A relationship between opioid withdrawal, pain catastrophizing, and the experience of pain may be present in women with chronic pain who misuse prescription opioids, according to a study published in Pain Medicine.

The study included participants with ongoing chronic pain who reported misusing prescription opioids on ≥1 day during the previous 30 days (n=181; 44% women). Participants were asked to complete online questionnaires on demographic characteristics, as well as the Brief Pain Inventory (BPI), the Pain Catastrophizing Scale (PCS), and the Subjective Opiate Withdrawal Scale. The primary outcome was the relationship between pain and opioid misuse. The most commonly reported pain locations were lower back (74%), upper back (42%), and knees (36.5%).

Women vs men reported higher levels of current (P <.001), average (P <.001), and worst (P =.002) pain in the previous 24 hours. Women reported misusing opioids on more days in the past 30 days compared with men (mean, 18.1±11.1 vs 14.3±10.0, respectively; P =.018). Women vs men also had higher scores on the PCS Total Scale (mean, 26.16±12.0 vs 21.1±12.3, respectively; P =.006). In particular, women vs men scored higher on the Rumination (mean, 8.8±4.2 vs 7.2±4.3, respectively; P =.011) and Helplessness (mean, 11.8±5.9 vs 9.0±5.8, respectively; P =.002) PCS subscales.

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The Subjective Opiate Withdrawal Scale rating was found to moderate the relationship between PCS and BPI Worst Pain in women (P =.001) but not in men (P =.954).

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“Additional research aimed at delineating sex- based differences in motivation to misuse opioids may also have a meaningful impact on chronic pain treatment as precision medical approaches are developed to maximize analgesia and minimize risk [for] opioid misuse and subsequent issues such as the onset of [opioid use disorder] and/or risk for opioid overdose,” the researchers noted.

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Huhn AS, Tompkins DA, Cambell CM, Dunn KE. Individuals with chronic pain who misuse prescription opioids report sex-based differences in pain and opioid withdrawal. [published online January 25, 2019]. Pain Medicine. doi:10.1093/pm/pny295