Pain, Borderline Personality Disorder, Emotional Lability and Opiate Abuse

An article from pain.org regarding BPD, emotional lability and Opiate Abuse:

The medical borderline: personality characteristics that promote increased risk of opioid misuse

Geralyn Datz, Melissa Bonnell, Toni Merkey, Todd Sitzman
Forrest General Hospital, Hattiesburg, MS, USA,
University of Southern Mississippi, Hattiesburg, MS, USA, Advanced Pain Therapy, PLLC, Hattiesburg, MS, USA

Purpose

Undiagnosed or untreated psychiatric comorbidities may contribute to medication misuse. In particular, personality disorders may place patients at risk for medical nonadherence, via negative coping styles. Patients with Borderline Personality Disorder (BPD) utilize medical services more frequently than those without BPD and are less likely to adhere to medical regimens. Patients with borderline traits have greater incidences of risky behavior, including abuse of prescription medications. We examined a large outpatient sample of chronic pain patients being screened for appropriateness of long-term opioid therapy in order to determine correlations between high-risk behaviors and personality type.

Method

Participants were 96 patients who were assessed in an outpatient pain management program. Participants were administered the Millon Behavioral Medicine Diagnostic (MBMD), which measures psychosocial assets and liabilities that affect treatment response, and the Screener and Opioid Assessment for Patients with Pain – Revised (SOAPP-R), which is a measure designed to predict aberrant medication-related behavior. Hierarchical regression analysis was used to evaluate which psychiatric indicators of the MBMD would predict total SOAPP-R score. Each analysis adjusted for age, gender, duration of pain, and number of pain sites.

Results

Hierarchical regression analysis was used to evaluate which psychiatric indicators of the MBMD would predict total SOAPP-R score. Each analysis adjusted for age, gender, duration of pain, and number of pain sites. Model 1 included demographic variables, duration of pain, and number of pain sites, F(5,91)=5.81, P<.001. Overall, the model explained 24.2% of the variance in SOAPP-R scores. Results indicated that age and number of pain sites significantly predicted SOAPP-R score. Model 2 added the psychiatric indicators of the MBMD. Overall, Model 2 explained 42.7% of the variance in SOAPP-R scores, F(5,91)=6.42, P<.001. Number of pain sites and emotional lability significantly predicted SOAPP-R score over other psychiatric indicators.

Conclusions

Identifying “at-risk” patients for opioid misuse has significant importance in today’s climate of increased scrutiny towards pain medications. These findings suggest personality assessment serves as an effective adjunct to risk stratification. Personality factors such as emotional lability and traits of borderline personality may increase opioid misuse potential. Clinical interview, history taking, and psychological assessment are valid ways pain specialists can assess personality. Prescribing strategies such as prescreening, close monitoring, limit setting, inclusion of psychological support can mitigate risk. Personality traits are key factors that may contribute to aberrant behavior and are of importance to prescribers of opioid regimens.