Physical, Sexual Abuse and Concurrent Opioid/Benzodiazepine Use in Chronic Pain
Concurrent opioid/benzodiazepine use was reported by 16% of the study participants.
Patients with chronic pain and a history of physical and sexual abuse were found to be more likely to concurrently use benzodiazepine and opioids, according to a study published in the Journal of Pain.
A total of 1785 individuals (average age, 50.34 years) receiving opioids for chronic pain were asked to report on their medication use, anxiety level, and history of physical and sexual abuse. In this cohort, 287 study participants (16.08%) reported concurrently using opioids and benzodiazepines, and approximately 17% reported a history of physical or sexual abuse, 69.02% and 16.50% of whom reported having experienced abuse as a child only and as an adult only, respectively, and 14.48% of whom reported cumulative abuse.
Compared with patients who reported never experiencing abuse or experiencing abuse as an adult only, participants who experienced abuse as children only or cumulative abuse reported concurrent opioid and benzodiazepine use more often (P <.001). Participants reporting concurrent opioid/benzodiazepine use were also found to be younger (P =.001) and to be at greater risk for higher pain severity, pain interference, fibromyalgia scores, and depression and anxiety (P <.001 for all). Patients who reported cumulative abuse and high levels of anxiety were found to be more likely to concurrently use opioids and benzodiazepines (P =.003).
Study limitations include potential underreporting of benzodiazepine use as a result of a narrow list of medications for patients to report.
"Providers in all specialties should be aware of the dire psychological and physical health consequences stemming from interpersonal violence and abuse," the researchers noted. "Addressing trauma sequela through alternative treatments (e.g., psychological therapy) may be necessary for patients who have experienced interpersonal violence victimization, particularly cumulative abuse."
Pierce J, et al. Influence of abuse history on concurrent benzodiazepine and opioid use in chronic pain patients [published online November 16, 2018]. J Pain. doi: 10.1016/j.jpain.2018.10.009