Researchers found a relationship between pain-related anxiety with pain intensity, interference, and the potential for opioid overuse. These results, which included an analysis of data from 2 studies, were published in Behaviour Research and Therapy.

Study 1 recruited adults (n=425) with chronic pain who were using opioids. These individuals were assessed for anxiety, pain-related anxiety, emotional regulation, distress tolerance, pain, and opioid use.

Participants had a mean age of 38.29 years (standard deviation [SD], 11.09); 73.9% were female, 77.9% were white, and 38.8% earned more than $50,000 annually. The reported pain intensity was an average of 7.29 out of 10 (SD, 1.82), the pain-related disability was 9.26 out of 10 (SD, 2.97), and pain was experienced 121.12 of the previous 180 days (SD, 63.08).

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Pain intensity was associated with pain-related anxiety symptoms (r, 0.178; P =.001). Pain-related disability was associated with pain-related anxiety (r, 0.251; P <.001), emotional regulation (r, 0.114; P =.02), and distress tolerance (r, 0.121; P =.03).

Current opioid use was associated with pain-related anxiety (r, 0.382; P <.001), emotional regulation (r, 0.635; P <.001), anxiety sensitivity (r, 0.589; P <.001), and distress tolerance (r, 0.449; P <.001).

Study 2 recruited adults (n=290) with chronic lower back pain, who were assessed by the same instruments as participants in study 1.

These participants had a mean age of 45.79 years (SD, 11.23), 69.0% were female, 83.4% were white, and 44.1% earned more than $50,000 annually. The average pain intensity was 6.62 out of 10 (SD, 1.55), and the pain-related interference was 6.77 out of 10 (SD, 1.91).

Pain intensity was significantly associated with pain-related anxiety (b, 0.427; P =.002) and emotional regulation (b, 0.324; P =.02). Pain-related negative affect was significantly associated with pain-related anxiety (b, 0.66; P <.001) and emotional regulation (b, 0.53; P <.001).

Opioid misuse was associated with age (b, -0.24; P <.001), gender (b, -0.23; P <.001), emotional regulation (b, 0.41; P =.001), and anxiety sensitivity (b, 0.30; P =.03).

This study was limited by its cross-sectional design, which did not allow for making causal relationships.

These data indicated that transdiagnostic factors are needed for understanding the complex relationship between chronic pain and opioid misuse. Interventions are needed to target not only symptoms of pain but secondary mental health conditions.


Rogers AH, Garey L, Allan NP, Zvolensky MJ. Exploring transdiagnostic processes for chronic pain and opioid misuse among two studies of adults with chronic pain. Published online December 9, 2020. Behav Res Ther. 2021;136:103786. doi:10.1016/j.brat.2020.103786