{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T18:25:43Z","timestamp":1788805543627,"version":"build-2803163510"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Danish Victims Fund","award":["17-910-00055"],"award-info":[{"award-number":["17-910-00055"]}]},{"name":"Council of the Danish Victims Fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Opioids are suggested to serve as an emotional substitute for social attachments, which could be why patients with persistent back pain and high levels of attachment avoidance might be vulnerable to long-term opioid treatment (LTOT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The primary aim was to assess the association between attachment insecurity and LTOT. The secondary aim was to assess the associations between attachment insecurity, pain, and disability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a 5-year follow-up study of patients with persistent back pain. Questionnaire data on attachment insecurity, psychological distress, pain intensity, and disability were collected and combined with longitudinal registry data on prescriptions of opioids.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 3102 patients were included. Patients in LTOT (9.3%) were significantly more avoidantly attached than were nonusers of opioids. For every 1-point increase in attachment avoidance, the odds of LTOT increased by 4%. After adjustment for covariates, only age, pain, and depression were significantly associated with LTOT. Both attachment avoidance and attachment anxiety were significantly associated with pain intensity and disability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Attachment insecurity could be associated with an increased risk of LTOT, pain, and disability. Acknowledging that unmet attachment needs and emotional distress can be linked to an increased risk of LTOT highlights the importance of considering these factors before prescribing the first opioid.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/pm\/pnaf148","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T12:05:45Z","timestamp":1761307545000},"page":"401-408","source":"Crossref","is-referenced-by-count":1,"title":["Opioids as an attachment substitute: the association between attachment insecurity, pain, disability, and long-term opioid treatment in persistent back pain"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9045-7500","authenticated-orcid":false,"given":"Tonny Elmose","family":"Andersen","sequence":"first","affiliation":[{"name":"Department of Psychology, University of Southern Denmark , Odense,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie Lykkegaard","family":"Ravn","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Southern Denmark , Odense,","place":["Denmark"]},{"name":"Specialized Hospital for Polio and Accident Victims , R\u00f8dovre,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5213-2799","authenticated-orcid":false,"given":"Ole","family":"Skov","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Southern Denmark , Odense,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Manniche","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Institute of Clinical Research Odense University Hospital, University of Southern Denmark ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"2026040815364982600_pnaf148-B1","doi-asserted-by":"publisher","first-page":"e483","DOI":"10.1016\/S2468-2667(19)30156-2","article-title":"Are we facing an opioid crisis in Europe?","volume":"4","author":"Verhamme","year":"2019","journal-title":"Lancet Publich Health"},{"key":"2026040815364982600_pnaf148-B2","doi-asserted-by":"publisher","first-page":"e498","DOI":"10.1016\/S2468-2667(19)30128-8","article-title":"A trends in use and misuse of opioids in the Netherlands: a retrospective, multi-source dartabase study","volume":"4","author":"Kalkman","year":"2019","journal-title":"Lancet Public Health"},{"key":"2026040815364982600_pnaf148-B3","doi-asserted-by":"publisher","first-page":"2989","DOI":"10.1007\/s00586-021-06849-6","article-title":"Prevalence of long-term opioid therapy in spine center outpatients the Spinal Pain Opioid Cohort (SPOC)","volume":"30","author":"Manniche","year":"2021","journal-title":"Eur Spine J"},{"key":"2026040815364982600_pnaf148-B4","doi-asserted-by":"publisher","first-page":"1760","DOI":"10.1002\/ejp.1786","article-title":"Is Europe also facing an opioid crisis? 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