Pain-related anxiety, sex, and co-use of alcohol and prescription opioids among adults with chronic low back pain

Lisa R. LaRowe, Jessica M. Powers, Lorra Garey, Andrew H. Rogers, Michael J. Zvolensky, Joseph W. Ditre

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: Both alcohol and prescription opioid use/misuse are highly prevalent among individuals with chronic pain. Co-use of alcohol and prescription opioids is also common, despite contraindications due to increased risk of negative health effects and mortality. There is evidence that pain-related anxiety (i.e., the tendency to respond to pain with anxiety or fear) may be associated with heavier drinking and prescription opioid use/co-use, and that these associations may be especially salient among men. Methods: This study is the first examination of pain-related anxiety in relation to hazardous alcohol use, prescription opioid use/misuse, and alcohol-opioid co-use. Participants included 1812 adults with chronic low back pain (69 % female, Mage = 43.95) who completed an online survey assessing health behaviors. Results: Pain-related anxiety was positively associated with indices of alcohol (i.e., alcohol-related consequences) and opioid use (i.e., prescription opioid use/misuse, daily opioid consumption). Of note, sex moderated associations between pain-related anxiety and both alcohol-related consequences and prescription opioid misuse. In addition to being associated with alcohol and prescription opioid use, independently, pain-related anxiety was also associated with greater likelihood of endorsing co-use of alcohol and opioids and engaging in concurrent hazardous drinking and prescription opioid misuse. Conclusions: These findings contribute to a growing literature suggesting that pain-related anxiety is an important transdiagnostic factor in pain and alcohol and prescription opioid use/co-use, perhaps especially among males.

Original languageEnglish (US)
Article number108171
JournalDrug and Alcohol Dependence
StatePublished - Sep 1 2020


  • Alcohol
  • Chronic pain
  • Co-Use
  • Opioids
  • Pain

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)


Dive into the research topics of 'Pain-related anxiety, sex, and co-use of alcohol and prescription opioids among adults with chronic low back pain'. Together they form a unique fingerprint.

Cite this