Date of Award

1-1-2014

Document Type

Dissertation

Degree Name

Ph.D.

Department

Counseling Psychology

First Advisor

Cynthia McRae

Keywords

aberrant behavior, chronic pain, grounded theory, mixed methods, opioid abuse, predictors

Abstract

Author: Courtney R. Morris

Title: Predictors of the Risk for Aberrant Drug-Related Behavior in Chronic Pain Patients: A Mixed Methods Design

Advisor: Cynthia McRae, Phd

Degree Date: August 2014

Abstract

The use of opioids for the treatment of chronic non-cancer pain (CNCP) remains controversial (Manchikanti, 2008; McQuay, 1999). Controversy surrounds the type of conditions that should be treated with opioids, whether the treatment can be generally safe and effective, and what the clinical goals should be. If providers can predict those patients who will be most at risk for aberrant drug-related behavior, efficacious changes in chronic pain management could be initiated and fewer patients potentially at risk for addiction. The current study explored the role of self-efficacy of pain, severity of depressive symptoms, perceived social support, and ethnic identity as predictors for the risk of aberrant drug-related behavior in CNCP patients. 102 CNCP patients being treated at a large, metropolitan health care clinic were invited to participate in this study. Qualitative data were conducted with the use of grounded theory methodology and data were collected from 10 participants out of the total sample.

A two-way ANOVA found non-significant effects of sex, ethnicity CNCP patients prescribed opioids and those who were not. This suggests that all other statistical findings are generalizable across gender and across white and Hispanic populations. A hierarchical logistic regression analysis predicted group membership in participants prescribed opioids and those who were not. Participants' level of pain self-efficacy was the only statistically significant predictor for distinguishing whether participants were prescribed opioids. Results from a hierarchical multiple regression, the main foci of this study, indicated that two predictor variables (level of depression and level of pain self-efficacy) in participants on opioids contributed significantly to the explanation of patients being at risk for opioid misuse. Additionally, three predictor variables (level of depression, level of perceived social support, and level of ethnic identity) in participants not prescribed opioids, contributed significantly to the explanation of patients being at risk for aberrant drug-related behavior.

Following in-depth analyses of 10 interviews, 43 open, 9 axial, and 5 selective grounded theory categories emerged. Three domains found described the grounded theory. These three domains include (1) The Nature of Chronic Pain, (2) Professional Treatments used for the Management of Chronic Pain, and (3) Coping with Chronic Pain. The nature of participants' chronic pain included onset, pain sites, diagnoses, longevity, description of sensations, associated mood, and the impact of stress on levels of pain. All of these aspects contributed to patients' descriptions of pain, satisfaction with treatments for pain and the management of chronic pain. Patients' relationships with physical health and mental health providers contributed to their satisfaction of pain management. Injections, physical therapy and psychotherapy were found to be the most valuable professional treatment methods. Moreover, self-coping strategies for chronic pain management included drug treatments and non-medication treatments. The most efficacious non-medication strategies found were social support, heat, exercise, physical therapy, pleasant activities and distraction. Drug treatments found to be the most beneficial included opioids, nonsteroidal anti-inflammatory drugs, antidepressants and cannabis.

Provenance

Recieved from ProQuest

Rights holder

Courtney Renee Morris

File size

195 p.

File format

application/pdf

Language

en

Discipline

Psychology, Health care management, Health education

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