How do depression symptoms influence use of prescription opioid pain medications?

3 February 2023

How do depression symptoms influence use of prescription opioid pain medications?

What is the research about?

More than 50% of people living with chronic pain experience depression. Symptoms of depression can include difficulties sleeping, loss of interest in enjoyable activities, feelings of sadness, lack of energy, difficulties concentrating, and changes in appetite.

Experiencing depressive symptoms in addition to chronic pain can make managing pain more challenging. Individuals with depression are more likely to report using prescription opioid medications in ways other than prescribed (e.g., using a higher dose or taking medication more frequently than prescribed). But we do not know why this is.

In this study, we investigated whether negative thoughts about pain (e.g., “I worry all the time about whether the pain will end”) and impulsivity traits influence prescription opioid medications use. We were particularly interested in finding out whether impulsive personality traits such as prioritising rewarding behaviours and the tendency to act without thinking, could be related to using opioid medications in ways other than prescribed by the treating doctor.

What did the researchers do?

198 individuals with chronic pain completed an online survey. We asked participants to answer questions about their depressive symptoms, thoughts about pain, impulsivity traits, and use of prescription opioid medications. 

What did the researchers find?

We found that individuals who experienced depressive symptoms were more likely to report negative thoughts about their pain, which in turn was related to using opioids not as prescribed.

These findings suggest that individuals may use prescription opioids in ways other than prescribed to cope with feelings of emotional distress associated with depressive symptoms and negative thoughts about pain.

Higher levels of emotional distress can also trigger impulsive behaviours that lead individuals to prioritising rewarding behaviours such as, taking an extra tablet at night-time to assist with sleep. We found that individuals susceptible to reward-seeking behaviours may have less of an ability to stop themselves from engaging in using opioid medications other than as prescribed. The emotional experiences of chronic pain and depression, which include unhelpful thoughts about pain could increase the incentive value (e.g., pain relief, feelings of euphoria, sleep assistance) of prescription opioids.

How can you use this research?

Health professionals and individuals with chronic pain can look out for how depressive symptoms and thoughts about pain could be affecting opioid medication use, particularly for those who are more impulsive.

Currently, there are no clinical guidelines that offer recommendations for best treatment of depressive symptoms, thoughts about pain, and impulsive behaviours. We are working to address this gap by designing personalised treatments that may reduce the unintended consequences of opioid medications use.

Dr. Rachel Elphinston and a team of researchers at The University of Queensland are currently co-designing and testing specialised digital psychological treatments to assist people with chronic pain manage their use of opioid medications. For more information, contact Dr Elphinston via email

About the researchers

Chloe-Emily Eather

Chloe-Emily Eather is a PhD Candidate with RECOVER Injury Research Centre, The University of Queensland.

Associate Professor Matthew Gullo is a Clinical Psychologist and Principal Research Fellow at the National Centre for Youth Substance Use Research, The University of Queensland.

Dr. Rachel Elphinston is a Clinical Psychologist and Senior Research Fellow at RECOVER Injury Research Centre, The University of Queensland and Metro South Health.



Eather, C. E., Gullo, M. J., & Elphinston, R. A. (2022). Reward drive moderates the effect of depression-related cognitive mechanisms on risk of prescription opioid misuse among patients with chronic non-cancer pain. The Journal of Pain.


Depressive symptoms, pain catastrophising, impulsivity, prescription opioids, chronic non-cancer pain.

Contact information, acknowledgements

Chloe-Emily Eather

RECOVER Injury Research Centre, The University of Queensland


Twitter: @ChloeEather; @rachelphinston

We would like to thank the participants for their time completing the survey, and those who assisted with data collection and data management.