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Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients

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Abstract

Emerging research suggests that prescription opioid craving is associated with negative mood and depression, but less is known about cognitive factors linking depressive symptoms to opioid craving among adults with chronic pain. The present cross-sectional study examined thought suppression as a mediator of the relation between depression and prescription opioid craving in a sample of chronic pain patients receiving long-term opioid pharmacotherapy. Data were obtained from 115 chronic pain patients recruited from primary care, pain, and neurology clinics who had taken prescription opioids daily or nearly every day for ≥90 days prior to assessment. In this sample, 60 % of participants met DSM-IV criteria for current major depressive disorder. Depressed mood (r = .36, p < .001) and thought suppression (r = .33, p < .001) were significantly correlated with opioid craving. Multivariate path analyses with bootstrapping indicated the presence of a significant indirect effect of thought suppression on the association between depressed mood and opioid craving (indirect effect = .09, 95 % CI .01, .20). Sensitivity analyses showed a similar indirect effect of suppression linking major depressive disorder diagnosis and opioid craving. Attempts to suppress distressing and intrusive thoughts may result in increased craving to use opioids among chronic pain patients with depressive symptoms. Results highlight the need for interventions that mitigate thought suppression among adults with pain and mood disorders.

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Acknowledgments

This study was funded by Grant R03DA032517 from the National Institute on Drug Abuse. ELG was also supported by Grant R34DA037005 from the National Institute on Drug Abuse during the preparation of this manuscript. The National Institute on Drug Abuse had no role in the interpretation of the data and preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA

    Eric L. Garland

  2. University of Denver Graduate School of Social Work, 2199 S University Blvd., Denver, CO, 80208, USA

    Samantha M. Brown

  3. University of North Carolina-Chapel Hill, Tate Turner Kuralt Bldg. 325 Pittsboro St #3550, Chapel Hill, NC, 27599, USA

    Samantha M. Brown & Matthew O. Howard

  4. College of Social Work, University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA

    Eric L. Garland

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All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Garland, E.L., Brown, S.M. & Howard, M.O. Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med 39, 128–138 (2016). https://doi.org/10.1007/s10865-015-9675-9

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