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SRFP096: The association between trauma exposure and prescription opioid use duration in non-cancer pain

Ivana Massabki; Jeffrey Scherrer, PhD; Joanne Salas, MPH

Abstract

Context: The relationship between trauma exposure and opioid misuse has been investigated extensively. However, less is known about the association between traumatic stress and chronic prescription opioid use in patients with non-cancer pain. As opioid prescribing remains a common strategy for pain management, understanding risk factors for prolonged use of these medications is important to mitigate risks and harms to the patient. Objective: To determine whether chronic pain patients with vs. without trauma exposure have a greater risk for longer prescription opioid use duration. Study Design: Cross-sectional. Dataset: Preliminary survey data obtained from ongoing baseline assessment of longitudinal study. Population Studied: The first 489 patients who completed the baseline survey by 03/2021 were included if they had been using prescription opioids for 30-90 days and had not used opioids for at least 3 months prior to the current episode of use. Outcome measures and instruments: opioid duration, trauma obtained from Life Events Checklist-5, PTSD by the Primary Care PTSD Screen for DSM-5. Results: Patients were on average 52.3 (SD±12.4) years of age, 66.5% female and 67% white race. 62.8% reported trauma history, and compared to those without trauma, they were significantly (p<0.05) younger, female, and had more pain sites, higher pain interference, as well as depression, anxiety, and smoking histories. Unadjusted analysis revealed trauma vs. no trauma was associated with >90 day opioid use (OR=1.37; CI:0.94-1.99). After adjusting for age, gender, race, number of pain sites, pain severity, pain interference, anxiety, depression, substance use disorder history, and smoking, the association remained (OR=1.42; CI: 0.96-2.10). No significant association was found between positive PC-PTSD-5 screen and opioid use duration in patients with trauma history. Conclusions: Patients with trauma history have a greater risk for prolonged prescription opioid use. This relationship appears to be independent of PTSD symptoms. Exposure to traumatic stress should be considered among other risk factors, such as depression, that are correlated with chronic prescription opioid use. This study highlights the need for trauma-informed, patient-centered pain management.
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Jack Westfall
jwestfall@aafp.org 11/21/2021

This is a great topic and research study. Nice work. Thanks for sharing at NAPCRG

Gillian Bartlett
gillian.bartlett@health.missouri.edu 11/21/2021

You research adds to a growing body highlighting the need for trauma-informed primary care. I hope you continue your work so that recommendations on how to better help our patients can be developed in this key area.

William R. Phillips
wphllps@uw.edu 11/22/2021

Wow! This is a complex and very important topic. Great poster. If you have data in this area – particularly if collected in the down-home primary care setting –  you have a lot of high-yield research ahead.  I agree it is important to differentiate between history of trauma exposure, PTSD symptoms and PTSD diagnosis. What do we know about any association between the a priorinrisk of opiate use and risk of developing PTSD symptoms after exposure to trauma? Thanks for sharing your work here at NAPCRG. - Bill Phillips

Diane Harper
harperdi@med.umich.edu 11/22/2021

trauma happens for so many in so many different forms. Thank you for sharing your work with NAPCRG!

Andy Pasternak
avpiv711@sbcglobal.net 11/27/2021

Really nice study- I'm wondering if providers would change prescribing habits if they knew about trauma history

Louise Acheson
11/30/2021

I see that you did control for number of pain sites, pain ratings, and PTSD, among other variables. Was the actual questionnaire about trauma able to distinguish whether the opioid was prescribed at the time of a recent physical trauma, or whether the trauma had occurred in the past? I am reflecting on my experience as an attending physician after our hospital became a regional trauma center. We started getting patients at hospital discharge from the trauma surgery service, many of whom had extensive and severe injuries such as multiple trauma from vehicle crashes or gunshot wounds. The severity of physical trauma and pain seemed greater than what I'd been used to seeing in postoperative or post-fracture patients (the kinds of patients who would have received opioids for acute pain) in the past. This extensive trauma seemed more likely to lead to longer prescriptions for opioids.

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