Is post-traumatic stress disorder a risk factor for development of opioid use disorder among individuals with chronic non-cancer pain? A systematic review

Arvind Kendurkar; Jack Wilson; Matthew Sunderland; Adrian Dunlop; Chris Hayes; Christina Marel; Katherine L Mills

doi:10.1177/20494637231202078

Is post-traumatic stress disorder a risk factor for development of opioid use disorder among individuals with chronic non-cancer pain? A systematic review

Br J Pain. 2024 Feb;18(1):70-81. doi: 10.1177/20494637231202078. Epub 2023 Sep 20.

Authors

Arvind Kendurkar^{1

2

3

4}, Jack Wilson¹, Matthew Sunderland¹, Adrian Dunlop^{2

3

4

5}, Chris Hayes², Christina Marel¹, Katherine L Mills¹

Affiliations

¹ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia.
² Hunter New England Local Health District, NSW Health, New Lambton, NSW, Australia.
³ School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia.
⁴ Healthcare Transformation Research Program, Hunter Medical Research Institute, New Lambton, NSW, Australia.
⁵ NSW Drug & Alcohol Clinical Research and Improvement Network, Sydney, NSW, Australia.

PMID: 38344261
PMCID: PMC10851884 (available on 2025-02-01)
DOI: 10.1177/20494637231202078

Abstract

Introduction: There is emerging evidence that posttraumatic-stress disorder may have mediating effects in development of chronic-non-cancer-pain and opioid-use-disorder independently, but its impact on the development of opioid-use-disorder in people with chronic-non-cancer pain is still unclear.

Objectives: (i) Estimate the risk of opioid-use-disorder among individuals with chronic-non-cancer-pain and posttraumatic-stress disorder, relative to those with chronic-non-cancer-pain only, and (ii) identify potential correlates of opioid-use-disorder among people with chronic-non-cancer-pain and posttraumatic-stress disorder.

Methods: This systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Longitudinal, epidemiological, cohort, follow-up, retrospective, prospective and cross-sectional studies reporting measures of variance on the likelihood of developing opioid-use-disorder with posttraumatic-stress disorder among individuals with chronic-non-cancer-pain were identified from six-electronic databases (Medline, Embase, Evidence-based Medicine reviews, PsycINFO, Scopus and Web of Science) until December 2022.

Results: Three out of the four studies, which met the selection criteria for this analysis reported statistically significant positive association between risk of developing opioid-use-disorder with posttraumatic-stress disorder among chronic-non-cancer-pain cohort (unadjusted Relative-Risk range: 1.51-5.27) but this association was not evident in the fourth study (adjusted Relative-Risk: 0.96; statistically non-significant), when adjusted for sociodemographic variables. The increased risk was noted particularly with females and chronic musculoskeletal pain conditions.

Conclusions: Posttraumatic-stress disorder can increase the risk of development of opioid-use-disorder among people with chronic-non-cancer-pain and a better understanding of this relationship will help to predict and prevent the development of opioid-use-disorder and may also help in reducing the disability and burden associated with chronic-non-cancer-pain.

Perspective: This review quantifies the risk of developing opioid-use-disorder in the context of posttraumatic-stress disorder among individuals with chronic-non-cancer-pain. Awareness and subsequent practice change will reduce the increasing global burden associated with the chronic-non-cancer-pain.

Keywords: Chronic non-cancer pain; opioid use disorder; post-traumatic stress disorder.