distress intolerance is strongly associated with [opioid misuse] outcomes.” The relationship likely occurs because patients who are intensely apprehensive of distressing experiences may seek quick stress relief through behaviors such as substance use, risk taking, avoidance, and escapism.
Based on the study findings, Dr. McHugh recommends that physicians who treat patients for chronic pain assess their distress intolerance. For those with high intolerance, close prescription monitoring will be warranted, and behavioral interventions to build adaptive responses and foster resilience to stress may improve outcomes. Dr. McHugh says, “Enhancing tolerance of distress has great potential for mitigating the risk of opioid misuse and treating opioid use disorder.”
Dr. McHugh suggests that the DII can function well as a clinical tool. “The tool we used included only 10 items and is easy to administer and score,” she says. She notes that the researchers also assessed the study participants’ persisting pain levels and pain sensitivity thresholds, neither of which showed an association with the risk of opioid misuse.
Dr. McHugh comments, “One rarely discussed aspect of the opioid crisis is the impact of stress-related dysfunction and co-occurring psychiatric disorders. Among people struggling with opioid use disorders, heightened stress reactivity and stress-related disorders like anxiety and traumatic stress disorders are the norms rather than the exceptions.”
Dr. Yu Lin, a Health Science Administrator in NIDA’s Integrative Neuroscience Branch, agrees that clinicians “should assess negative affect and psychiatric conditions regularly. Distress-intolerant patients may be less responsive to analgesia and are certainly more prone to opioid misuse because they are less adaptive to and tolerant of negative emotional and somatic states.”
This study was supported by NIH grants DA034102, DA022288, and DA015831.
McHugh, R.K., Weiss, R.D., Cornelius, M., et al. Distress intolerance and prescription opioid misuse among patients with chronic pain. Journal of Pain 17(7):806-814, 2016.