The Moderating Role of Fatigue Sensitivity in the Relation between Depression and Alcohol and Opioid Misuse among Adults with Chronic Low Back Pain

Chronic low back pain (CLBP) is the second leading cause of disability in the United States. Opioids are frequently prescribed to adults with CLBP. Also, CLBP is frequently associated with problematic substance use. Moreover, individuals with CLBP, compared to those without chronic pain, report depression at a greater rate. Fatigue sensitivity is defined as the perception and fear of negative consequences related to fatigue symptoms. Fatigue may worsen health conditions, and fatigue sensitivity may augment fatigue symptoms. Consequently, it is significant to examine the moderating factor of fatigue sensitivity on the influence of depression on problematic substance use since it is predicted to vary. A sample of 291 adults (69.1% female, Mage = 45.77 years, SD = 11.22) with CLBP and currently using opioids were studied to analyze fatigue sensitivity at different levels as a moderator for the relation between depression and opioid and alcohol misuse. For higher levels of fatigue sensitivity, compared to lower levels, the relation between depression and opioid and alcohol misuse is statistically significant. Results present fatigue sensitivity moderated the effect of depression on opioid misuse (beta=0.60, p= .001, 95%CI [0.02, 0.06]) and alcohol misuse (beta=0.45, p= .025, 95%CI [0.002, 0.03]). Results suggest the current model is the first to propose evidence for fatigue sensitivity to be associated with problematic substance use and establishes fatigue sensitivity as a moderating factor in the relation between depression and alcohol and opioid misuse among adults with CLBP currently using opioids.