Anxiety sensitivity may mediate the indirect effect of anxiety and depressive symptoms on opioid misuse in those with chronic pain, according to a study published in The Clinical Journal of Pain.

Adults (N=429) experiencing moderate to severe chronic pain for a minimum of 3 months who were using opioid pain medication were recruited. Participants responded to a self-questionnaire which included the Graded Chronic Pain Scale (GCPS), Health Questionnaire-4 (PHQ-4), Anxiety Sensitivity Index-3 (ASI-3), Current Opioid Misuse Measure (COMM), Severity of Dependence Scale (SDS), and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST).

Participants were majority women (73.9%), aged mean 38.32 (standard deviation [SD], 11.07) years, majority White (72.7%), mostly college educated (63.9%), currently married (43.4%), and the median yearly income was between $35,999 to $49,999.

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A confirmatory factor analysis (CFA) was able to fit well the results from the RMSEA (CFA, 0.067), CFI (CFA, 0.98), and TLI (CFA, 0.98) but was a poor fit for ASSIST (CFA, 0.52). The CFA had a poor overall model fit for these data (χ2, 92.72; degrees of freedom [df], 32; P <.001).

A structural meditation model (SMM) had a better overall fit for the data (χ2, 234.55; df, 72; P <.001). Both the total effect model (b, 4.05; standard error [SE], 0.52; P <.001) and the indirect effects (b, 1.81; SE, 0.39; P <.001) of using opioids were significant. After controlling for covariates, the model remained significant and 53% of the variance for anxiety and 62% of the variance for opioid misuse were explained.

Similar significant results were obtained through an alternative model (χ2, 244.03; df, 72; P <.001). The total effects (b, 0.54; SE, 0.07; P <.001) and indirect effects (b, 0.20; SE, 0.05; P <.001) of opioid use were significant. After controlling for covariates, this model could explain 53% of the observed variance for mental health and 62% of the variance for opioid misuse.

The limitations of this study included the cross-sectional design, which prohibited the investigators from assigning any causal relationships. Moreover, this study was designed as a single snapshot into the lives of opioid users and it remains unclear how the overall health of these patients in chronic pain changed over time.

The conclusions drawn from this study were that anxiety sensitivity may explain the relationship between depression and anxiety with the misuse of opioids, however, further research is needed to explore the bi-directional effects of opioid use among individuals with anxiety and depression.


Rogers A H, Garey L, Bakhshaie J, et al. Anxiety, depression, and opioid misuse among adults with chronic pain: The role of anxiety sensitivity. Published online August 4, 2020. Clin J Pain. doi:10.1097/AJP.0000000000000870.