Correlates of Mental Defeat in Individuals with Chronic Non-Cancer Pain on Long-term Opioid Therapy.

Background: Individuals with chronic non-cancer pain (CNCP) often present with significant challenges that can impact physical, psychological, and social well-being. Mental defeat is a critical consequence of CNCP being a known predictor of suicidality. This study examines the relationships between specific psychological and coping factors and mental defeat among individuals with CNCP on long-term opioid therapy (LTOT).

Design: A cross-sectional study of secondary data.

Setting: Primary care, pain, and substance abuse clinics in Pennsylvania, Washington, and Utah.

Subjects: 744 adults with CNCP receiving LTOT (≥ 6 months).

Methods: Anxiety and depression symptoms and pain coping strategies were examined with hierarchical multiple linear regression analysis to describe their relationship to mental defeat. In an exploratory analysis, we also stratified the sample by the presence of opioid use disorder (OUD) to determine if the associations were differently represented.

Results: After controlling for covariates, anxiety (β = 7.07, P < 0.001) and depression symptoms (β = 14.17, P < 0.001) were statistically significant correlates of increased mental defeat. Diverting attention (β = 0.31, P < 0.05), coping self-statements (β= -0.30, P < 0.05), and catastrophizing (β = 1.47, P < 0.001) were significant correlates, explaining 51% of the variance in mental defeat (P < 0.001). Exploratory analysis revealed subgroup differences, such that while depression symptoms and catastrophizing were significant correlates of mental defeat in persons with and without OUD, anxiety and diverting attention were significant only in persons without OUD.

Conclusions: These findings identify key psychological and coping correlates of mental defeat in persons with CNCP on LTOT, informing the development of interventions to mitigate it, and thereby reducing the risk of suicide in this vulnerable population.