Pain Med. 2025 Oct 25:pnaf148. doi: 10.1093/pm/pnaf148. Online ahead of print.
ABSTRACT
INTRODUCTION: Opioids are suggested to serve as an emotional substitute for social attachments, why patients with persistent back pain and high levels of attachment-avoidance may be vulnerable to long-term opioid treatment (LTOT).
AIMS: The primary aim was to assess the association between attachment insecurity and LTOT and secondary to assess the associations between attachment insecurity, pain, and disability.
METHODS: A 5-year follow-up study of patients with persistent back pain. Questionnaire data on attachment insecurity, psychological distress, pain intensity, and disability were collected and combined with longitudinal register data on prescriptions of opioids.
RESULTS: A total of 3,102 patients was included. Patients in LTOT (9.3%) were significantly more avoidantly attached compared to non-opioid users. For every one-point increase on attachment-avoidance, the odds of LTOT increased by 4%. When adjusting for covariates, only age, pain, and depression were significantly associated with LTOT. Both attachment-avoidance and attachment-anxiety were significantly associated with pain intensity and disability.
CONCLUSION: Attachment insecurity may be associated with an increased risk of LTOT, pain, and disability. Acknowledging that unmet attachment needs and emotional distress can be linked to an increased risk of LTOT highlights the importance of considering these factors before prescribing the first opioid.
PMID:41138157 | DOI:10.1093/pm/pnaf148
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