Posttraumatic Stress and Opioid Use and Pain among Individuals with Probable Posttraumatic Stress Disorder and Self-Reported Chronic Pain: The Role of Health Literacy

Abstract

Background

Chronic pain and opioid misuse are a prevalent comorbidity with deleterious health outcomes. Growing work indicates that posttraumatic stress disorder (PTSD) can increase the risk for chronic pain and opioid misuse and dependence. However, there is little understanding of social determinants of health (SDoH) that may account for interrelations of PTSD with chronic pain and opioid misuse and dependence. Health literacy is one relevant SDoH construct, reflecting the ability to gather, process, and comprehend health-related information required to engage in a healthcare setting.

Objective

The purpose of the present cross-sectional study was to examine the indirect effect of health literacy in the association between PTSD and opioid misuse, opioid dependence, pain intensity, and pain disability.

Method

The sample included 142 adults (Mage = 35.2, SD = 9.9; 67.4% female; 70.1% White/Caucasian) with self-reported chronic pain and probable PTSD who were using opioid medication.

Results

Results demonstrated that PTSD symptom severity had a small indirect effect on opioid misuse and opioid dependence via health literacy; no indirect effects were evident for pain intensity and disability.

Conclusion

The present investigation provides evidence that health literacy may serve as an important explanatory factor in associations between PTSD symptom severity and opioid misuse and dependence among adults with co-occurring probable PTSD and chronic pain.

Keywords:

• PTSD
• health literacy
• opioid use
• chronic pain
• SDoH

Disclosure statement

No potential conflict of interest was reported by the author(s).

Figure 1. Illustration of the theoretical model of the indirect effect of PTSD symptom severity on (1) opioid misuse; (2) opioid dependency; (3) pain intensity; and 4) pain disability via health literacy. Covariates included gender, age, and education.

Additional information

Funding

Author one acknowledges that research reported in this publication was supported, in part, by the National Institute of Mental Health of the National Institutes of Health Diversity Research Supplement [NIMH R01MH126586]. Author seven acknowledges that research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH) to the University of Houston under Award Number U54MD015946. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.