Risk factors for analgesic medication misuse in individuals with multiple sclerosis.

TitleRisk factors for analgesic medication misuse in individuals with multiple sclerosis.
Publication TypeJournal Article
AuthorsMolton IR, Jensen MP, Johnson KL
JournalMultiple Sclerosis

Multiple sclerosis (MS) is often associated with chronic neuropathic pain that is treatment refractory. Although opioid analgesics are often prescribed for this population, little is known about patient beliefs regarding the use of these medications, or about risk factors for medication misuse. The present study assessed the tendency for analgesic medication misuse in a population of 134 adults with MS and associated pain, and sought to identify key risk factors for this behavior. Participants were predominantly Caucasian (96%) women (81%); 45% had completed some college. Measures included the Pain Medication Questionnaire (PMQ; a 26-item measure of medication misuse reflecting medication seeking and off-prescription usage), the PHQ-9 measure of depression, measures of substance use and social support, and numeric rating scale measures of the severity of secondary symptoms (including pain, fatigue, weakness, and imbalance). As analyses were exploratory, backwards multiple linear regression was used to identify potential predictors. The final model was significant (F=11.75, P<.001) and accounted for 41% of the variance in medication misuse. Statistically significant predictors included current alcohol abuse (B=.22), greater report of current pain (B=.38), lower perceived social support (B=-.17) and depression (B=.43). Age, time with disability, education level, income, sex and ethnicity were not associated with report of medication misuse. The results suggest the possibility that opioid analgesics may be misused, at least in part, as a way to cope with depression, and by individuals reporting pain who also use alcohol to cope with stress. Research is needed to determine if interventions that teach more adaptive pain coping responses and that address depression might lower the incidence of opioid misuse in individuals with MS.


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