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Lee SJ, Koussa M, Gelberg L, Heinzerling K, Young SD. Somatization, mental health and pain catastrophizing factors associated with risk of opioid misuse among patients with chronic non-cancer pain. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2019.1704079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Sung-Jae Lee
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Maryann Koussa
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Keith Heinzerling
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sean D. Young
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Utility of Patient-reported Symptoms and Health Conditions for Predicting Surgical Candidacy and Utilization of Surgery via an Outpatient Spine Clinic Nomogram. Clin Spine Surg 2019; 32:E407-E415. [PMID: 31169614 DOI: 10.1097/bsd.0000000000000838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE Identify the nonradiographic predictors of a patient's decision to undergo elective spine surgery. SUMMARY OF BACKGROUND DATA Up to 132 million people seek elective evaluation by spine surgeons annually, though 55%-82% of specialty referrals may be inappropriate. We sought to determine which clinical and psychosocial factors are associated with surgical utilization by patients seeking surgical evaluation for degenerative spine pathologies. MATERIALS AND METHODS Consecutive elective outpatient visits seen in a single clinic between May 2016 and April 2017 for degenerative spine pathologies were reviewed. Data were collected on presenting symptoms, baseline medical illness, demographics, and previous spine care. Multivariable logistic regressions were performed to determine which factors were associated with surgical candidacy and surgical utilization. RESULTS A total of 353 patients were seen during the period reviewed, of which 144 had complete medical records. Our cohort included 90 nonsurgical candidates, 25 surgical candidates who declined surgery, and 29 patients who underwent surgery. In multivariable analysis, factors negatively associated with surgical candidacy were age, a history of smoking, and osteoporosis, where those positively associated with surgical candidacy were reports of spine-specific pain, higher Charlson Comorbidity Index, pain medication use, number of neurological symptoms, and being myelopathic. Factors positively associated with surgical utilization included proportion of all complaints that were neurological in nature, being myelopathic, higher Charlson Comorbidity Index, and report of pain as chronic, whereas being osteoporotic was negatively associated with surgical use. A receiver operating curve constructed for these models produced c-statistics of 0.75 and 0.80, respectively. CONCLUSIONS Our results suggest that the results of standard clinic intake questions, such as review of systems, medical history, and chief complaints, may be predictive of surgical candidacy before evaluation by a surgeon. The present pilot study suggests a preliminary algorithm that can be further validated and expanded upon to help decide on optimal patient referrals to spine surgery specialists.
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Chesin M, Interian A, Kline A, St Hill L, King A, Miller R, Latorre M, Stanley B. Past-year opioid misuse and suicide attempt are positively associated in high suicide risk veterans who endorse past- year substance use. Addict Behav 2019; 99:106064. [PMID: 31425930 DOI: 10.1016/j.addbeh.2019.106064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 11/19/2022]
Abstract
The main purpose of this study was to test the relationship between past-year suicide attempt (SA) and past-year opioid misuse among Veterans at high risk of suicide who reported using at least one illicit substance or alcohol in the past year. Baseline data from 130 high suicide-risk Veterans (n = 39 past-year opioid misusers; n = 91 past-year users of other substances) who enrolled in a randomized controlled trial testing adjunctive Mindfulness-Based Cognitive Therapy to Prevent Suicidal Behavior were used. Information was collected on a semi-structured interview that included the Columbia-Suicide Severity Rating Scale to collect suicide attempt history. Past-year opioid misusers, compared to those who used at least one other illicit substance or alcohol in the past year, were more likely to have made a past-year SA. Past-year opioid misuse remained associated with past-year SA in multivariate analysis that included other known risk factors for SA. Our findings show a robust link between near-term SA and opioid misuse in Veterans.
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Affiliation(s)
- Megan Chesin
- Department of Psychology, William Paterson University, Wayne, NJ, United States of America.
| | - Alejandro Interian
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, NJ, United States of America; Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers-The State University of New Jersey, Piscataway, NJ, United States of America
| | - Anna Kline
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers-The State University of New Jersey, Piscataway, NJ, United States of America
| | - Lauren St Hill
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, NJ, United States of America
| | - Arlene King
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, NJ, United States of America
| | - Rachael Miller
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, NJ, United States of America
| | - Miriam Latorre
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, NJ, United States of America
| | - Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, New York, NY, United States of America
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You DS, Hah JM, Collins S, Ziadni MS, Domingue BW, Cook KF, Mackey SC. Evaluation of the Preliminary Validity of Misuse of Prescription Pain Medication Items from the Patient-Reported Outcomes Measurement Information System (PROMIS)®. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:1925-1933. [PMID: 30856659 PMCID: PMC6784744 DOI: 10.1093/pm/pnz001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The National Institutes of Health's Patient-Reported Outcomes Measurement Information System (PROMIS)® includes an item bank for measuring misuse of prescription pain medication (PROMIS-Rx Misuse). The bank was developed and its validity evaluated in samples of community-dwelling adults and patients in addiction treatment programs. The goal of the current study was to investigate the validity of the item bank among patients with mixed-etiology chronic pain conditions. METHOD A consecutive sample of 288 patients who presented for initial medical evaluations at a tertiary pain clinic completed questionnaires using the open-source Collaborative Health Outcomes Information Registry. Participants were predominantly middle-aged (M [SD] = 51.6 [15.5] years), female (62.2%), and white/non-Hispanic (51.7%). Validity was evaluated by estimating the association between PROMIS-Rx Misuse scores and scores on other measures and testing the ability of scores to distinguish among risk factor subgroups expected to have different levels of prescription pain medicine misuse (known groups analyses). RESULTS Overall, score associations with other measures were as expected and scores effectively distinguished among patients with and without relevant risk factors. CONCLUSION The study results supported the preliminary validity of PROMIS-Rx Misuse item bank scores for the assessment of prescription opioid misuse in patients visiting an outpatient pain clinic.
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Affiliation(s)
- Dokyoung Sophia You
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer M Hah
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Sophie Collins
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Maisa S Ziadni
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Ben W Domingue
- Stanford University Graduate School of Education, Palo Alto, California
| | - Karon F Cook
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sean C Mackey
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
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van Rijswijk SM, van Beek MHCT, Schoof GM, Schene AH, Steegers M, Schellekens AF. Iatrogenic opioid use disorder, chronic pain and psychiatric comorbidity: A systematic review. Gen Hosp Psychiatry 2019; 59:37-50. [PMID: 31141759 DOI: 10.1016/j.genhosppsych.2019.04.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/29/2019] [Accepted: 04/14/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE A systematic review of the literature on the risks of developing iatrogenic opioid use disorders in chronic pain patients with psychiatric comorbidity. METHODS We conducted literature searches on Pubmed with key subjects: "chronic pain", "psychiatry", "opioids" and "opioid use disorder" and for original, English written articles published from 2000 until the first of September 2017. Final selection of the articles for review was made in a consensus between three reviewers. RESULTS Longitudinal studies showed a significant association between psychiatric comorbidity, especially depression and anxiety disorders and the development of problematic opioid use, more severe opioid craving and poor opioid treatment outcome (analgesia and side effects) in chronic pain patients. Cross-sectional studies showed a similar association between psychiatric disorders and problematic opioid use, where studies in specialized pain settings showed a higher prevalence of psychiatric disorders, compared to non-specialized settings. CONCLUSIONS This systematic review showed a significant association between psychiatric comorbidity, especially depression and anxiety disorders and the development of problematic opioid use in chronic pain patients. We therefore recommend psychiatric screening in chronic pain management. Chronic pain patients with comorbid psychiatric disorders need a multidisciplinary approach and monitoring opioid use is warranted in these patients.
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Affiliation(s)
- S M van Rijswijk
- Department of Psychiatry, Radboudumc, Reinier Postlaan 10, 6525 GC Nijmegen, the Netherlands.
| | - M H C T van Beek
- Department of Psychiatry, Radboudumc, Reinier Postlaan 10, 6525 GC Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Montessorilaan 3, 6525 HR Nijmegen, the Netherlands
| | - G M Schoof
- Vincent van Gogh Centre, Addiction, Tegelseweg 210, 5912 BL Venlo, the Netherlands
| | - A H Schene
- Department of Psychiatry, Radboudumc, Reinier Postlaan 10, 6525 GC Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Montessorilaan 3, 6525 HR Nijmegen, the Netherlands
| | - M Steegers
- Department of Anesthesiology Specialized in Paincare, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - A F Schellekens
- Department of Psychiatry, Radboudumc, Reinier Postlaan 10, 6525 GC Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Montessorilaan 3, 6525 HR Nijmegen, the Netherlands; Nijmegen Institute for Scientist-Practitioners in Addiction, Montessorilaan 3, 6525 HR Nijmegen, the Netherlands
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Kneeland ET, Griffin ML, Taghian N, Weiss RD, McHugh RK. Associations between pain catastrophizing and clinical characteristics in adults with substance use disorders and co-occurring chronic pain. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:488-494. [DOI: 10.1080/00952990.2019.1581793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Elizabeth T. Kneeland
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Margaret L. Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Nadine Taghian
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
| | - Roger D. Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Rogers AH, Shepherd JM, Orr MF, Bakhshaie J, McHugh RK, Zvolensky MJ. Exploring anxiety sensitivity in the relationship between pain intensity and opioid misuse among opioid-using adults with chronic pain. J Psychiatr Res 2019; 111:154-159. [PMID: 30771621 DOI: 10.1016/j.jpsychires.2019.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/25/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
Opioid misuse is a significant public health problem. Chronic pain is one highly prevalent factor that is strongly associated with increased risk for opioid misuse. Anxiety sensitivity (fear of anxiety related physical sensations) is an individual difference factor consistently linked to pain experience, and separately, heroin use. The present study examined if anxiety sensitivity may be one factor related to the relationship between pain intensity and opioid misuse among opioid-using adults with chronic pain. Results indicated that anxiety sensitivity total score was significantly associated with the relationship between pain intensity and current opioid misuse, as well as pain intensity and severity of opioid dependence. Overall, results suggest that anxiety sensitivity may be an important assessment and intervention target to ultimately reduce the rates of opioid misuse among adults with chronic pain.
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Affiliation(s)
| | | | - Michael F Orr
- Department of Psychology, University of Houston, USA
| | | | - R Kathryn McHugh
- Department of Psychiatry, McLean Hospital & Harvard Medical School, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, USA; HEALTH Institute, University of Houston, USA.
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Rogers AH, Kauffman BY, Bakhshaie J, McHugh RK, Ditre JW, Zvolensky MJ. Anxiety sensitivity and opioid misuse among opioid-using adults with chronic pain. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:470-478. [PMID: 30896985 DOI: 10.1080/00952990.2019.1569670] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: The opioid epidemic is a significant public health crisis, and this problem is particularly prevalent among individuals with chronic pain. Accordingly, there is an urgent need for interventions to mitigate the risk for opioid misuse and opioid use disorder among people with pain. Given that mental health problems, specifically anxiety, are common among people who misuse opioids, it is important to examine factors that link mental health problems with opioid misuse to ultimately inform the development of novel interventions. Anxiety sensitivity, a transdiagnostic vulnerability factor defined as the fear of anxiety-related physical sensations, may be one important mechanism in elevated opioid misuse among persons with chronic pain. Objective: Therefore, the current cross-sectional study examined anxiety sensitivity (and construct sub-facets) as a predictor of opioid misuse among adults with chronic pain. Method: Adults reporting chronic pain and prescription opioid use completed an online survey. Results: Anxiety sensitivity was associated with multiple aspects of opioid misuse, including current opioid misuse, severity of opioid dependence, and number of opioids used to get high. The magnitude of effects ranged from medium to large. Associations between anxiety sensitivity and opioid misuse were observed over and above the variance accounted for by age, sex, income, education, perceived health, and pain severity. Conclusion: These findings suggest that anxiety sensitivity may be an important treatment target among adults with chronic pain who misuse opioids. Future research should continue to explore the explanatory relevance of anxiety sensitivity in opioid misuse among individuals with chronic pain.
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Affiliation(s)
- Andrew H Rogers
- a Department of Psychology, University of Houston , Houston , TX , USA
| | - Brooke Y Kauffman
- a Department of Psychology, University of Houston , Houston , TX , USA
| | - Jafar Bakhshaie
- a Department of Psychology, University of Houston , Houston , TX , USA
| | | | - Joseph W Ditre
- c Department of Psychology, Syracuse University , Syracuse , NY , USA
| | - Michael J Zvolensky
- a Department of Psychology, University of Houston , Houston , TX , USA.,d Department of Behavioral Science, The University of Texas MD Anderson Cancer Center , Houston , TX , USA.,e HEALTH Institute, University of Houston , Houston , TX , USA
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Sturgeon JA, Hah JM, Sharifzadeh Y, Middleton SK, Rico T, Johnson KA, Mackey SC. Predictors of Daily Pain Medication Use in Individuals with Recurrent Back Pain. Int J Behav Med 2019; 25:252-258. [PMID: 28875436 DOI: 10.1007/s12529-017-9686-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE A key component to chronic pain management regimens is the use of analgesic medications. Psychological factors, such as mood states, may also affect the use of pain medications for individuals with chronic pain, but few observational studies have examined how these factors may predict pain medication use at the daily level. METHODS Daily assessments from 104 individuals with back pain were used to examine fluctuations in daily pain intensity, mood, sleep quality, and physical activity as predictors of the likelihood of pain medication (opioid and non-opioid) use and levels of medication use on the same day. RESULTS Pain intensity and mood ratings significantly predicted whether participants used pain medication on the same day, while only pain intensity predicted whether participants used more medication than usual. Further, current opioid users were more likely to increase the amount of their medication use on days of higher pain. DISCUSSION This article identifies fluctuations in daily pain intensity and mood as salient predictors of daily pain medication use in individuals with recurrent back pain. The current study is among the first to highlight both pain and mood states as predictors of daily pain medication use in individuals with back pain, though future studies may expand on these findings through the use of higher-resolution daily medication use variables.
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Affiliation(s)
- John A Sturgeon
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford Systems Neuroscience and Pain Laboratory, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA, USA.
| | - Jennifer M Hah
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford Systems Neuroscience and Pain Laboratory, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA, USA
| | - Yasamin Sharifzadeh
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford Systems Neuroscience and Pain Laboratory, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA, USA
| | - Stephanie K Middleton
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford Systems Neuroscience and Pain Laboratory, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA, USA
| | - Thomas Rico
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford Systems Neuroscience and Pain Laboratory, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA, USA
| | - Kevin A Johnson
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford Systems Neuroscience and Pain Laboratory, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford Systems Neuroscience and Pain Laboratory, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA, USA
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Oberleitner LMS, Lumley MA, Grekin ER, M Z Smith K, Loree AM, Carty JN, Valentino D. Problematic Prescription Opioid Use in a Chronic Pain Treatment Facility: The Role of Emotional Processes. Subst Use Misuse 2019; 54:495-505. [PMID: 30380985 DOI: 10.1080/10826084.2018.1521426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Factors associated with prescription opioid misuse in a chronic pain treatment population are limited, and increasing our understanding of associated factors could lead to improved targeting of prevention and intervention efforts. OBJECTIVE The aim of this study was to evaluate factors associated with problematic prescription opioid use in patients with chronic pain, and whether assessing emotional processes - alexithymia, ambivalence over emotional expression (AEQ), and emotional approach coping - improves understanding of problematic prescription opioid use beyond traditional risk factors. METHODS Participants were 100 patients with chronic pain (mean age = 47.57 years, SD = 11.57; 53% female; 81% African American) who were receiving a self-administered opioid medication through a local pain clinic. We assessed traditional risk factors (substance use history, pain, psychiatric distress, and pain catastrophizing), the three emotional processes, and problematic prescription opioid-related outcomes. RESULTS Zero-order correlations revealed that alexithymia was significantly, positively related to problematic prescription opioid use behaviors (PDUQ), and AEQ was significantly positively related to both prescription opioid misuse behaviors and opioid use disorder symptoms. Multiple regressions that included traditional risk factors and the three emotional processes indicated that AEQ was a unique correlate of problematic opioid use behaviors (β=.27, p=.04) and prescription opioid-related symptoms of abuse and dependence (β=.37, p=.01); history of substance use disorders was also associated. CONCLUSIONS In addition to personal history of substance use problems, AEQ is a modifiable risk factor - and thus potential treatment target - for prescription opioid misuse and opioid use disorders.
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Affiliation(s)
- Lindsay M S Oberleitner
- a Department of Psychology , Wayne State University , New Haven, Michigan , USA.,b Department of Psychiatry , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Mark A Lumley
- a Department of Psychology , Wayne State University , New Haven, Michigan , USA
| | - Emily R Grekin
- a Department of Psychology , Wayne State University , New Haven, Michigan , USA
| | - Kathryn M Z Smith
- a Department of Psychology , Wayne State University , New Haven, Michigan , USA.,c Department of Psychiatry, Division on Substance Abuse , Columbia University Medical Center/New York State Psychiatric Institute , New York , New York , USA
| | - Amy M Loree
- a Department of Psychology , Wayne State University , New Haven, Michigan , USA.,d Henry Ford Health System , Center for Health Services Research , Detroit , Michigan , USA
| | - Jennifer N Carty
- a Department of Psychology , Wayne State University , New Haven, Michigan , USA.,e Department of Family Medicine & Community Health , University of Massachusetts Medical School , Worcester , Massachusetts , USA
| | - Deborah Valentino
- a Department of Psychology , Wayne State University , New Haven, Michigan , USA
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Finan PH, Remeniuk B, Dunn KE. The risk for problematic opioid use in chronic pain: What can we learn from studies of pain and reward? Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:255-262. [PMID: 28778406 PMCID: PMC5821601 DOI: 10.1016/j.pnpbp.2017.07.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 12/22/2022]
Abstract
Problematic prescription opioid use is cited as a primary contributor to the current 'opioid epidemic' in the United States, which is characterized by recent rapid increases in individuals seeking treatment for opioid dependence and staggering rates of opioid overdose deaths. Individuals with chronic pain are commonly prescribed opioids to treat pain, and by this mere exposure are at increased risk for the development of problematic opioid use. However, the factors contributing to variation in risk across patients have only recently begun to be unraveled. In the present review, we describe the recent and expanding literature on interactions between pain and reward system function in an effort to inform our understanding of risk for problematic opioid use in chronic pain. To that end, we describe the limited experimental evidence regarding opioid abuse liability under conditions of pain, and offer suggestions for how to advance a research agenda that better informs clinicians about the factors contributing to opioid addiction risk in patients with chronic pain. We raise mechanistic hypotheses by highlighting the primary conclusions of several recent reviews on the neurobiology of pain and reward, with an emphasis on describing dopamine deficits in chronic pain, the role of the reward system in mediating the affective and motivational components of pain, and the role of opponent reward/anti-reward processes in the perpetuation of pain states and the development of problematic opioid use behaviors. Finally, we also argue that positive affect-which is directly regulated by the mesolimbic reward system-is a key pain inhibitory factor that, when deficient, may increase risk for problematic opioid use, and present a model that integrates the potential contributions of pain, reward system function, and positive affect to problematic opioid use risk.
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Affiliation(s)
- Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, United States.
| | - Bethany Remeniuk
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, United States
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, United States
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Substance-related disorders: A review of prevalence and correlates among patients with chronic pain. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:245-254. [PMID: 28669582 DOI: 10.1016/j.pnpbp.2017.06.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 01/25/2023]
Abstract
Over the past few decades, research has revealed high rates of substance-related disorders among patients with chronic pain. In addition to their potentially deleterious health consequences, substance-related disorders have consistently been associated with negative pain-related outcomes among patients with chronic pain. The goal of this narrative review was to provide an overview of studies that have examined the prevalence and correlates of substance-related disorders among patients with chronic pain. A particular focus was placed on opioids, sedatives/hypnotics, cannabis, tobacco, and alcohol given that these substances have received the bulk of research attention among patients with pain. Research conducted to date suggests that a host of biological and psychological factors are likely to contribute to the elevated rates of substance-related disorders among patients with chronic pain. In this review, in addition to reviewing the prevalence and correlates of substance-related disorders among patients with pain, we briefly discussed the changes that were recently made from the DSM-4 to the DSM-5 in the diagnostic criteria for substance-related disorders, and the implications of these changes for the assessment of patients with chronic pain. We also provided a brief overview of instruments that can be used for the assessment of these disorders in clinical and research settings.
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Black RA, McCaffrey SA, Villapiano AJ, Jamison RN, Butler SF. Development and Validation of an Eight-Item Brief Form of the SOAPP-R (SOAPP-8). PAIN MEDICINE 2018; 19:1982-1987. [PMID: 29024987 DOI: 10.1093/pm/pnx194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Although the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) has become a widely used screener for aberrant opioid-related behavior in adults, the length of the instrument may limit its utility. The purpose of the current study was to develop a short form of the SOAPP-R by retaining as few items as possible while maximizing predictive accuracy. Methods Participants (N = 555), recruited from pain clinics, completed the 24-item SOAPP-R and participated in a five-month follow-up visit to evaluate aberrant drug-related behaviors. Opioid aberrant-related behavior was determined through self-report, physician report, and urine toxicology screen. The optimal subset of SOAPP-R items to predict aberrant opioid-related behavior was identified empirically by employing the LASSO selection method and the leave-one-out cross-validation (LOOCV) method offered in the GLMSELECT procedure in SAS 9.4 in conjunction with content expertise. Results Eight items were identified before the selection method stopped. The receiver operating characteristic curve generated from the predicted probabilities from the model produced an area under the curve (AUC) value greater than the AUC value produced by the 24-item SOAPP-R total score and yielded a sensitivity of 0.74 and a specificity of 0.66. Conclusions These results provide strong preliminary support for the SOAPP-8 as a brief screening tool of aberrant opioid-related behavior in chronic pain patients.
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Affiliation(s)
| | | | | | - Robert N Jamison
- Anesthesia and Psychiatry, Brigham and Women's Hospital, Boston, MA
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Riddle DL, Slover JD, Ang DC, Bair MJ, Kroenke K, Perera RA, Dumenci L. Opioid use prior to knee arthroplasty in patients who catastrophize about their pain: preoperative data from a multisite randomized clinical trial. J Pain Res 2018; 11:1549-1557. [PMID: 30174454 PMCID: PMC6109658 DOI: 10.2147/jpr.s168251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Opioid use rates prior to knee arthroplasty (KA) among people who catastrophize about their pain are unknown. We determined prevalence of opioid use and compared patterns of preoperative opioid use and oral morphine equivalent (OME), a measure of daily opioid dose, across varied geographic sites. We also determined which baseline variables were associated with opioid use and OME. Patients and methods Preoperative opioid use data described type of opioid, dosage, and frequency among 397 patients scheduled for KA. Demographic, knee-related pain, and psychological distress dimensions were examined to identify variables associated with opioid use and opioid dose (OME). Opioid use prevalence and OME were compared across the four sites. A three-level censored regression determined variables associated with opioid use and OME. Results The overall opioid use prevalence was 31.7% (95% confidence interval [CI] = 27.0, 36.3) and varied across sites from 15.9% (95% CI = 9.0, 22.8) to 51.2% (95% CI = 40.5, 61.9). After adjustment, patients using opioids were more likely to be younger, African American, and have higher self-efficacy and comorbidity scores (P < 0.05). The only variable independently associated with OME was lower depressive symptoms (P < 0.05). Conclusion People who catastrophized prior to KA did not demonstrate increased preoperative opioid use based on current evidence, but variation in the prevalence of opioid use across study sites was substantial. Variables associated with opioid use were non-modifiable demographic and comorbidity variables.
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Affiliation(s)
- Daniel L Riddle
- Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Virginia Commonwealth University, Richmond, VA, USA,
| | - James D Slover
- Department of Orthopaedic Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Dennis C Ang
- Department of Rheumatology, Wake Forest University School of Medicine, Raleigh, NC, USA
| | - Matthew J Bair
- Department of Medicine, VA Center for Health Information and Communication, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Levent Dumenci
- College of Public Health, Temple University, Philadelphia, PA, USA
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Dash GF, Wilson AC, Morasco BJ, Feldstein Ewing SW. A Model of the Intersection of Pain and Opioid Misuse in Children and Adolescents. Clin Psychol Sci 2018; 6:629-646. [PMID: 30333942 PMCID: PMC6186448 DOI: 10.1177/2167702618773323] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Despite being a significant public health concern, the role of opioid prescriptions in potentiating risk of opioid misuse in the context of pediatric pain has been under-investigated. To address this gap, the present review identifies theory-based hypotheses about these associations, reviews the extant literature on opioid prescriptions that supports these hypotheses, and provides routes for future empirical studies. A multi-level model of mechanisms through which opioid prescriptions may impact pain and other negative outcomes in youth, including risk for opioid misuse and related problems, is proposed with particular attention paid to the role that psychologists can play in informing policies and developing preventative interventions in healthcare settings.
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Affiliation(s)
- Genevieve F. Dash
- Department of Psychological Sciences, University of Missouri, Columbia, MO USA
| | - Anna C. Wilson
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Portland, OR USA
| | - Benjamin J. Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Department of Psychiatry, Oregon Health & Science University, Portland, OR USA
| | - Sarah W. Feldstein Ewing
- Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR USA
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Abstract
Opioid-related overdose deaths have reached epidemic levels within the last decade. The efforts to prevent, identify, and treat opioid use disorders (OUDs) mostly focus on the outpatient setting. Despite their frequent overrepresentation, less is known about the inpatient management of patients with OUDs. Specifically, the perioperative phase is a very vulnerable time for patients with OUDs, and little has been studied on the optimal management of acute pain in these patients. The preoperative evaluation should aim to identify those with OUDs and assess factors that may interfere with OUD treatment and pain management. Efforts should be made to provide education and assistance to patients and their support systems. For those who are actively struggling with opioid use, the perioperative phase can be an opportunity for engagement and to initiate treatment. Buprenorphine, methadone, and naltrexone medication treatment for OUD and opioid tolerance complicate perioperative pain management. A multidisciplinary team approach is crucial to provide clinically balanced pain relief without jeopardizing the patient's recovery. This article reviews the existing literature on the perioperative management of patients with OUDs and provides clinical suggestions for the optimal care of this patient population.
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Affiliation(s)
- Emine Nalan Ward
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Aurora Naa-Afoley Quaye
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Timothy E. Wilens
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Riquino MR, Priddy SE, Howard MO, Garland EL. Emotion dysregulation as a transdiagnostic mechanism of opioid misuse and suicidality among chronic pain patients. Borderline Personal Disord Emot Dysregul 2018; 5:11. [PMID: 29992025 PMCID: PMC5989346 DOI: 10.1186/s40479-018-0088-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/17/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Chronic pain is a prevalent condition that causes functional impairment and emotional suffering. To allay pain-induced suffering, opioids are often prescribed for chronic pain management. Yet, chronic pain patients on opioid therapy are at heightened risk for opioid misuse-behaviors that can lead to addiction and overdose. Relatedly, chronic pain patients are at elevated risk for suicidal ideation and suicidal behaviors. MAIN BODY Opioid misuse and suicidality are maladaptive processes aimed at alleviating the negative emotional hyperreactivity, hedonic hyporeactivity, and emotion dysregulation experienced by chronic pain patients on opioid therapy. In this review, we explore the role of emotion dysregulation in chronic pain. We then describe why emotionally dysregulated chronic pain patients are vulnerable to opioid misuse and suicidality in response to these negative affective states. CONCLUSION Emotion dysregulation is an important and malleable treatment target with the potential to reduce or prevent opioid misuse and suicidality among opioid-treated chronic pain patients.
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Affiliation(s)
- Michael R. Riquino
- University of Utah College of Social Work, 395 South 1500 East, Salt Lake City, UT 84112 USA
- Center on Mindfulness and Integrative Health Intervention Development, 395 South 1500 East, Salt Lake City, UT 84112 USA
| | - Sarah E. Priddy
- University of Utah College of Social Work, 395 South 1500 East, Salt Lake City, UT 84112 USA
- Center on Mindfulness and Integrative Health Intervention Development, 395 South 1500 East, Salt Lake City, UT 84112 USA
| | - Matthew O. Howard
- University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, Chapel Hill, NC 25799 USA
| | - Eric L. Garland
- University of Utah College of Social Work, 395 South 1500 East, Salt Lake City, UT 84112 USA
- Center on Mindfulness and Integrative Health Intervention Development, 395 South 1500 East, Salt Lake City, UT 84112 USA
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Adachi T, Nakae A, Maruo T, Shi K, Maeda L, Saitoh Y, Shibata M, Sasaki J. The Relationships Between Pain-Catastrophizing Subcomponents and Multiple Pain-Related Outcomes in Japanese Outpatients with Chronic Pain: A Cross-Sectional Study. Pain Pract 2018; 19:27-36. [PMID: 29772106 DOI: 10.1111/papr.12712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/09/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The present study sought to examine associations between the pain-catastrophizing subcomponents and multiple pain-related outcomes in Japanese individuals with chronic pain. METHODS A cross-sectional study design was employed with 213 chronic pain outpatients. The participants were recruited from 3 units at a university hospital and from a pain clinic at a municipal hospital. Study measures were used to assess pain catastrophizing, anxiety, depression, pain interference, and pain severity. RESULTS Path analysis with multiple pain-related outcomes while controlling for age and gender revealed that the Helplessness subcomponent was associated with anxiety, depression, pain interference, and pain severity. The Magnification subcomponent was related to anxiety and depression, and the Rumination subcomponent accounted for the variance of pain interference. DISCUSSION The present results suggested the important role of helplessness across cultural backgrounds. It also provides guidance on the application of cognitive behavioral techniques for chronic pain management in Japan.
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Affiliation(s)
- Tomonori Adachi
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
- Japan Society for the Promotion of Science, Chiyoda, Tokyo, Japan
- Center for Pain Management, Osaka University Medical Hospital, Suita, Osaka, Japan
| | - Aya Nakae
- Immunology Frontier Research Center, Osaka University, Suita, Osaka, Japan
| | - Tomoyuki Maruo
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Neurosurgery, Otemae Hospital, Osaka, Japan
| | - Kenrin Shi
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Lynn Maeda
- Department of Anesthesia and Pain Management, Nishinomiya Municipal Central Hospital, Nishinomiya, Hyogo, Japan
| | - Youichi Saitoh
- Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masahiko Shibata
- Department of Pain Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Jun Sasaki
- Department of Human Sciences, Osaka University Graduate School of Human Sciences, Suita, Osaka, Japan
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Darnall BD, Ziadni MS, Roy A, Kao MC, Sturgeon JA, Cook KF, Lorig K, Burns JW, Mackey SC. Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology Class in Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial. Trials 2018; 19:165. [PMID: 29510735 PMCID: PMC5838852 DOI: 10.1186/s13063-018-2537-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/08/2018] [Indexed: 01/07/2023] Open
Abstract
Background The Institute of Medicine (IOM) reported that chronic pain affects about 100 million U.S. adults, with chronic low back pain (CLBP) cited as the most prevalent type. Pain catastrophizing is a psychological construct shown to predict the development and trajectory of chronic pain and patient response to pain treatments. While effective treatment for pain catastrophizing typically includes eight-session groups of cognitive behavioral therapy (CBT), a single-session targeted treatment class yielded promising results which, if replicated and extended, could prove to efficiently and cost-effectively reduce pain catastrophizing. In this trial, we seek to determine the comparative efficacy of this novel single-session pain catastrophizing class to an eight-session course of pain CBT and a single-session back pain health education class. We will also explore the psychosocial mechanisms and outcomes of pain catastrophizing treatment. Methods In this trial we will randomize 231 individuals with CLBP to one of three treatment arms: (1) pain-CBT (eight weekly 2-h group sessions with home exercises and readings); (2) a single 2-h pain catastrophizing class; or (3) a single 2-h back pain health education class (active control). For the primary outcome of pain catastrophizing, the trial is designed as a non-inferiority test between pain-CBT and the single-session pain catastrophizing class, and as a superiority test between the single-session pain catastrophizing class and the health education class. Team researchers masked to treatment assignment will assess outcomes up to six months post treatment. Discussion If the single-session targeted pain catastrophizing class is found to be an effective treatment for patients with CLBP, this low cost and low burden treatment could dismantle many of the current barriers and burdens of effective pain care. Further, elucidation of the mechanisms of pain catastrophizing treatments will facilitate future research on the topic as well as further development and refinement of treatments. Trial registration ClinicalTrials.gov, NCT03167086. Registered on 22 May 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2537-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA.
| | - Maisa S Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - Anuradha Roy
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - Ming-Chih Kao
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - John A Sturgeon
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - Karon F Cook
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Kate Lorig
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - John W Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
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Rogers AH, Bakhshaie J, Lam H, Langdon KJ, Ditre JW, Zvolensky MJ. Pain-related anxiety and opioid misuse in a racially/ethnically diverse young adult sample with moderate/severe pain. Cogn Behav Ther 2018; 47:372-382. [PMID: 29482460 DOI: 10.1080/16506073.2018.1436085] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Pain problems are of significant public health concern, and with opioid-related problems and death due to overdose at an all-time high, there is significant public health importance to identify risk factors that link instances of pain to opioid misuse among persons with pain whether or not they have been prescribed opioids for pain management. Severe pain and pain-related problems have been associated with increased risk for opioid misuse, and recent research indicates that pain-related anxiety (worry about the negative consequences of pain) may contribute to a more debilitating pain experience. Additionally, pain-related anxiety has previously been linked to substance use motives and dependence for cannabis and tobacco. However, little research has examined pain-related anxiety as a transdiagnostic risk factor for opioid misuse. The current study examined the relationship between pain-related anxiety and self-reported opioid misuse (addiction, prescription denial, family concerns, detox) in a racially/ethnically diverse sample of young adults (N = 256, M age = 22.84) reporting moderate to severe bodily pain over the previous four weeks. Results indicated that pain-related anxiety was significantly related to several indicators of opioid misuse as well as an increased number of opioid-related problems. Findings from the current study suggest that targeting pain-related anxiety may be one therapeutic strategy to reduce opioid misuse.
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Affiliation(s)
- Andrew H Rogers
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Jafar Bakhshaie
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Hantin Lam
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Kirsten J Langdon
- b Department of Psychiatry , Rhode Island Hospital , Providence , RI , USA.,c Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University , Providence , RI , USA
| | - Joseph W Ditre
- d Department of Psychology , Syracuse University , Syracuse , NY , USA
| | - Michael J Zvolensky
- a Department of Psychology , University of Houston , Houston , TX , USA.,e Department of Behavioral Sciences , University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Finan PH, Carroll CP, Moscou-Jackson G, Martel MO, Campbell CM, Pressman A, Smyth JM, Tremblay JM, Lanzkron SM, Haythornthwaite JA. Daily Opioid Use Fluctuates as a Function of Pain, Catastrophizing, and Affect in Patients With Sickle Cell Disease: An Electronic Daily Diary Analysis. THE JOURNAL OF PAIN 2018; 19:46-56. [PMID: 28943232 PMCID: PMC5820769 DOI: 10.1016/j.jpain.2017.08.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/23/2017] [Accepted: 08/31/2017] [Indexed: 11/25/2022]
Abstract
Chronic opioid therapy is a common treatment regimen for patients with sickle cell disease (SCD), a chronically painful recessive hemoglobinopathy. The collective risk profile of chronic opioid therapy necessitates an understanding of which pain-related factors, such as affect and pain catastrophizing, are associated with the ebbs and flows of opioid use in daily life, a topic that has received very little attention among patients with any type of chronically painful condition, including SCD. We therefore investigated the variability of day-to-day patterns of short- and long-acting opioid use and their associations with pain and pain-related cognitive and affective processes in daily life among patients with SCD using a nightly electronic diary (N = 45). Opioid use was self-reported and converted into oral morphine equivalents for analysis, which was conducted with mixed effects modeling. Results indicated that greater pain and pain catastrophizing were associated with greater use of short-acting opioids, and negative affect was associated with greater use of long-acting opioids. Additionally, the association of pain and short-acting opioid use was moderated by pain catastrophizing, showing that opioid use was elevated when patients catastrophized about their pain, even if they reported low levels of pain. These findings suggest that monitoring pain-related cognitive and affective variables may be a useful approach to understanding risk for problematic opioid use in patients with daily pain. PERSPECTIVE The present study shows that pain and pain-related cognitive and affective variables are associated with daily variation in prescription opioid use in SCD. The findings may have broad implications for tracking and defining risk for prescription opioid misuse in patients with daily pain.
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Affiliation(s)
- Patrick H Finan
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
| | - C Patrick Carroll
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Gyasi Moscou-Jackson
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Marc O Martel
- Faculty of Dentistry, McGill University, Quebec, Canada
| | - Claudia M Campbell
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Alex Pressman
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Joshua M Smyth
- Department of Biobehavioral Health, Pennsylvania State University, State College, Pennsylvania
| | - Jean-Michel Tremblay
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Sophie M Lanzkron
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland
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McCaffrey SA, Black RA, Villapiano AJ, Jamison RN, Butler SF. Development of a Brief Version of the Current Opioid Misuse Measure (COMM): The COMM-9. PAIN MEDICINE 2017; 20:113-118. [DOI: 10.1093/pm/pnx311] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Ryan A Black
- Inflexxion Inc., Waltham, Massachusetts
- Nova Southeastern University, College of Psychology, Fort Lauderdale, Florida
| | | | - Robert N Jamison
- Anesthesia and Psychiatry, Brigham and Women’s Hospital Harvard Medical Center, Pain Management Center, Chestnut Hill, Massachusetts, USA
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Hooten WM, Brummett CM, Sullivan MD, Goesling J, Tilburt JC, Merlin JS, St Sauver JL, Wasan AD, Clauw DJ, Warner DO. A Conceptual Framework for Understanding Unintended Prolonged Opioid Use. Mayo Clin Proc 2017; 92:1822-1830. [PMID: 29108841 DOI: 10.1016/j.mayocp.2017.10.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/22/2017] [Accepted: 10/09/2017] [Indexed: 12/12/2022]
Abstract
An urgent need exists to better understand the transition from short-term opioid use to unintended prolonged opioid use (UPOU). The purpose of this work is to propose a conceptual framework for understanding UPOU that posits the influence of 3 principal domains that include the characteristics of (1) individual patients, (2) the practice environment, and (3) opioid prescribers. Although no standardized method exists for developing a conceptual framework, the process often involves identifying corroborative evidence, leveraging expert opinion to identify factors for inclusion in the framework, and developing a graphic depiction of the relationships between the various factors and the clinical problem of interest. Key patient characteristics potentially associated with UPOU include (1) medical and mental health conditions; (2) pain etiology; (3) individual affective, behavioral, and neurophysiologic reactions to pain and opioids; and (4) sociodemographic factors. Also, UPOU could be influenced by structural and health care policy factors: (1) the practice environment, including the roles of prescribing clinicians, adoption of relevant practice guidelines, and clinician incentives or disincentives, and (2) the regulatory environment. Finally, characteristics inherent to clinicians that could influence prescribing practices include (1) training in pain management and opioid use; (2) personal attitudes, knowledge, and beliefs regarding the risks and benefits of opioids; and (3) professionalism. As the gatekeeper to opioid access, the behavior of prescribing clinicians directly mediates UPOU, with the 3 domains interacting to determine this behavior. This proposed conceptual framework could guide future research on the topic and allow plausible hypothesis-based interventions to reduce UPOU.
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Affiliation(s)
- W Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN.
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Jenna Goesling
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Jon C Tilburt
- Department of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Jessica S Merlin
- Division of Infectious Diseases, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
| | - Jennifer L St Sauver
- Division of Epidemiology, Department of Health Science Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Ajay D Wasan
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN
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Pratt NL, Roughead EE. Can we reduce the prevalence of persistent opioid use after surgery by predicting the future? Anaesth Intensive Care 2017; 45:658-659. [PMID: 29137573 DOI: 10.1177/0310057x1704500602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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76
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Elsesser K, Cegla T. Long-term treatment in chronic noncancer pain: Results of an observational study comparing opioid and nonopioid therapy. Scand J Pain 2017; 17:87-98. [DOI: 10.1016/j.sjpain.2017.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 12/17/2022]
Abstract
Abstract
Background and aims
Recent studies reveal high prevalence rates of patients receiving long-term opioids. However, well designed studies assessing effectiveness with longer than 3 months follow-up are sparse. The present study investigated the outcomes of long-term opioid therapy compared to nonopioid treatment in CNCP patients with respect to measures of pain, functional disability, psychological wellbeing, and quality of life (QoL).
Methods
Three hundred and thirty three consecutive patients at our pain clinic were included and divided into patients with continuous opioid treatment for at least 3 months (51%) and patients receiving nonopioid analgesics (49%). Further, outcome of different doses of opioid (<120 mg vs. >120 mg morphine equivalents) and differences between high and low potency opioids were examined.
Results
The opioid and nonopioid groups did not differ with regard to pain intensity or satisfaction with analgesic. Patients with continuous opioids treatment reported higher neuropathic like pain, longer duration of pain disorder, lower functional level, wellbeing, and physical QoL in comparison to patients receiving nonopioid analgesics. Higher opioid doses were associated with male gender, intake of high potency opioids and depression but there were no differences with regard to pain relief or improvement of functional level between high and low doses. Similarly, patients on high potency opioids reported more psychological impairment than patients on low potency opioids but no advantage with regard to pain relief. Overall, remaining level of pain, functional disability and poor QoL were quite high irrespective of the analgesic used or opioid dosing.
Conclusions
In the long-term no clear advantage of opioid vs. non-opioid analgesics could be revealed. In terms of remaining pain intensity, functional disability and quality of life, treatment with pain medication proved insufficient. Additionally, with higher doses of opioids the benefit to risk relationship becomes worse and patients on high potency opioids reported more psychological impairment than patients on low potency opioids but no advantage with regard to pain relief.
Implications
Our results raise questions about the long-term effectiveness of analgesic treatment regimens irrespective of analgesics type employed and call for more multidisciplinary treatment strategies.
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Affiliation(s)
- Karin Elsesser
- Sankt Josef Krankenhaus , Clinic of Pain Medicine, Bergstr , 6-12, 42105 Wuppertal , Germany
| | - Thomas Cegla
- Sankt Josef Krankenhaus , Clinic of Pain Medicine, Bergstr , 6-12, 42105 Wuppertal , Germany
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Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription: Nonlinear Sex Differences Revealed Using a Learning Health System. Anesthesiology 2017; 127:136-146. [PMID: 28614083 DOI: 10.1097/aln.0000000000001656] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pain catastrophizing is a maladaptive response to pain that amplifies chronic pain intensity and distress. Few studies have examined how pain catastrophizing relates to opioid prescription in outpatients with chronic pain. METHODS The authors conducted a retrospective observational study of the relationships between opioid prescription, pain intensity, and pain catastrophizing in 1,794 adults (1,129 women; 63%) presenting for new evaluation at a large tertiary care pain treatment center. Data were sourced primarily from an open-source, learning health system and pain registry and secondarily from manual review of electronic medical records. A binary opioid prescription variable (yes/no) constituted the dependent variable; independent variables were age, sex, pain intensity, pain catastrophizing, depression, and anxiety. RESULTS Most patients were prescribed at least one opioid medication (57%; n = 1,020). A significant interaction and main effects of pain intensity and pain catastrophizing on opioid prescription were noted (P < 0.04). Additive modeling revealed sex differences in the relationship between pain catastrophizing, pain intensity, and opioid prescription, such that opioid prescription became more common at lower levels of pain catastrophizing for women than for men. CONCLUSIONS Results supported the conclusion that pain catastrophizing and sex moderate the relationship between pain intensity and opioid prescription. Although men and women patients had similar Pain Catastrophizing Scale scores, historically "subthreshold" levels of pain catastrophizing were significantly associated with opioid prescription only for women patients. These findings suggest that pain intensity and catastrophizing contribute to different patterns of opioid prescription for men and women patients, highlighting a potential need for examination and intervention in future studies.
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Hah JM, Sturgeon JA, Zocca J, Sharifzadeh Y, Mackey SC. Factors associated with prescription opioid misuse in a cross-sectional cohort of patients with chronic non-cancer pain. J Pain Res 2017; 10:979-987. [PMID: 28496354 PMCID: PMC5422534 DOI: 10.2147/jpr.s131979] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To examine demographic features, psychosocial characteristics, pain-specific behavioral factors, substance abuse history, sleep, and indicators of overall physical function as predictors of opioid misuse in patients presenting for new patient evaluation at a tertiary pain clinic. METHODS Overall, 625 patients with chronic non-cancer pain prospectively completed the Collaborative Health Outcomes Information Registry, assessing pain catastrophizing, National Institutes of Health Patient-Reported Outcomes Measurement Information System standardized measures (pain intensity, pain behavior, pain interference, physical function, sleep disturbance, sleep-related impairment, anger, depression, anxiety, and fatigue), and substance use history. Additional information regarding current opioid prescriptions and opioid misuse was examined through retrospective chart review. RESULTS In all, 41 (6.6%) patients presented with some indication of prescription opioid misuse. In the final multivariable logistic regression model, those with a history of illicit drug use (odds ratio [OR] 5.45, 95% confidence interval [CI] 2.48-11.98, p<0.0001) and a current opioid prescription (OR 4.06, 95% CI 1.62-10.18, p=0.003) were at elevated risk for opioid misuse. Conversely, every 1-h increase in average hours of nightly sleep decreased the risk of opioid misuse by 20% (OR 0.80, 95% CI 0.66-0.97, p=0.02). CONCLUSION These findings indicate the importance of considering substance use history, current opioid prescriptions, and sleep in universal screening of patients with chronic non-cancer pain for opioid misuse. Future work should target longitudinal studies to verify the causal relationships between these variables and subsequent opioid misuse.
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Affiliation(s)
| | | | - Jennifer Zocca
- Department of Anesthesiology, Perioperative, and Pain Medicine
| | - Yasamin Sharifzadeh
- Stanford Systems Neuroscience and Pain Lab, Stanford University, Palo Alto, CA, USA
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Lazaridou A, Franceschelli O, Buliteanu A, Cornelius M, Edwards RR, Jamison RN. Influence of catastrophizing on pain intensity, disability, side effects, and opioid misuse among pain patients in primary care. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/jabr.12081] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Asimina Lazaridou
- Pain Management Center; Brigham and Women's Hospital; Harvard Medical School; Chestnut Hill MA USA
| | - Olivia Franceschelli
- Pain Management Center; Brigham and Women's Hospital; Harvard Medical School; Chestnut Hill MA USA
| | - Alexandra Buliteanu
- Pain Management Center; Brigham and Women's Hospital; Harvard Medical School; Chestnut Hill MA USA
| | - Marise Cornelius
- Pain Management Center; Brigham and Women's Hospital; Harvard Medical School; Chestnut Hill MA USA
| | - Robert R. Edwards
- Pain Management Center; Brigham and Women's Hospital; Harvard Medical School; Chestnut Hill MA USA
| | - Robert N. Jamison
- Pain Management Center; Brigham and Women's Hospital; Harvard Medical School; Chestnut Hill MA USA
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Arteta J, Cobos B, Hu Y, Jordan K, Howard K. Evaluation of How Depression and Anxiety Mediate the Relationship Between Pain Catastrophizing and Prescription Opioid Misuse in a Chronic Pain Population. PAIN MEDICINE 2017; 17:295-303. [PMID: 26235471 DOI: 10.1111/pme.12886] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE We investigated the extent to which anxiety and depression mediate the relationship between pain catastrophizing and the risk of prescription opioid misuse in chronic pain patients. METHODS 215 patients with chronic occupational musculoskeletal disorders completed self-report measures upon admission to a functional restorational program. A bootstrap multivariate regression analysis was conducted to assess how depression and anxiety mediated the relationship between pain catastrophizing and prescription opioid misuse. RESULTS Catastrophizing, anxiety, and depression predicted higher risk for prescription opioid misuse. Furthermore, anxiety and depression acted as mediators while controlling for the effects of gender and age. Finally, it was found that the effects of catastrophizing on risk for prescription opioid misuse were completely eliminated by those of depression. CONCLUSION Due to the partially independent relationship of anxiety and catastrophizing, it is recommended that treatments for chronic pain patients employ techniques addressing both behaviors. The relationship between depression and catastrophizing requires more research since it was observed that their effects were confounded.
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81
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Chang YP, Compton P. Opioid Misuse/Abuse and Quality Persistent Pain Management in Older Adults. J Gerontol Nurs 2016; 42:21-30. [DOI: 10.3928/00989134-20161110-06] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/27/2016] [Indexed: 01/04/2023]
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Andrews NE, Strong J, Meredith PJ, Fleming JA. The relationship between overactivity and opioid use in chronic pain: a 5-day observational study. Pain 2016; 157:466-474. [PMID: 26458090 DOI: 10.1097/j.pain.0000000000000384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
With increasing concerns about the potential harm of long-term opioid therapy, there is a need for the development and implementation of alternative treatment strategies for patients with chronic pain who have been using opioids for a prolonged period of time. Based on the findings from a recent qualitative investigation that suggested there may be a bidirectional association between opioid reliance and habitual overactivity behaviour (activity engagement that significantly exacerbates pain), this study was designed to quantitatively investigate the association between opioid use and habitual overactivity over a 5-day period in a group of chronic pain patients. Participants provided a list of their prescribed pain medication, completed a self-report measure of habitual overactivity, and then commenced 5 days of data collection. Data collection required participants to wear an activity monitor and to complete a diary that detailed their daily activities and the time at which they took medication. Individuals reporting higher levels of habitual overactivity were more likely to be prescribed opioids. In addition, higher levels of habitual overactivity were associated with more frequent pro re nata ("as needed") opioid use over the 5 days, and with a discrepancy between the prescribed and actual oral morphine-equivalent daily dose, where more medication was taken than was prescribed. There was no predominant context for pro re nata use. The results of this study support the idea that habitual overactivity behaviour may play a role in the development of reliance on opioid medication and that such an association may provide a potential treatment target for opioid therapy rationalisation.
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Affiliation(s)
- Nicole Emma Andrews
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia Department of Occupational Therapy, The Royal Brisbane and Women's Hospital, Queensland, Australia The Professor Tess Cramond Multidisciplinary Pain Centre, The Royal Brisbane and Women's Hospital, Queensland, Australia
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83
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Edwards RR, Dworkin RH, Sullivan MD, Turk DC, Wasan AD. The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain. THE JOURNAL OF PAIN 2016; 17:T70-92. [PMID: 27586832 PMCID: PMC5012303 DOI: 10.1016/j.jpain.2016.01.001] [Citation(s) in RCA: 476] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/07/2015] [Accepted: 01/05/2016] [Indexed: 12/14/2022]
Abstract
UNLABELLED The recently proposed Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION)-American Pain Society (APS) Pain Taxonomy (AAPT) provides an evidence-based, multidimensional, chronic pain classification system. Psychosocial factors play a crucial role within several dimensions of the taxonomy. In this article, we discuss the evaluation of psychosocial factors that influence the diagnosis and trajectory of chronic pain disorders. We review studies in individuals with a variety of persistent pain conditions, and describe evidence that psychosocial variables play key roles in conferring risk for the development of pain, in shaping long-term pain-related adjustment, and in modulating pain treatment outcomes. We consider "general" psychosocial variables such as negative affect, childhood trauma, and social support, as well as "pain-specific" psychosocial variables that include pain-related catastrophizing, self-efficacy for managing pain, and pain-related coping. Collectively, the complexity and profound variability in chronic pain highlights the need to better understand the multidimensional array of interacting forces that determine the trajectory of chronic pain conditions. PERSPECTIVE The AAPT is an evidence-based chronic pain classification system in which psychosocial concepts and processes are essential in understanding the development of chronic pain and its effects. In this article we review psychosocial processes that influence the onset, exacerbation, and maintenance of chronic pain disorders.
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Affiliation(s)
- Robert R Edwards
- Department of Anesthesiology, Brigham & Women's Hospital and Harvard University, Boston, Massachusetts.
| | - Robert H Dworkin
- Departments of Anesthesiology and Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Ajay D Wasan
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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84
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Brailo V, Firić M, Vučićević Boras V, Andabak Rogulj A, Krstevski I, Alajbeg I. Impact of reassurance on pain perception in patients with primary burning mouth syndrome. Oral Dis 2016; 22:512-6. [DOI: 10.1111/odi.12493] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/30/2016] [Accepted: 04/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- V Brailo
- Department of Oral Medicine; School of Dental Medicine; University of Zagreb; Zagreb Croatia
| | - M Firić
- Department of Oral Medicine; School of Dental Medicine; University of Zagreb; Zagreb Croatia
| | - V Vučićević Boras
- Department of Oral Medicine; School of Dental Medicine; University of Zagreb; Zagreb Croatia
| | - A Andabak Rogulj
- Department of Oral Medicine; School of Dental Medicine; University of Zagreb; Zagreb Croatia
| | - I Krstevski
- Department of Oral Medicine; School of Dental Medicine; University of Zagreb; Zagreb Croatia
| | - I Alajbeg
- Department of Oral Medicine; School of Dental Medicine; University of Zagreb; Zagreb Croatia
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85
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Mudumbai SC, Oliva EM, Lewis ET, Trafton J, Posner D, Mariano ER, Stafford RS, Wagner T, Clark JD. Time-to-Cessation of Postoperative Opioids: A Population-Level Analysis of the Veterans Affairs Health Care System. PAIN MEDICINE 2016; 17:1732-43. [DOI: 10.1093/pm/pnw015] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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McHugh RK, Weiss RD, Cornelius M, Martel MO, Jamison RN, Edwards RR. Distress Intolerance and Prescription Opioid Misuse Among Patients With Chronic Pain. THE JOURNAL OF PAIN 2016; 17:806-14. [PMID: 27058161 DOI: 10.1016/j.jpain.2016.03.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/23/2016] [Accepted: 03/18/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED The risk for misuse of opioid medications is a significant challenge in the management of chronic pain. The identification of those who may be at greater risk for misusing opioids is needed to facilitate closer monitoring of high-risk subgroups, and may help to identify therapeutic targets for mitigating this risk. The aim of this study was to examine whether distress intolerance-the perceived or actual inability to manage negative emotional and somatic states-was associated with opioid misuse in those with chronic pain. A sample of 51 participants prescribed opioid analgesics for chronic back or neck pain were recruited for a 1-time laboratory study. Participants completed measures of distress intolerance and opioid misuse, and a quantitative sensory testing battery. Results suggested that distress intolerance was associated with opioid misuse, even controlling for pain severity and negative affect. Distress intolerance was not associated with pain severity, threshold, or tolerance, but was associated with self-reported anxiety and stress after noxious stimuli. This study found robust differences in distress intolerance between adults with chronic pain with and without opioid medication misuse. Distress intolerance may be a relevant marker of risk for opioid misuse among those with chronic pain. PERSPECTIVE This study demonstrated that distress intolerance was associated with opioid misuse in adults with chronic pain who were prescribed opioids. Distress intolerance can be modified with treatment, and thus may be relevant not only for identification of risk for opioid misuse, but also for mitigation of this risk.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Marise Cornelius
- Pain Management Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts
| | - Marc O Martel
- Pain Management Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts; Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts
| | - Robert N Jamison
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Pain Management Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts; Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts
| | - Robert R Edwards
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Pain Management Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts; Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts
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87
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Darnall BD. Pain Psychology and Pain Catastrophizing in the Perioperative Setting: A Review of Impacts, Interventions, and Unmet Needs. Hand Clin 2016; 32:33-9. [PMID: 26611387 PMCID: PMC4662774 DOI: 10.1016/j.hcl.2015.08.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article provides a brief overview of the literature on perioperative pain psychology in terms of relevant factors and treatments. Where possible, the content emphasizes hand surgery or hand trauma populations, although this literature is notably limited, as well as the relevant musculoskeletal surgery literature. In addition, gaps in understanding and patient care are identified and discussed.
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Affiliation(s)
- Beth D. Darnall
- Clinical Associate Professor, Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory
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88
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Psychiatric Comorbidity Is Associated Prospectively with Diminished Opioid Analgesia and Increased Opioid Misuse in Patients with Chronic Low Back Pain. Anesthesiology 2015; 123:861-72. [PMID: 26375824 DOI: 10.1097/aln.0000000000000768] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioids are frequently prescribed for chronic low back pain (CLBP), but there are little prospective data on which patient subgroups may benefit. Psychiatric comorbidity, such as high levels of depression and anxiety symptoms (termed comorbid negative affect [NA]), is a common presentation and may predict diminished opioid analgesia and/or increased opioid misuse. METHODS The authors conducted a 6½-month prospective cohort study of oral opioid therapy, with an active drug/placebo run-in period, in 81 CLBP patients with low, moderate, and high levels of NA. Treatment included an opioid titration phase with a prescribing physician blinded to NA group assignment and a 4-month continuation phase, during which subjects recorded daily pain levels using an electronic diary. The primary outcome was the percent improvement in average daily pain, summarized weekly. RESULTS There was an overall 25% dropout rate. Despite the high NA group being prescribed a higher average daily dose of morphine equivalents, linear mixed model analysis revealed that the 24 study completers in each of the high NA and low NA groups had an average 21 versus 39% improvement in pain, respectively (P < 0.01). The high NA group also had a significantly greater rate of opioid misuse (39 vs. 8%, P < 0.05) and significantly more and intense opioid side effects (P < 0.01). CONCLUSIONS These results indicate that the benefit and risk considerations in CLBP patients with high NA versus low NA are distinctly different. Thus, NA is an important phenotypic variable to characterize at baseline, before deciding whether to prescribe opioids for CLBP.
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89
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Expectancies Mediate the Relations Among Pain Catastrophizing, Fear of Movement, and Return to Work Outcomes After Whiplash Injury. THE JOURNAL OF PAIN 2015; 16:1280-1287. [DOI: 10.1016/j.jpain.2015.09.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/27/2015] [Accepted: 09/06/2015] [Indexed: 11/16/2022]
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Katz J, Weinrib A, Fashler SR, Katznelzon R, Shah BR, Ladak SS, Jiang J, Li Q, McMillan K, Santa Mina D, Wentlandt K, McRae K, Tamir D, Lyn S, de Perrot M, Rao V, Grant D, Roche-Nagle G, Cleary SP, Hofer SO, Gilbert R, Wijeysundera D, Ritvo P, Janmohamed T, O'Leary G, Clarke H. The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain. J Pain Res 2015; 8:695-702. [PMID: 26508886 PMCID: PMC4610888 DOI: 10.2147/jpr.s91924] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chronic postsurgical pain (CPSP), an often unanticipated result of necessary and even life-saving procedures, develops in 5-10% of patients one-year after major surgery. Substantial advances have been made in identifying patients at elevated risk of developing CPSP based on perioperative pain, opioid use, and negative affect, including depression, anxiety, pain catastrophizing, and posttraumatic stress disorder-like symptoms. The Transitional Pain Service (TPS) at Toronto General Hospital (TGH) is the first to comprehensively address the problem of CPSP at three stages: 1) preoperatively, 2) postoperatively in hospital, and 3) postoperatively in an outpatient setting for up to 6 months after surgery. Patients at high risk for CPSP are identified early and offered coordinated and comprehensive care by the multidisciplinary team consisting of pain physicians, advanced practice nurses, psychologists, and physiotherapists. Access to expert intervention through the Transitional Pain Service bypasses typically long wait times for surgical patients to be referred and seen in chronic pain clinics. This affords the opportunity to impact patients' pain trajectories, preventing the transition from acute to chronic pain, and reducing suffering, disability, and health care costs. In this report, we describe the workings of the Transitional Pain Service at Toronto General Hospital, including the clinical algorithm used to identify patients, and clinical services offered to patients as they transition through the stages of surgical recovery. We describe the role of the psychological treatment, which draws on innovations in Acceptance and Commitment Therapy that allow for brief and effective behavioral interventions to be applied transdiagnostically and preventatively. Finally, we describe our vision for future growth.
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Affiliation(s)
- Joel Katz
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Psychology, York University, Toronto, ON, Canada ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Aliza Weinrib
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Psychology, York University, Toronto, ON, Canada
| | | | - Rita Katznelzon
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Bansi R Shah
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Salima Sj Ladak
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jiao Jiang
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Qing Li
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kayla McMillan
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada ; Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Kirsten Wentlandt
- Palliative Care, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Karen McRae
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Diana Tamir
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Sheldon Lyn
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, York University, Toronto, ON, Canada
| | - Vivek Rao
- Division of Cardiovascular Surgery, Toronto General Hospital, York University, Toronto, ON, Canada
| | - David Grant
- Multiorgan Transplant Program, Toronto General Hospital, York University, Toronto, ON, Canada
| | - Graham Roche-Nagle
- Division of Vascular Surgery, Toronto General Hospital, York University, Toronto, ON, Canada
| | - Sean P Cleary
- Division of General Surgery, Toronto General Hospital, York University, Toronto, ON, Canada
| | - Stefan Op Hofer
- Division of Plastic Surgery, Toronto General Hospital, York University, Toronto, ON, Canada
| | - Ralph Gilbert
- Division of Otolaryngology - Head and Neck Surgery, Toronto General Hospital, York University, Toronto, ON, Canada
| | - Duminda Wijeysundera
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Paul Ritvo
- Department of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | | | - Gerald O'Leary
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada
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Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med 2015; 39:128-38. [PMID: 26345263 DOI: 10.1007/s10865-015-9675-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/26/2015] [Indexed: 12/17/2022]
Abstract
Emerging research suggests that prescription opioid craving is associated with negative mood and depression, but less is known about cognitive factors linking depressive symptoms to opioid craving among adults with chronic pain. The present cross-sectional study examined thought suppression as a mediator of the relation between depression and prescription opioid craving in a sample of chronic pain patients receiving long-term opioid pharmacotherapy. Data were obtained from 115 chronic pain patients recruited from primary care, pain, and neurology clinics who had taken prescription opioids daily or nearly every day for ≥90 days prior to assessment. In this sample, 60 % of participants met DSM-IV criteria for current major depressive disorder. Depressed mood (r = .36, p < .001) and thought suppression (r = .33, p < .001) were significantly correlated with opioid craving. Multivariate path analyses with bootstrapping indicated the presence of a significant indirect effect of thought suppression on the association between depressed mood and opioid craving (indirect effect = .09, 95 % CI .01, .20). Sensitivity analyses showed a similar indirect effect of suppression linking major depressive disorder diagnosis and opioid craving. Attempts to suppress distressing and intrusive thoughts may result in increased craving to use opioids among chronic pain patients with depressive symptoms. Results highlight the need for interventions that mitigate thought suppression among adults with pain and mood disorders.
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The Role of Catastrophizing Beliefs in Effective Chronic Pain Treatment. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2015. [DOI: 10.1007/s10942-015-0220-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Keefer L, Mandal S. The potential role of behavioral therapies in the management of centrally mediated abdominal pain. Neurogastroenterol Motil 2015; 27:313-23. [PMID: 25428520 DOI: 10.1111/nmo.12474] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 10/27/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic abdominal pain carries a substantial health care burden but little is known about best practices for it management across ambulatory, hospital, and emergency room settings. This is especially true when abdominal pain presents in the absence of peripheral triggers like tissue injury (e.g. appendicitis) or altered bowel movements (e.g. IBS). Unfortunately, once central sensitization has occurred, pain can present without any stimulation or with minimal peripheral stimulation (feeling of clothing on the area) to the abdominal region. Several studies have proven the superior efficacy of behavioral interventions on many centrally mediated pain conditions including headaches and musculoskeletal problems. However, behavioral treatment of centrally mediated abdominal pain is less investigated due to the complexity of the patients involved and the poor understanding of the factors which either initiate or maintain persistent GI pain. PURPOSE We examine the evidence for a range of psychological and behavioral interventions in the context of centrally mediated abdominal pain. In addition to a strong rationale for a behavioral approach tied to the fear avoidance model of pain, we describe the structure, therapeutic targets, current evidence and relevance for each class of behavioral interventions.
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Affiliation(s)
- L Keefer
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
The co-occurrence of substance use disorders (SUDs) and anxiety disorders has been now well established. This association is frequent and can be explained by three models: the shared vulnerability factors model, the self-medication model, and the substance-induced model. General population epidemiological studies provide strong evidence of the frequency of the association for the most used substances: tobacco, alcohol, cannabis, and to a lesser extent sedatives, opiates, and cocaine. For substances that are less commonly used in the general population, the frequency of the co-occurrence can more precisely be studied in clinical samples. We provide the most recent literature results on the association of SUDs and anxiety, and evidence for one explicative model or the other when available. For substances with sedative properties (alcohol, benzodiazepines, cannabis, opioids), both evidence for a self-medication and for a toxic effect exist. For substances with psychostimulant properties (tobacco, cocaine, and amphetamines), the literature favors the toxic hypothesis to explain the association with anxiety disorders. We give practical steps for the recognition of these dual diagnoses and present therapeutic issues, although the strategies are rarely evidence based.
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McHugh RK, Nielsen S, Weiss RD. Prescription drug abuse: from epidemiology to public policy. J Subst Abuse Treat 2015; 48:1-7. [PMID: 25239857 PMCID: PMC4250400 DOI: 10.1016/j.jsat.2014.08.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 11/26/2022]
Abstract
Prescription drug abuse has reached an epidemic level in the United States. The prevalence of prescription drug abuse escalated rapidly beginning in the late 1990s, requiring a significant increase in research to better understand the nature and treatment of this problem. Since this time, a research literature has begun to develop and has provided important information about how prescription drug abuse is similar to, and different from the abuse of other substances. This introduction to a special issue of the Journal of Substance Abuse Treatment on prescription drug abuse provides an overview of the current status of the research literature in this area. The papers in this special issue include a sampling of the latest research on the epidemiology, clinical correlates, treatment, and public policy considerations of prescription drug abuse. Although much has been learned about prescription drug abuse in recent years, this research remains in early stages, particularly with respect to understanding effective treatments for this population. Future research priorities include studies on the interaction of prescription drugs with other licit and illicit substances, the impact of prescription drug abuse across the lifespan, the optimal treatment for prescription drug abuse and co-occurring conditions, and effective public policy initiatives for reducing prescription drug abuse.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Suzanne Nielsen
- University of New South Wales, National Drug and Alcohol Research Centre, New South Wales, Australia; Drug and Alcohol Services, South Eastern Sydney Local Health District, New South Wales, Australia
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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98
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Darnall BD, Sturgeon JA, Kao MC, Hah JM, Mackey SC. From Catastrophizing to Recovery: a pilot study of a single-session treatment for pain catastrophizing. J Pain Res 2014; 7:219-26. [PMID: 24851056 PMCID: PMC4008292 DOI: 10.2147/jpr.s62329] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Pain catastrophizing (PC) – a pattern of negative cognitive-emotional responses to real or anticipated pain – maintains chronic pain and undermines medical treatments. Standard PC treatment involves multiple sessions of cognitive behavioral therapy. To provide efficient treatment, we developed a single-session, 2-hour class that solely treats PC entitled “From Catastrophizing to Recovery” [FCR]. Objectives To determine 1) feasibility of FCR; 2) participant ratings for acceptability, understandability, satisfaction, and likelihood to use the information learned; and 3) preliminary efficacy of FCR for reducing PC. Design and methods Uncontrolled prospective pilot trial with a retrospective chart and database review component. Seventy-six patients receiving care at an outpatient pain clinic (the Stanford Pain Management Center) attended the class as free treatment and 70 attendees completed and returned an anonymous survey immediately post-class. The Pain Catastrophizing Scale (PCS) was administered at class check-in (baseline) and at 2, and 4 weeks post-treatment. Within subjects repeated measures analysis of variance (ANOVA) with Student’s t-test contrasts were used to compare scores across time points. Results All attendees who completed a baseline PCS were included as study participants (N=57; F=82%; mean age =50.2 years); PCS was completed by 46 participants at week 2 and 35 participants at week 4. Participants had significantly reduced PC at both time points (P<0001) and large effect sizes were found (Cohen’s d=0.85 and d=1.15). Conclusion Preliminary data suggest that FCR is an acceptable and effective treatment for PC. Larger, controlled studies of longer duration are needed to determine durability of response, factors contributing to response, and the impact on pain, function and quality of life.
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Affiliation(s)
- Beth D Darnall
- Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, CA, USA
| | - John A Sturgeon
- Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ming-Chih Kao
- Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jennifer M Hah
- Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sean C Mackey
- Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, CA, USA
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Martel MO, Jamison RN, Wasan AD, Edwards RR. The association between catastrophizing and craving in patients with chronic pain prescribed opioid therapy: a preliminary analysis. PAIN MEDICINE 2014; 15:1757-64. [PMID: 24612286 DOI: 10.1111/pme.12416] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND A growing number of studies have shown that opioid craving (i.e., the perceived need or desire to consume opioids) is one of the strongest determinants of prescription opioid misuse in patients with chronic pain prescribed opioid therapy. To date, however, the factors that are associated with craving in patients with pain remain largely unexplored. Based on previous research, there is reason to believe that catastrophizing might be associated with heightened opioid craving. OBJECTIVES To test the hypothesis that catastrophizing would be associated with heightened craving in patients with chronic pain prescribed long-term opioid therapy. DESIGN AND SUBJECTS, AND METHODS In this cross-sectional study, 109 patients with chronic pain were asked to provide self-reports of catastrophizing and craving. Patients also provided self-reports of pain intensity and depressive symptoms. RESULTS We found that higher levels of catastrophizing were associated with higher levels of craving. Importantly, results of a regression analysis revealed that the association between catastrophizing and craving remained significant even after controlling for a host of demographic (i.e., age, sex), psychological (i.e., depressive symptoms), medical (i.e., pain intensity, pain duration), and medication regimen (i.e., opioid doses) variables. CONCLUSIONS Our preliminary findings provide valuable new insights into the determinants of craving in patients with pain. The finding that catastrophizing was associated with craving even after controlling for a host of demographic, psychological, medical, and medication regimen variables is particularly striking, and raises questions concerning the factors that underlie the association between catastrophizing and craving in patients prescribed opioid therapy.
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Affiliation(s)
- Marc O Martel
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts, USA
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Patel AN. Addiction in Chronic Pain Patients: Evidence-Based Approaches for Monitoring Chronic Opioid Therapy. Psychiatr Ann 2013. [DOI: 10.3928/00485713-20130906-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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