Opioids as an attachment substitute: the association between attachment insecurity, pain, disability, and long-term...

Opioids are suggested to serve as an emotional substitute for social attachments, which could be why patients with persistent back pain and high levels of attachment avoidance might be vulnerable to long-term opioid treatment (LTOT).

The primary aim was to assess the association between attachment insecurity and LTOT. The secondary aim was to assess the associations between attachment insecurity, pain, and disability.

We conducted a 5-year follow-up study of patients with persistent back pain. Questionnaire data on attachment insecurity, psychological distress, pain intensity, and disability were collected and combined with longitudinal registry data on prescriptions of opioids.

A total of 3102 patients were included. Patients in LTOT (9.3%) were significantly more avoidantly attached than were nonusers of opioids. For every 1-point increase in attachment avoidance, the odds of LTOT increased by 4%. After adjustment for covariates, only age, pain, and depression were significantly associated with LTOT. Both attachment avoidance and attachment anxiety were significantly associated with pain intensity and disability.

Attachment insecurity could be associated with an increased risk of LTOT, pain, and disability. Acknowledging that unmet attachment needs and emotional distress can be linked to an increased risk of LTOT highlights the importance of considering these factors before prescribing the first opioid.