title: Pain as a Predictor of Opioid Use Disorder in a Nationally Representative Sample.
abstract: OBJECTIVE
  The authors sought to ascertain the relationship between moderate and more severe pain and prescription opioid use disorders in the noninstitutionalized U.S.
  
  
  METHODS
  
  
  
  METHODS
  A structural equation model was used to assess prospectively the interdependency of pain and prescription opioid use disorder at waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Pain was measured with a 5-point scale of pain-related interference in daily activities and dichotomized as "no pain" (no or little interference) or "pain" (moderate to extreme interference). Prescription opioid use disorder was assessed with a structured interview (the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version). Other covariates included age, sex, anxiety or mood disorders, and family history of drug, alcohol, and behavioral problems.
  
  
  RESULTS
  In the structural equation model, pain and prescription opioid use disorders were significantly associated with one another at baseline and at 3-year follow-up. However, whereas pain at baseline was also significantly associated with prescription opioid use disorder at follow-up, prescription opioid use disorder at baseline was not associated with pain at follow-up. These associations were independent of several background demographic and clinical characteristics. The path for pain interference was associated with a 41% relative increase in the risk of developing a prescription opioid use disorder.
  
  
  CONCLUSIONS
  Painful conditions contribute to the risk of prescription opioid use disorders. To help reduce the incidence of prescription opioid abuse and dependence among adults with moderate to severe pain, careful monitoring and consideration of nonopioid alternative treatments is warranted.
authors.affiliation: From the Division of Epidemiology, Services, and Prevention Research, NIDA, Bethesda, Md.; the Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York; and the Department of Psychiatry, Fundación Jiménez-Díaz, Madrid.
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
authors.affiliation: From the Division of Epidemiology, Services, and Prevention Research, NIDA, Bethesda, Md.; the Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York; and the Department of Psychiatry, Fundación Jiménez-Díaz, Madrid.
authors.forename: Melanie M
authors.initials: MM
authors.lastname: Wall
authors.affiliation: From the Division of Epidemiology, Services, and Prevention Research, NIDA, Bethesda, Md.; the Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York; and the Department of Psychiatry, Fundación Jiménez-Díaz, Madrid.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Okuda
authors.affiliation: From the Division of Epidemiology, Services, and Prevention Research, NIDA, Bethesda, Md.; the Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York; and the Department of Psychiatry, Fundación Jiménez-Díaz, Madrid.
authors.forename: Shuai
authors.initials: S
authors.lastname: Wang
authors.affiliation: From the Division of Epidemiology, Services, and Prevention Research, NIDA, Bethesda, Md.; the Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York; and the Department of Psychiatry, Fundación Jiménez-Díaz, Madrid.
authors.forename: Miren
authors.initials: M
authors.lastname: Iza
authors.affiliation: From the Division of Epidemiology, Services, and Prevention Research, NIDA, Bethesda, Md.; the Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York; and the Department of Psychiatry, Fundación Jiménez-Díaz, Madrid.
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
mesh_terms: D000328:Adult; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010146:Pain / Q000453:epidemiology*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology