Posttraumatic Stress and Distress Tolerance in Relation to Opioid Misuse and Dependence Among Trauma-exposed Adults with Chronic Pain

Posttraumatic stress symptoms have been associated with opioid misuse and dependence among adults with chronic pain. Lower levels of distress tolerance have been independently associated with posttraumatic stress symptoms and opioid-related problems among non-chronic pain samples. However, there has not been a test of whether distress tolerance moderates the relation between posttraumatic stress and opioid misuse among trauma exposed persons with chronic pain. Therefore, the present study examined the moderating role of perceived distress tolerance in the relationship between posttraumatic stress symptoms and opioid misuse and dependence among trauma-exposed adults with chronic pain who were using opioids (N = 289; 70.9% female, Mage = 37.75, SD = 10.83). In partial contrast to expectation, results indicated that posttraumatic stress was statistically significantly related to current opioid misuse and opioid dependence for individuals with both lower and higher levels of perceived distress tolerance. Other analyses indicated that posttraumatic stress was statistically significantly related to number of opioids used to get high in the past month for individuals with only lower levels of perceived distress tolerance. The current findings help refine our understanding of the subgroups of persons distinguished by distress tolerance with chronic pain using opioids at greatest risk for misusing opioids. Current models of chronic pain and opioid misuse could be refined by integrating distress tolerance as a moderator individual difference factor, but also considering both ends of the dimensional variability continuum for the construct (i.e., low, and high levels of the construct). These findings could help identify subgroups of trauma exposed persons with chronic pain who may be at greater risk for opioid misuse.