Emotional Support, Post-Traumatic Stress Disorder and Risk for Long-Term, High-Dose, Daily Prescription Opioid Use

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 non-cancer pain. Eligible participants were ≥ 18, and had completed a new period of prescription opioid use lasting 30-90 days Bivariate association between cohort characteristics and each key variable was assessed using Chi-square tests for categorical variables and t-tests for continuous variables. Interaction between PTSD and emotional support was assessed by apriori 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<.0001) more common among those without probable PTSD. Prescription opioid use at 6-month follow-up was significantly (p=.0368) more common among patients with versus 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 (OR=2.07; 95%CI: 1.20-3.59) and adjusted models (OR=2.36; 95%CI:1.28-4.34). This suggests that improvement of emotional support in vulnerable patients with chronic pain and PTSD may help reduce sustained opioid use.