Relationship of Negative Affect and Outcome of an Opioid Therapy Trial Among Low Back Pain Patients

Robert N. Jamison, Robert R. Edwards, Xiaoxia Liu, Edgar L. Ross, Edward Michna, Meredith Warnick, Ajay D. Wasan

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Objectives: Patients with chronic noncancer pain frequently report symptoms of depression and anxiety (negative affect), which are associated with higher ratings of pain intensity and a greater likelihood of being prescribed chronic opioid therapy. The purpose of this secondary analysis was to test the hypothesis that initial levels of negative affect can predict treatment-related outcomes in a double-blind, placebo-controlled study of extended-release (ER) hydromorphone among opioid-tolerant patients with chronic low back pain. Methods: Four hundred fifty-nine (N=459) patients participated in the titration/conversion phase of a multicenter study, of which 268 were randomized to receive once-daily hydromorphone or placebo. All patients completed the Hospital Anxiety and Depression Scale (HADS) at baseline and were divided evenly into Low (N=157), Moderate (N=155), and High (N=147) negative affect groups based on their scores. Group differences in numerical pain intensity measures at home and in the clinic, Roland-Morris Disability ratings, and measures of symptoms from the Subjective Opiate Withdrawal Scale (SOWS) throughout the trial were analyzed. Results: Two hundred sixty-eight of the initial 459 subjects who entered the 2 to 4-week titration/conversion phase (pretreatment) were successfully randomized to either placebo or ER hydromorphone; a total of 110 patients then completed this double-bflind phase of the study. Those in the Moderate and High negative affect groups tended to drop out more often during the titration/conversion phase because of the adverse effects or lack of efficacy of their prescribed opioid than those in the Low negative mood group (P

Original languageEnglish (US)
Pages (from-to)173-181
Number of pages9
JournalPain Practice
Issue number3
StatePublished - Mar 2013
Externally publishedYes


  • Chronic pain
  • Clinical trial
  • Double-blind
  • Mood
  • Negative affect
  • Opioid tolerance
  • Opioids
  • Placebo-controlled
  • Randomized controlled trial
  • RCT

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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