Sex differences in opioid misuse among adults with chronic lower back pain: the roles of negative affect and related transdiagnostic factors

Background: The opioid epidemic is a significant public health concern, particularly among adults with chronic pain. Although sex differences in opioid-related behaviors have been observed, little work has examined the role of negative affect and related variables in greater opioid misuse severity risk among men. Methods: We tested whether, among 206 (72.3% female) adults (aged 18–64, M = 45.5) with chronic lower back pain (CLBP), the relation of sex with opioid misuse severity could be moderated by a range of negative affect-related variables (anxiety, depression, pain anxiety, pain catastrophizing, difficulty with emotion regulation, anxiety sensitivity, and distress intolerance). Results: Although these negative affect-related variables were related to more severe opioid misuse for both men and women; the relation of sex to misuse varied as a function of the following variables: anxiety, pain anxiety, pain catastrophizing, and difficulty with emotion regulation, such that at higher levels of these variables, men reported more severe opioid misuse than women. This same pattern was not evident for depression, anxiety sensitivity, or distress intolerance. Conclusions: Results highlight the important roles specific types of negative affect-related variables may play in observed sex differences in opioid misuse severity among individuals with CLBP.