If you’ve seen the regular stream of stories in the media about the “opioid epidemic,” the thought of starting an opioid pain medication might make you a little uneasy. But if you are scheduled for an elective surgery, dental work, or experience an acute injury, your doctor is likely to prescribe one – an estimated 1 out of every 5 patients with non-cancer pain are prescribed opioids by their doctors. So how can you make sure you don’t turn into a bad statistic?

There are many physical and genetic factors that impact your risk for addiction – family history of addiction, age, duration of treatment, just to name a few – and your doctor should discuss these with you. But it doesn’t stop there. There is a strong body of evidence to show that a person’s psychological health at the time painkillers are started plays a big, but often overlooked, role in addiction.

While ordinarily only 1.7% of patients prescribed an initial dose of opioids will go on to become long-term users, research shows that the rate of addiction becomes substantially higher when prescribed to patients with mental health conditions, like depression, PTSD, anxiety disorders, and a past substance abuse history. A recent study from Indiana University published in the journal Pain looked at over 10 million patient records involving insurance claims for opioid prescriptions. The study authors concluded that pre-existing psychiatric and behavioral conditions as well as the use of psychoactive medications, like anti-depressants, anti-anxiety medications and anti-psychotic medications were associated with the long-term use of opioid painkillers. The data tells us that those who cling to painkillers the tightest are usually those who are suffering the most.

Based on the study’s data, people with a past history of addiction, especially involving opioids, are at greatest risk for becoming dependent on opioids. Depression is another important risk factor to consider, especially since it’s such a widespread condition, affecting an estimated 6.7% of American adults. And as you might expect, the most common psychiatric disorder occurring alongside opioid use is depression.

Another important, but hidden, factor that impacts opioid dependence is attitude – our thoughts, impressions, and judgments. Pain not only impacts how we feel, but it also changes how we think.

Catastrophic thinking – irrational thinking that something is much worse than it really is – is an easy, but dangerous, trap to fall into when we are hurting or injured. Research suggests that catastrophic thinking can be a risk factor for developing more intense and lasting pain and make us more likely to want to stay on opioid painkillers.

Studies have also found a link between perceived injustice and opioid use. When we feel we have been treated wrongly in some way, this can impact how well we cope with pain and whether or not we continue to use opioid painkillers. Perceived injustice can crop up in a variety of ways including impressions about who is at fault in causing an injury or accident, feeling mistreated by others when we are in pain, and perceptions about the medical care we receive from our doctors.

Changing the way we think about our health can certainly improve our outcomes with treatment, but creating attitude shifts is no small feat. Becoming better educated about a problem can help. Once you learn that most back injuries recover well on their own in a relatively short period of time, then you start to worry less about becoming wheel-chair bound or permanently impaired. Counselors and therapists can be of great help in changing dysfunctional thought processes that are holding you back from more productive ways of thinking about your health. We can all benefit from outside help at some point in our lives to become better problem-solvers.

Each person’s own medical situation and pain experience is unique and needs special attention. But when making decisions about what medications to take and for how long, make sure you and your providers pay as much attention to how you are doing on the inside as they do to how you are recovering on the outside.

NOTE: Ask your doctor about the pros and cons, as well as potential side effects, before starting any new medication. In addition, talk with your doctor about your goals and expectations for treatment to make sure everyone is on the same page. Here is a link to learn more about the CDC Guidelines for Prescribing Opioids for Chronic Pain.