Individuals with Chronic Pain Who Misuse Prescription Opioids Report Sex-Based Differences in Pain and Opioid Withdrawal

Objective. Individuals with chronic pain who misuse prescription opioids are at high risk for developing opioid use disorder and/or succumbing to opioid overdose. The current study conducted a survey to evaluate sex-based differences in pain catastrophizing, opioid withdrawal, and current pain in persons with co-occurring chronic pain and opioid misuse. We hypothesized that women with chronic pain who misused prescription opioids would self-report higher pain ratings compared with men and that the relationship between pain catastrophizing and self-reported current pain would be moderated by symptoms of opioid withdrawal in women only. Design. Survey assessment of the relationship between pain and opioid misuse. Setting. Online via Amazon Mechanical Turk. Participants. Persons with ongoing chronic pain who also misused prescription opioids on one or more days in the last 30 days were eligible (N=181). Methods. Participants completed demographic and standardized assessments including the Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), and Subjective Opiate Withdrawal Scale (SOWS). Results. Women reported higher levels of current (P<0.001), average (P<0.001), and worst (P=.002) pain in the last 24 hours compared with men. Women also endorsed higher scores on the PCS (P=0.006) and marginally higher past-30-day SOWS ratings (P=0.068) compared with men. SOWS ratings moderated the relationship between PCS and BPI Worst Pain in women (Delta R-2<0.127, Delta F(1, 78)=12.39, P=0.001), but not in men (Delta R-2<0.000, Delta F(1, 98)=0.003, P=0.954). Conclusions. These data suggest a strong relationship between opioid withdrawal, pain catastrophizing, and the experience of pain in women with chronic pain who misuse opioids.