Chronic pain is a complex biopsychosocial phenomenon that integrates somatic, psycho-emotional, and behavioral components. An important characteristic of chronic pain is its persistence for more than three months; over time, it ceases to be merely a symptom and transforms into an independent pathological condition with its own behavioral dynamics. One of the key complications of chronic pain is the development of operant behavior, which increases the risk of therapy ineffectiveness and the emergence of opioid analgesic addiction. Age and sex factors may play a modifying role in the development of such behavioral patterns, influencing clinical prognosis and therapeutic strategies. The objective: to determine the role of sex and age as modifying factors in the formation of operant behavior and the risk of opioid addiction among patients with different types of chronic pain. To investigate the relationship between pain type (primary, secondary, mixed), behavioral patterns of patients, and the scores on the Diagnosis, Intractability, Risk, Efficacy (DIRE) scale, with the aim of improving personalized pain management strategies and determining the appropriateness of initiating or continuing opioid analgesia. Materials and methods. A total of 302 patients aged 18–70 years with chronic primary, secondary, and mixed pain completed the study program. The diagnosis of mental and psychosomatic disorders was performed according to the International Classification of Diseases, 11th Revision (ICD-11) criteria. Based on the aetiopathogenetic mechanisms of pain and the clinical-psychopathological characteristics defined by ICD-11, all participants were divided into 5 groups: PPP 1 – Primary psychogenic pain; PPP 2 – Psychophysiological pain; PPP 3 – Mixed primary psychogenic and psychophysiological pain; SMP – Secondary mixed pain; SOP – Secondary organic pain. The DIRE scale was used to assess the risk of operant behavior formation and to predict the appropriateness of opioid analgesia. Statistical analysis was performed using the χ2 test, Kruskal–Wallis test, and Dunn’s multiple comparison test. Results. The difference in the frequency of operant behavior risk between men and women was not statistically significant; however, aetiopathogenetic stratification by groups revealed significant differences. In Group PPP 1, men showed a markedly higher risk of operant behavior development and opioid therapy addiction – almost 1.5 times higher than women (χ2 = 8.35, p = 0.003). In Group PPP 3, the risk of operant behavior formation and probable opioid analgesia addiction was maximal in men (100%) compared with women (76.7%) (χ2 = 5.82, p = 0.015). In Groups PPP 2 and SMP, sex differences did not reach statistical significance. In Group SOP, most patients, regardless of gender, had the lowest risk of developing addiction to opioid analgesia. In the total sample (p = 0.572), no association was found between age and risk, but subgroup analysis (age саtegories) showed that PPP 1 and PPP 3 demonstrated a pronounced tendency toward risk-related behavior among younger patients (under 29 years). The only statistically significant age-risk relationship was observed in PPP 1 (p = 0.035). Older patients with SOP and SMP had the highest DIRE scores and the lowest risk of operant behavior formation. Conclusions. Sex and age are significant modifying factors in the development of operant behavior and the risk of opioid addiction among patients with chronic pain. The most vulnerable group comprises young men with primary psychogenic and mixed pain, who require proactive psychotherapeutic, psychoeducational, and preventive interventions to reduce the risk of operant behavior. The identified patterns have practical implications for forming personalized analgesic strategies and for substantiating indications for the initiation or continuation of opioid therapy.
Азізе Асанова (Mon,) studied this question.