The Editor’s choice September 2019

written by Jess G. Fiedorowicz, Editor-in-Chief, Journal of Psychosomatic Research, September 2019

I’m pleased to select a timely study as Editor’s Choice for this quarter’s newsletter of the European Association of Psychosomatic Medicine.  Of the many deserving papers that were considered, “The prospective association between personality traits and persistent pain and opioid medication use” by Angelina Sutin, Yannick Stephan, Martina Luchetti, and Antonio Terracciano seemed particularly relevant and rigorous [1].  These Trans-Atlantic collaborators from Florida State University and the University of Montpellier concisely summarize their findings in the following:

The opioid crisis has brought renewed interest on pain and prescription opioid medication use. We used data from >8000 participants from the Health and Retirement Study to examine whether personality prospectively predicts persistent pain and who is prescribed opioids. Over a 10-year follow-up, individuals higher in neuroticism had greater vulnerability to persistent pain, whereas individuals higher in extraversion or conscientiousness were less likely to report pain. Neuroticism was also associated with a greater likelihood of being prescribed opioids. Personality traits may be useful to identify risk and resilience to pain and to help tailor more effective interventions.

Sadly, as the opioid crisis extends beyond the poor, minority, and disenfranchised communities where it was ignored or criminalized, opioid addiction is finally getting some of the attention that it deserves [2].  It is also becoming increasingly recognized that pain and treatment of pain may lead to opioid addiction [3].  As a medical student during the height of marketing of long-acting opioid agents, such as Oxycontin, I quite vividly recall having been inundated with lectures explaining that treating pain with opioids does not lead or almost never leads to addiction.  Pain was promoted as the 5^th vital sign to encourage greater identification of the vast reservoir of patients unnecessarily suffering with untreated pain.  This industry marketing fueled public health campaign produced dramatic increases in opioid prescriptions.  While screening for and addressing pain is an important clinical practice, it turns out that pain and treatment thereof are indeed risk factors for opioid addictions and there are concrete steps that we can take to better assess and manage this risk.  Pain and its management are more complex and nuanced than advertised.

Sutin and colleagues appreciate this complexity and open describing pain as “multi-determined, with biological, social, and psychological antecedents [1].”  They utilized a large, prospective dataset to test hypotheses involving how the Big Five personality traits may influence the development of persistent pain and opioid use. Pain was assessed every two years following a baseline personality assessment.  Meanwhile, opioid use was assessed at the time of the most recent assessment, 8-10 years after the baseline assessment.  Findings for persistent pain mirrored those of opioid use.  Both outcomes were predicted by higher neuroticism, lower extraversion, and lower conscientiousness at baseline.  These findings suggest that stable personality traits may influence risk and, importantly, in those who did not have pain at baseline.  This provides one piece of a more complex, biopsychosocial framework for understanding the development of persistent pain and its sequelae.  The clustering of results around both outcomes is noteworthy and underscores the importance of persistent pain in leading to opioid use.

The innovative work of Sutin et al. was also discussed in an accompanying editorial by Nicholas Turiano [4]. Turiano nicely summarizes the “medical system push in the early 2000’s to better treat pain” that I previous described from my early clinical training.  He discusses various measures to mitigate risk, but importantly notes that “even when prescribed properly, a significant portion of the population will abuse or become addicted to opioids.”  This underscores the need for models to predict risk.  Turiano details how personality assessment can be used to identify those at risk, tailor existing interventions, and even help in targeting personality itself for intervention.  In closing, he discusses several key directions for future research.  The  Journal of Psychosomatic Research welcomes submissions of any such work.  Our interdisciplinary journal with its focus on the interface between psychology and medicine is well-positioned to promote more comprehensive study of this complex problem from the many perspectives necessary to understand and address it.

References:

[1] A.R. Sutin, Y. Stephan, M. Luchetti, A. Terracciano, The prospective association between personality traits and persistent pain and opioid medication use, J Psychosom Res 123 (2019) 109721.

[2] A. Schukar, Separate, Unequal and Overlooked. https://www.usnews.com/news/health-news/articles/2019-01-28/black-americas-opioid-crisis-separate-unequal-overlooked (Accessed September 16, 2019).

[3] N. Volkow, H. Benveniste, A.T. McLellan, Use and Misuse of Opioids in Chronic Pain, Annu Rev Med 69 (2018) 451-465.

[4] N.A. Turiano, Personality and the opioid epidemic, J Psychosom Res 123 (2019) 109732.

Article selected: The prospective association between personality traits and persistent pain and opioid medication use

Angelina R. Sutin, Yannick Stephan, Martina Luchetti, Antonio Terracciano

Vol. 123, August 2019

Corresponding Author’s Commentary

The opioid crisis has brought renewed interest on pain and prescription opioid medication use. We used data from >8000 participants from the Health and Retirement Study to examine whether personality prospectively predicts persistent pain and who is prescribed opioids. Over a 10-year follow-up, individuals higher in neuroticism had greater vulnerability to persistent pain, whereas individuals higher in extraversion or conscientiousness were less likely to report pain. Neuroticism was also associated with a greater likelihood of being prescribed opioids. Personality traits may be useful to identify risk and resilience to pain and to help tailor more effective interventions.

Find out more:  https://www.journals.elsevier.com/journal-of-psychosomatic-research/editors-choice