Two dimensions of pain acceptance: divergent links to opioid misuse and readiness to change

More than 13 million Americans remain on long-term opioid therapy for chronic pain (CP) despite well-established risks and no quality evidence of long-term benefits. Pain acceptance, defined as willingness to experience pain and engage in valued life activities despite pain, has been consistently linked to improved pain outcomes and more recently identified as a protective factor against opioid misuse. This study examined the relationship between both factors of pain acceptance and opioid misuse behaviors and readiness to change opioid use among opioid-using individuals with CP. A community sample of adults with a variety of CP conditions using opioid medications (N = 157) were recruited through ResearchMatch.org. Participants completed self-report questionnaires, including the Chronic Pain Acceptance Questionnaire (CPAQ), Prescription Opioid Misuse Index (POMI), Brief Pain Inventory (BPI), and single-item Visual Analog Scale (VAS) measures of readiness and confidence to discontinue opioid use. Two CPAQ subscales (activity engagement and pain willingness) and pain severity were entered into a logistic regression predicting POMI score and multiple linear regression models predicting readiness and confidence to reduce opioid use. All three models were significant (p < 0.05). Activity engagement was associated with greater odds of opioid misuse, whereas pain willingness was associated with lower odds of misuse. In contrast, higher activity engagement and lower pain willingness predicted higher readiness and confidence to taper opioid use. Findings demonstrate nuances in the dimensions of pain acceptance and support the value of further exploring activity engagement and pain willingness in efforts to reduce opioid-related risks.