Groundbreaking Study Discovers Link between Severity of Pain and Abuse of Opioids

Study findings may help doctors reduce misuse of prescription opioid pain relievers and, ultimately, accidental deaths


RESEARCH TRIANGLE PARK, NC – A first-of-its-kind study conducted by RTI International in conjunction with the National Institute on Drug Abuse found that those who experience severe, chronic pain are more likely than those with less severe or episodic pain to misuse prescription opioid pain relievers. These drugs are often prescribed to alleviate pain associated with surgery, cancer, and other diseases and injuries, but are being increasingly used to self-medicate resulting in about 14,000 accidental deaths annually.

“One hundred million Americans suffer from chronic pain, and there’s an associated high rate of opioid prescribing to manage pain,” said Scott Novak, Ph.D., lead author of the study and senior development epidemiologist at RTI. “Opioid overdoses are now the leading cause of accidental death in the U.S. There are many new policies that aim to reduce the prescribing of opioids, even to legitimate patients. We wanted to see whether persons with a history of chronic pain were self-administering these medications during periods in which their pain was greatest, suggesting a type of self-medication.”

The study was published in Journal of Substance Abuse and Rehabilitation. Novak and his team of researchers used the National Epidemiologic Survey on Alcohol and Related Conditions – a three-year survey of more than 34,000 adults that examined self-reported pain and prescription pain reliever misuse – to examine the who, why, and how opioids are being misused.  

Relying on a nationally representative sample of American adults, this study was the first to look at measures of pain and drug use over an extended period of time. Participants in the survey shared their level of pain on a three-point scale – none, mild/moderate, and high – as well as their drug use over a span of three years during face-to-face interviews. In the study, the researchers found that misuse of prescription opioids increases with severity and length of pain.

The largest group of opioid misusers in the study included participants who reported stable levels of high pain over the three years. However, even if participants started off with none or mild pain, the likelihood of them abusing opioids increased if they suffered from high pain at some point during the study. About 5,600 participants reported high levels of pain at the beginning of the survey, and more than 3,500 reported high pain levels at the end.

“The rate of accidental overdoses, dependency, and death due to opioids continues to climb, and this study helps us identify factors of misuse,” Novak said. “Understanding the psychology behind opioid abuse – in many cases to ease or escape pain – may help clinicians identify patients who may be at risk of abusing or developing a dependency on prescription opioids. Additionally, this study provides a window into the future – more patients may turn to illicit opioids to help curb their pain if clinicians implement broad-scale reductions, particularly among patients in need of pain relief.”

A leader in opioid research, RTI leads a variety of multidisciplinary studies to better understand, prevent, and treat opioid misuse and abuse.