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Gereau GB, Torruella-Suárez ML, Sizer SE, Xia M, Zhou D, Wykoff LA, Teklezghi AT, Alvarez-Pamir A, Boyt KM, Kash TL, McElligott ZA. GABA release from central amygdala neurotensin neurons differentially modulates ethanol consumption in male and female mice. Neuropsychopharmacology 2024; 49:1151-1161. [PMID: 38418568 PMCID: PMC11109172 DOI: 10.1038/s41386-024-01830-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 03/01/2024]
Abstract
The central nucleus of the amygdala is known to play key roles in alcohol use and affect. Neurotensin neurons in the central nucleus of the amygdala have been shown to regulate alcohol drinking in male mice. However, little is known about which neurotransmitters released by these cells drive alcohol consumption or whether these cells drive alcohol consumption in female mice. Here we show that knockdown of GABA release from central amygdala neurotensin neurons using a Nts-cre-dependent vGAT-shRNA-based AAV strategy reduces alcohol drinking in male, but not female, mice. This manipulation did not impact avoidance behavior, except in a fasted novelty-suppressed feeding test, in which vGAT shRNA mice demonstrated increased latency to feed on a familiar high-value food reward, an effect driven by male mice. In contrast, vGAT shRNA female mice showed heightened sensitivity to thermal stimulation. These data show a role for GABA release from central amygdala neurotensin neurons in modulating consumption of rewarding substances in different motivational states.
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Affiliation(s)
- Graydon B Gereau
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - María L Torruella-Suárez
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Graduate Program in Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah E Sizer
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mengfan Xia
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diana Zhou
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Luke A Wykoff
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adonay T Teklezghi
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ali Alvarez-Pamir
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen M Boyt
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas L Kash
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zoé A McElligott
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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2
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Lape EC, Powers JM, LaRowe LR, Ditre JW. Initial validation of the expectancies for Benzodiazepine Analgesia Scale. Exp Clin Psychopharmacol 2024; 32:369-378. [PMID: 38010761 PMCID: PMC11098706 DOI: 10.1037/pha0000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Chronic pain populations exhibit greater prevalence of benzodiazepine (BZD) prescription (vs. the general population) and greater likelihood of BZD use not as prescribed and dependence symptoms. Individuals report taking BZDs for pain relief, potentially contributing to maintenance/escalation of BZD use and hazardous couse with prescription opioids. Identifying cognitive factors underlying pain-BZD use relations represents a critical step toward understanding the role of pain in BZD use trajectories. Outcome expectancies for substance-related analgesia have been implicated in pain-substance use comorbidity (e.g., alcohol), and there is reason to believe these processes may extend to BZD use. The present study aimed to examine psychometric properties of a newly adapted Expectancies for Benzodiazepine Analgesia (EBA) scale and probe associations between EBA scores and prescription opioid use behaviors. Participants were 306 adults (38.9% females) endorsing chronic pain and current BZD prescription who completed an online survey. Results provided initial support for psychometric validity of the EBA: evidence of single-factor structure with good model fit (Bollen-Stine bootstrap p = .101), excellent internal consistency (α = .93), and evidence of concurrent validity via correlations with pain variables, likelihood of BZD use not as prescribed, BZD dependence symptoms, and self-reported BZD use for pain relief. Exploratory findings among participants prescribed opioids indicated positive covariation between EBA scores and behaviors associated with higher risk opioid use. This is, to our knowledge, the first study to assess analgesia expectancies for BZD use. BZD analgesic expectancies warrant further study as a treatment target in comorbid pain and BZD use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Emma C. Lape
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, United States
| | - Jessica M. Powers
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, 625 North Michigan Avenue, 21st Floor, Chicago, IL 60611, United States
| | - Lisa R. LaRowe
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA 02114, United States
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, United States
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3
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Hall OT, Rausch J, Entrup P, Lagisetty P, Bryan C, Black L, Moreno J, Gorka S, Phan KL, Clauw DJ. Nociplastic Pain and Pain-Motivated Drinking in Alcohol Use Disorder. THE JOURNAL OF PAIN 2024; 25:104467. [PMID: 38219852 DOI: 10.1016/j.jpain.2024.01.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/25/2023] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
Heavy chronic alcohol use may produce pain amplification through neurochemical and neuroplastic changes at multiple levels of the nervous system. Similar changes are thought to underlie nociplastic pain. The American College of Rheumatology Fibromyalgia Survey has been used as a surrogate for nociplastic pain, including among individuals with alcohol use disorder (AUD). However, studies linking nociplastic pain to pain-motivated drinking are lacking. The present study aimed to determine if nociplastic pain is associated with pain-motivated drinking in AUD. To achieve this aim, a new scale-the Pain-Motivated Drinking Scale (PMDS)-was developed to measure how often participants were motivated by pain to drink alcohol. Measurement properties of this new scale were determined, including its factor structure, internal consistency reliability, and construct validity. In this cross-sectional observational study, participants with AUD (n = 138) were consecutively recruited from the patient pool at an academic addiction treatment facility. Seventy-two percent (95, 72.0%) reported they drank alcohol "to get relief from physical pain" at least some of the time, and over forty-two percent (56, 42.4%) reported pain relief motivated their drinking at least half of the time. PMDS had a single-factor structure, strong internal consistency reliability, and construct validity. A multiple hierarchical linear regression was run to determine if nociplastic pain was associated with pain-motivated drinking. Nociplastic pain was associated with PMDS even after controlling for potential confounders and pain severity. These findings suggest nociplastic pain is uniquely associated with pain-motivated drinking in AUD. PERSPECTIVE: Nociplastic pain is independently associated with pain-motivated drinking in alcohol use disorder (AUD). The Pain-Motivated Drinking Scale (PMDS) is a new scale to measure how often people drink to cope with pain. PMDS has promising psychometric properties. Nociplastic pain may be uniquely associated with pain-motivated drinking in AUD.
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Affiliation(s)
- Orman Trent Hall
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Johnathan Rausch
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Parker Entrup
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Pooja Lagisetty
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Craig Bryan
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Lora Black
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jose Moreno
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Stephanie Gorka
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - K Luan Phan
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan
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Bush NJ, Ferguson E, Zale E, Boissoneault J. A Brief Screening Tool for Risk of Self-Medication of Pain With Substance Use. J Addict Med 2024; 18:282-287. [PMID: 38357999 PMCID: PMC11150098 DOI: 10.1097/adm.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Substance use and pain are both growing public health concerns globally. Evidence suggests that individuals may use substances in order to self-medicate their pain. The Catastrophizing, Anxiety, Negative Urgency, and Expectancy model was developed to provide a theoretical foundation for the modifiable risk factors implicated in self-medication of pain with substance use. This study aimed to use the outcomes in the Catastrophizing, Anxiety, Negative Urgency, and Expectancy model to develop a brief clinical screening tool to identify individuals at risk for self-medication. METHODS Participants (N = 520; M age = 38.8) were adults who endorsed the past three-month use of at least one substance and completed an online questionnaire. Logistic regression and receiver operator characteristic analyses were used to reduce the initial 104-item questionnaire to the items needed to achieve a minimum accuracy score of 0.95 and 0.90. RESULTS A 14-item and a 7-item questionnaire were derived from the initial larger questionnaire. Both of these questionnaires were significantly correlated with the outcome variables and were significantly associated with health risk and percent of use because of pain. The R2 values between the 14- and 7-item versions were only significantly different for the percent of alcohol use because of pain. CONCLUSIONS The study provides two brief screening tools to screen for individuals at risk for self-medication of pain with substance use that can be easily implemented within clinical settings. Further, the screening tools provide insight into modifiable risk factors for self-medication and may also be valuable to monitor treatment response.
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Affiliation(s)
- Nicholas J Bush
- From the Department of Anesthesiology, University of Minnesota, Minneapolis, MN (NJB, JB); Department of Clinical and Health Psychology, University of Florida, Gainesville, FL (EF); Department of Psychology, Binghamton University, Binghamton, NY (EZ)
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5
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Farrior H, Teitelbaum S, Phalin B, Janner A, Solomon L, Mathias K, Hunt J, Boissoneault J, Lewis B. Pain Predicts Dropout From Substance Use Treatment. J Stud Alcohol Drugs 2024; 85:381-388. [PMID: 38206669 PMCID: PMC11095491 DOI: 10.15288/jsad.23-00099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE This project aimed to characterize the relationship between physical pain experienced at time of entry to residential treatment for substance use disorders (SUDs) and the frequency of treatment dropout. We hypothesized that both endorsement of recent pain and higher magnitude of endorsed pain intensity would be associated with higher dropout rates. We further hypothesized that these effects would be exacerbated among patients with opioid use disorder (OUD). METHOD Participants included 1,095 individuals in residential treatment for SUD. Data were collected within 24 hours of treatment entry. Analyses were conducted using logistic regression with dropout as the dependent variable. Dropout was operationally defined as leaving treatment against medical advice or being discharged from treatment because of use of substances. Pain (including endorsement and intensity) was the primary independent variable in all analyses. Analyses included demographic and affective covariates and included both main effects of OUD and interaction terms between OUD and pain. RESULTS Pain endorsement was associated with greater frequency of dropout (odds ratio [OR] = 1.49, p = .04). Higher levels of pain intensity predicted increased rates of dropout (OR = 1.13, p < .01). In contrast with our hypothesis, no interactions between OUD and pain were observed. CONCLUSIONS These results underscore the import of integrating pain monitoring and pain interventions as core components of treatment for SUD. Our findings are highly consistent with a growing literature recognizing the impact of pain across a constellation of important treatment outcomes and provide novel data strongly suggesting that pain predicts early cessation of treatment.
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Affiliation(s)
- Hugh Farrior
- Department of Psychiatry, University of Florida, Gainesville, Florida
- Department of Psychology, University of Florida, Gainesville, Florida
| | - Scott Teitelbaum
- Department of Psychiatry, University of Florida, Gainesville, Florida
| | - Ben Phalin
- Department of Psychiatry, University of Florida, Gainesville, Florida
| | - Amanda Janner
- Department of Psychiatry, University of Florida, Gainesville, Florida
| | - Laurie Solomon
- Department of Psychiatry, University of Florida, Gainesville, Florida
| | - Kent Mathias
- Department of Psychiatry, University of Florida, Gainesville, Florida
| | - Jason Hunt
- Department of Psychiatry, University of Florida, Gainesville, Florida
| | - Jeff Boissoneault
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota
| | - Ben Lewis
- Department of Psychiatry, University of Florida, Gainesville, Florida
- Department of Psychology, University of Florida, Gainesville, Florida
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Alexander C, Bush NJ, Neubert JK, Robinson M, Boissoneault J. Expectancy of alcohol analgesia moderates perception of pain relief following acute alcohol intake. Exp Clin Psychopharmacol 2024; 32:228-235. [PMID: 37358545 PMCID: PMC10749982 DOI: 10.1037/pha0000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Although laboratory studies indicate alcohol reduces pain intensity and increases pain threshold, these effects likely do not completely explain perceived pain relief from alcohol intake. In this study, we tested expectancy of alcohol analgesia (EAA) as a moderator of subjective pain relief following oral alcohol challenge in individuals with and without chronic orofacial pain. Social drinkers (N = 48; 19 chronic pain; 29 pain-free controls) completed two testing sessions: alcohol administration (BrAC: 0.08 g/dL) and placebo. Alcohol expectancy (AE) was assessed using the EAA questionnaire and two 100-mm Visual Analogue Scales (VASs) regarding strength of belief that alcohol provides pain relief (AE VAS 1) or reduces pain sensitivity (AE VAS 2). Participants completed quantitative sensory testing (QST) involving application of pressure to the masseter insertion. Pain threshold (lbf; three repetitions) and pain intensity (4, 5, and 6 lbf; three repetitions each; 100-mm VAS) were collected. After each stimulus, participants rated perceived pain relief due to consumption of the study beverage (0-100 VAS). Higher EAA and AE VAS 1 ratings were associated with stronger perceived relief in the alcohol, but not placebo, condition. However, expectancy specifically related to reduction in pain sensitivity (AE VAS 2) was not associated with relief. Additionally, changes in pain threshold and intensity were not significantly correlated with perceived relief. Taken together, results suggest expectancy that alcohol provides pain relief is an important determinant of its negative reinforcing effects. Future studies should investigate challenging these expectancies as a means of reducing alcohol-related risk in people with pain. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Casey Alexander
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL 32610
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610
| | - Nicholas J. Bush
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL 32610
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610
| | - John K. Neubert
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL 32610
- Department of Orthodontics, University of Florida, Gainesville, FL 32610
| | - Michael Robinson
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL 32610
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610
| | - Jeff Boissoneault
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL 32610
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610
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7
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Polhill SE, Lape EC, Deyo AG, Smit T, Zvolensky MJ, Zale EL, Ditre JW. Pain Intensity, Pain-Related Anxiety, and Hazardous Drinking Among Individuals With PTSD. J Dual Diagn 2024; 20:122-131. [PMID: 38408374 DOI: 10.1080/15504263.2024.2319034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Evidence suggests that pain intensity may be indirectly linked to hazardous drinking and PTSD symptom severity via pain-related anxiety. The goal of this analysis was to test the hypotheses in a population with PTSD symptoms that pain intensity would be positively and indirectly associated with hazardous drinking, alcohol dependence, alcohol-related problems, and PTSD symptom severity via pain-related anxiety. METHODS Heavy drinkers with probable PTSD were recruited via Qualtrics panels (N = 371, 53% Female, Mage = 39.68, SD = 10.86). Linear regression and conditional process models were conducted to examine indirect associations between pain intensity and primary outcomes via pain-related anxiety. RESULTS Pain intensity was found to be indirectly associated with hazardous drinking, alcohol dependence, alcohol-related problems, and PTSD symptom severity via greater pain-related anxiety. CONCLUSION These initial findings suggest that pain-related anxiety may play an important role in relations between the experience of pain and hazardous patterns of alcohol consumption among individuals with probable PTSD. Future research is needed to determine the temporal nature of these associations and to examine the potential utility of treatments that address pain-related anxiety in the context of comorbid pain, PTSD, and hazardous drinking.
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Affiliation(s)
- Sarah E Polhill
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Emma C Lape
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Alexa G Deyo
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - T Smit
- Department of Psychology, University of Houston, Houston, TX, USA
| | - M J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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8
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Moskal D, Loughran TA, Funderburk JS, Scharer JL, Buckheit KA, Beehler GP. Pain and Hazardous Alcohol Use in Veterans in Primary Care: The Role of Affective Pain Interference and Alcohol Pain-Coping Perceptions. THE JOURNAL OF PAIN 2024; 25:682-689. [PMID: 37783381 DOI: 10.1016/j.jpain.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
Chronic pain and unhealthy alcohol use commonly co-occur and are associated with negative health outcomes. Veterans may be particularly vulnerable to these conditions, yet limited research has examined factors involved in their co-occurrence. This cross-sectional study aimed to examine the role of affective pain interference and alcohol pain-coping perceptions in the relationship between pain and hazardous alcohol use. As informed by the catastrophizing, anxiety, negative urgency, and expectancy model, we hypothesized that the relationship between pain and hazardous alcohol consumption is mediated by affective pain interference and stronger among those with greater perceptions that alcohol helps cope with pain. Participants were 254 VA primary care patients (87.8% male, Mage = 64.03, 76.4% White) with a history of chronic musculoskeletal pain, past-year alcohol use, and past-week pain. Veterans completed a mailed survey including measures of pain, affective pain interference, alcohol pain-coping perceptions, and hazardous alcohol use. Hypotheses were tested with regression models and PROCESS macros. As hypothesized, affective pain interference mediated the pain-hazardous alcohol use association. Contrary to hypotheses, results showed no moderating effect of alcohol pain-coping perceptions. Findings partially support relationships among theorized constructs and suggest that for Veterans with co-occurring pain and alcohol use it may be important to target pain-related affective interference and perceptions that alcohol helps cope with pain. PERSPECTIVE: This article presents a test of factors involved in the pain and alcohol relationship, as informed by the CANUE model. Findings suggest that for Veterans with co-occurring pain and past-year alcohol use, it may be important to target pain-related affective interference and perceptions that alcohol helps cope with pain.
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Affiliation(s)
- Dezarie Moskal
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York; Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Travis A Loughran
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York; Department of Psychology, Syracuse University, Syracuse, New York; Department of Psychiatry, University of Rochester, Rochester, New York
| | - Jacob L Scharer
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Katherine A Buckheit
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Gregory P Beehler
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York; Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
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9
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Summit AG, Chen C, Pettersson E, Boersma K, D'Onofrio BM, Lichtenstein P, Quinn PD. Preliminary Validation of a General Factor Model of Chronic Overlapping Pain Conditions. THE JOURNAL OF PAIN 2024:104502. [PMID: 38417595 DOI: 10.1016/j.jpain.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 03/01/2024]
Abstract
Chronic overlapping pain conditions (COPCs) by definition, frequently co-occur, perhaps reflecting their shared etiologies. Their overlapping nature presents a methodological challenge, possibly masking associations between COPCs and health outcomes attributable to either general or specific processes. To address this challenge, we used population-based cohort data to evaluate the predictive validity of a bifactor model of 9 self-reported COPCs by assessing its association with incident pain-related clinical diagnoses; pain-relevant pharmacotherapy; and other health outcomes. We obtained data from a 2005 to 2006 study of Swedish adult twins linked with health data from nationwide registers through 2016 (N = 25,418). We then fit a bifactor model comprising a general COPC factor and 2 independent specific factors measuring pain-related somatic symptoms and neck and shoulder pain. Accounting for age, biological sex, and cancer, the general factor was associated with increased risk of all pain-related outcomes (eg, COPC diagnosis adjusted odds ratio [aOR], 1.71; 95% confidence interval [1.62, 1.81]), most mental health-related outcomes (eg, depression aOR, 1.72 [1.60, 1.85]), and overdose and mortality (eg, all-cause mortality aOR, 1.25 [1.09, 1.43]). The somatic symptoms specific factor was associated with pain-relevant pharmacotherapy (eg, prescribed opioids aOR, 1.25 [1.15, 1.36]), most mental health-related outcomes (eg, depression aOR, 1.95 [1.70, 2.23]), and overdose (eg, nonfatal overdose aOR, 1.66 [1.31, 2.10]). The neck and shoulder pain-specific factor was weakly and inconsistently associated with the outcomes. Findings provide initial support for the validity and utility of a general-factor model of COPCs as a tool to strengthen understanding of co-occurrence, etiology, and consequences of chronic pain. PERSPECTIVE: This article presents associations between a novel measurement model of COPCs and various health outcomes. Findings provide support for measuring pain across multiple domains rather than only measuring pain specific to one physical location in both research and clinical contexts.
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Affiliation(s)
- Alynna G Summit
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana
| | - Cen Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Katja Boersma
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Patrick D Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana
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10
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Williams CM, Mastroleo NR, Brimhall KC, Zale EL. Associations Between Alcohol and Cannabis Use and Pain Among College Student-Athletes. Subst Use Misuse 2024; 59:567-575. [PMID: 38087985 DOI: 10.1080/10826084.2023.2287239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Background: Pain motivates alcohol and cannabis use, with evidence that pain catastrophizing (i.e., ruminative exaggeration of pain) mediates these associations. Student-athletes represent a unique population who engage in riskier substance use, experience more substance-related consequences, and are more likely to develop chronic pain compared to non-athletes. Objectives: This study examined relationships between pain, catastrophizing, alcohol and cannabis use and consequences. Student-athletes from two Division I universities (N = 549; 51% female) completed a cross-sectional survey. Moderated mediation tested the conditional indirect effect of pain catastrophizing on associations between pain and alcohol- and cannabis- use and consequences, separately, with sex moderating the a and b paths. Results: There was a significant direct effect between pain and alcohol-related consequences (b = 0.11, p = .008). Pain and pain catastrophizing were positively associated in all four models (bs = 0.68-0.72, ps <.001), and this relationship was stronger among female than male athletes. No other direct or conditional indirect effects were observed. Conclusions: Student-athletes experiencing pain report more alcohol-related consequences, and pain catastrophizing may be particularly relevant for student-athletes with greater pain. Future research should examine other factors proposed by theoretical models, such as negative affect, while focusing on athletes with more significant pain (e.g., injured athletes).
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Affiliation(s)
- Callon M Williams
- Department of Psychology, Harpur College of Arts & Sciences, Binghamton University, Binghamton, New York, USA
| | - Nadine R Mastroleo
- Department of Psychology, Harpur College of Arts & Sciences, Binghamton University, Binghamton, New York, USA
| | - Kim C Brimhall
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Emily L Zale
- Department of Psychology, Harpur College of Arts & Sciences, Binghamton University, Binghamton, New York, USA
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11
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Gereau GB, Torruella-Suárez ML, Sizer SE, Xia M, Zhou D, Wykoff LA, Teklezghi AT, Alvarez-Pamir A, Boyt KM, Kash TL, McElligott ZA. GABA Release From Central Amygdala Neurotensin Neurons Differentially Modulates Reward and Consummatory Behavior in Male and Female Mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.14.557768. [PMID: 37745547 PMCID: PMC10515895 DOI: 10.1101/2023.09.14.557768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
The central nucleus of the amygdala is known to play key roles in alcohol use and affect. Neurotensin neurons in the central nucleus of the amygdala have been shown to regulate alcohol drinking in male mice. However, little is known about which neurotransmitters released by these cells drive alcohol consumption or whether these cells drive alcohol consumption in female mice. Here we show that knockdown of GABA release from central amygdala neurotensin neurons using a Nts-cre-dependent vGAT-shRNA-based AAV strategy reduces alcohol drinking in male, but not female, mice. This manipulation did not impact avoidance behavior, except in a fasted novelty-suppressed feeding test, in which vGAT shRNA mice demonstrated increased latency to feed on a familiar high-value food reward, an effect driven by male mice. In contrast, vGAT shRNA female mice showed heightened sensitivity to thermal stimulation. These data show a role for GABA release from central amygdala neurotensin neurons in modulating consumption of rewarding substances in different motivational states.
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Affiliation(s)
- Graydon B Gereau
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, USA
- Department of Pharmacology, University of North Carolina at Chapel Hill, USA
| | - María L Torruella-Suárez
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, USA
- Graduate Program in Neuroscience, University of North Carolina at Chapel Hill, USA
| | - Sarah E Sizer
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, USA
| | - Mengfan Xia
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, USA
| | - Diana Zhou
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, USA
| | - Luke A Wykoff
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, USA
| | - Adonay T Teklezghi
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, USA
| | - Ali Alvarez-Pamir
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, USA
| | - Kristen M Boyt
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, USA
| | - Thomas L Kash
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, USA
- Department of Pharmacology, University of North Carolina at Chapel Hill, USA
| | - Zoé A McElligott
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, USA
- Department of Pharmacology, University of North Carolina at Chapel Hill, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA
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12
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El Ansari W, Suominen S, El-Ansari K, Šebeňa R. Are behavioural risk factors clusters associated with self-reported health complaints? University students in Finland. Cent Eur J Public Health 2023; 31:248-255. [PMID: 38309702 DOI: 10.21101/cejph.a7916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/14/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVES No previous research of university students in Finland assessed lifestyle behavioural risk factors (BRFs) and categorized students into clusters, explored the associations of the clusters with self-reported health complaints (HCs), whilst controlling for potential confounders. The current study undertook this task. METHODS Students at the University of Turku (1,177) completed an online well-being questionnaire that assessed socio-demographic variables, 5 BRFs - problematic alcohol consumption, smoking, illicit drug use, food consumption habits, moderate-to-vigorous physical activity (MVPA), and 22 HCs. A food frequency questionnaire assessed students' consumption of a range of foods, and a dietary guideline adherence score was computed based on WHO dietary recommendations for Europe. Three separate regression models appraised the associations between the cluster membership and HCs factors, adjusting for sex, income sufficiency and self-rated health. RESULTS Mean age was 23 ± 5.2 years, 77% had never smoked and 79% never used illicit drug/s. Factor analysis of HCs resulted in four-factors (psychological, circulatory/breathing, gastro-intestinal, pains/aches); cluster analysis of BRFs identified two distinctive student clusters. Cluster 1 represented more healthy students who never smoked/used illicit drugs, had no problematic drinking, and undertook MVPA on 4.42 ± 3.36 days/week. As for cluster 2 students, half the cluster smoked occasionally/daily, used illicit drug/s, and > 50% had problematic drinking and students undertook MVPA on 4.02 ± 3.12 days/week. More cluster 2 students adhered to healthy eating recommendations, but the difference was not significant between clusters. Regression analysis revealed that females, those with sufficient income, and with excellent/very good self-rated general health were significantly less likely to report all four HCs. Cluster 2 students were significantly more likely to report psychological complaints, circulatory/breathing and gastro-intestinal complaints. There was no significant association between BRFs clusters and pains/aches factor. CONCLUSIONS Risk taking students with less healthy lifestyles and behaviour were consistently associated with poorer psychological and somatic health.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Department of Population Health, Weill Cornell Medicine Qatar, Doha, Qatar
| | - Sakari Suominen
- School of Health and Education, University of Skovde, Skovde, Sweden
- Department of Public Health, University of Turku, Turku, Finland
- Wellbeing Services, County of Southwest Finland, Finland
| | - Kareem El-Ansari
- School of Medicine, St. George's University, Grenada, West Indies
| | - René Šebeňa
- Department of Psychology, Faculty of Arts, Pavol Josef Safarik University, Kosice, Slovak Republic
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13
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Boissoneault J, Stennett-Blackmon B, Gilmour C, Blaes S. Neural and Psychosocial Mechanisms Underlying Alcohol Use and Pain Interactions: Overview of Current Evidence and Future Directions. CURRENT ADDICTION REPORTS 2023; 10:677-689. [PMID: 38645279 PMCID: PMC11031255 DOI: 10.1007/s40429-023-00518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 04/23/2024]
Abstract
Purpose of Review A growing body of research indicates bidirectional associations between alcohol use and pain. In this review, we highlight common neural and psychosocial mechanisms underlying pain and alcohol use and identify current gaps in the literature regarding alcohol/pain interactions. We also suggest future directions for the field moving forward, including more nuanced conceptualization of alcohol's negative reinforcing effects in the context of pain, broader use of clinically-relevant experimental pain induction modalities, and characterization of age, biological sex, gender, race, and ethnicity as moderators of pain/alcohol interactions. Recent Findings Acute alcohol intake has analgesic and negative-reinforcing effects in the context of pain, and chronic heavy alcohol use appears to increase risk for development of chronic pain. At the same time, pain, both acute and chronic, acts as a proximal antecedent for alcohol use and is associated with relapse risk for individuals in recovery from alcohol use disorder. Summary Although the links between alcohol use and pain are increasingly appreciated, significant gaps in understanding remain and systematic study of alcohol/pain interactions at all levels, including basic, preclinical, translational, and interventional, is needed.
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Affiliation(s)
- Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | - Bethany Stennett-Blackmon
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Christina Gilmour
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Shelby Blaes
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
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14
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Endrighi R, Borrelli B. Pain-Related Smoking Expectancies and Smoking Behavior Among U.S. Adult Cigarette Smokers with Chronic Pain. Int J Behav Med 2023:10.1007/s12529-023-10239-1. [PMID: 37935908 DOI: 10.1007/s12529-023-10239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND This study investigated the factor structure of a measure of pain-smoking interrelations and expectancies (pain and smoking inventory (PSI)) and examined associations with risk factors for smoking maintenance among smokers with chronic pain (CP). METHOD Participants (n = 504; M age = 46 ± 13 years; 58% female) completed an online survey about health-related factors and smoking characteristics. Data were analyzed using Horn's parallel analysis (PA) and multiple linear regression. RESULTS PA indicated that a single-dimension structure was the best fit for the PSI. Our regression model accounted for 34% of the variance in PSI score. The PSI was associated with younger age, higher education, poorer physical functioning, greater pain severity and pain intensity, higher psychological distress, greater nicotine dependence, lower self-efficacy and greater perceived difficulty quitting, and lifetime use of behavioral treatment for quitting smoking. CONCLUSION This research is the first step in identifying potential targets for smoking cessation approaches tailored to smokers with CP.
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Affiliation(s)
- Romano Endrighi
- Center for Behavioral Science Research, Department of Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, 560 Harrison Ave, Boston, MA, 02118, USA.
| | - Belinda Borrelli
- Center for Behavioral Science Research, Department of Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, 560 Harrison Ave, Boston, MA, 02118, USA
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15
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Powers JM, Zale EL, Deyo AG, Rubenstein D, Terry EL, Heckman BW, Ditre JW. Pain and Menthol Use Are Related to Greater Nicotine Dependence Among Black Adults Who Smoke Cigarettes at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health (PATH) Study. J Racial Ethn Health Disparities 2023; 10:2407-2416. [PMID: 36171497 PMCID: PMC10651305 DOI: 10.1007/s40615-022-01419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 12/01/2022]
Abstract
Burdens related to pain, smoking/nicotine dependence, and pain-smoking comorbidity disproportionately impact Black Americans, and menthol cigarette use is overrepresented among Black adults who smoke cigarettes. Menthol may increase nicotine exposure, potentially conferring enhanced acute analgesia and driving greater dependence. Therefore, the goal of the current study was to examine associations between pain, menthol cigarette use, and nicotine dependence. Data was drawn from Black adults who were current cigarette smokers (n = 1370) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study. Nicotine dependence was assessed using the Wisconsin Inventory of Smoking Dependence Motives. ANCOVA revealed that moderate/severe pain (vs. no/low pain) was associated with greater overall nicotine dependence (p < .001) and greater negative reinforcement, cognitive enhancement, and affiliative attachment smoking motives (ps < .001). Menthol smokers with moderate/severe pain also endorsed greater cigarette craving and tolerance, compared to non-menthol smokers with no/low pain (ps < .05). Findings support the notion that among Black individuals who smoke cigarettes, the presence of moderate/severe pain (vs. no/low pain) and menthol use may engender greater physical indices of nicotine dependence relative to non-menthol use. Compared to no/low pain, moderate/severe pain was associated with greater emotional attachment to smoking and greater proclivity to smoke for reducing negative affect and enhancing cognitive function. Clinical implications include the need to address the role of pain and menthol cigarette use in the assessment and treatment of nicotine dependence, particularly among Black adults. These data may help to inform evolving tobacco control policies aimed at regulating or banning menthol tobacco additives.
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Affiliation(s)
- Jessica M Powers
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA.
| | - Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, NY, 13902, USA
| | - Alexa G Deyo
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
| | - Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Ellen L Terry
- Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, 32610, USA
| | - Bryan W Heckman
- The Center for the Study of Social Determinants of Health, Meharry Medical College, Nashville, TN, USA
- Psychiatry and Behavioral Sciences, School of Medicine, Meharry Medical College, Nashville, TN, USA
- Division of Public Health, School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
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16
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Rogers AH, Heggeness LF, Smit T, Zvolensky MJ. Opioid coping motives and pain intensity among adults with chronic low back pain: associations with mood, pain reactivity, and opioid misuse. J Behav Med 2023; 46:860-870. [PMID: 37148396 DOI: 10.1007/s10865-023-00416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/21/2023] [Indexed: 05/08/2023]
Abstract
Chronic low back pain (CLBP) is a significant public health problem that is associated with opioid misuse and use disorder. Despite limited evidence for the efficacy of opioids in the management of chronic pain, they continue to be prescribed and people with CLBP are at increased risk for misuse. Identifying individual difference factors involved in opioid misuse, such as pain intensity as well as reasons for using opioids (also known as motives), may provide pertinent clinical information to reduce opioid misuse among this vulnerable population. Therefore, the aims of the current study were to examine the relationships between opioid motives-to cope with pain-related distress and pain intensity, in terms of anxiety, depression, pain catastrophizing, pain-related anxiety, and opioid misuse among 300 (Mage= 45.69, SD = 11.17, 69% female) adults with CLBP currently using opioids. Results from the current study suggest that both pain intensity and motives to cope with pain-related distress with opioids were associated with all criterion variables, but the magnitude of variance explained by coping motives was larger than pain intensity in terms of opioid misuse. The present findings provide initial empirical evidence for the importance of motives to cope with pain-related distress with opioids and pain intensity in efforts to better understand opioid misuse and related clinical correlates among adults with CLBP.
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Affiliation(s)
- Andrew H Rogers
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA.
| | - Luke F Heggeness
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, USA
- Health Institute, University of Houston, Houston, USA
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17
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Parisi CE, Gracy HR, Bush NJ, Cook RL, Wang Y, Chichetto N. Does treating pain with alcohol affect drinking reduction among women with HIV enrolled in a clinical trial of naltrexone? ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1917-1925. [PMID: 37864537 PMCID: PMC10662960 DOI: 10.1111/acer.15165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/23/2023] [Accepted: 07/31/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Many women living with HIV (WLWH) experience pain. Alcohol use with the intent to treat pain could lead to hazardous drinking and difficulty in reducing drinking. Naltrexone acts on opioid receptors important for pain regulation and is an approved treatment for alcohol use disorder. In this secondary analysis of a randomized double-blind placebo-controlled naltrexone clinical trial, the goals were to (1) compare alcohol reduction between women who drank to treat pain and those who did not and (2) examine differences in alcohol reduction by both drinking intention and treatment arm. METHODS Women living with HIV (N = 194, mean age 48.3 years, 83% non-Hispanic Black, 11% Hispanic) with hazardous drinking (>7 drinks/week) were randomized to receive daily treatment with naltrexone 50 mg or placebo for 4 months. Study visits occurred at baseline and 2, 4, and 7 months (posttreatment). The number of drinks/week was measured using the Timeline Follow Back. Use of alcohol to treat pain was self-reported. Participants were categorized as using alcohol to treat pain or not and in the naltrexone or placebo group. Chi-square, t-test, MANOVA, and sequential mixed effects models were used to determine group differences in demographic factors, mean/drinks per week, and percent change in mean drinks/week at baseline and each follow-up visit. RESULTS There was a consistent decrease in drinking throughout the study. There was not a significant difference in mean drinks/week at any point in the study between women who used alcohol to treat pain and those who did not. When considering treatment arm, at 2 months only those who did not use alcohol to treat pain in the naltrexone group had a significantly lower mean drinks/week than the other groups (p = 0.007); all groups had similar decreases in drinking from 4 months onward. CONCLUSION In the naltrexone group, WLWH who drank to treat pain reduced their alcohol consumption more slowly than WLWH who did not drink to treat pain. Replication of these findings would suggest that alcohol treatment guidelines should address pain as a factor in drinking outcomes.
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Affiliation(s)
- Christina E. Parisi
- Department of Epidemiology, University of Florida, Gainesville, FL
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
| | - Hannah R. Gracy
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
| | - Nicholas J. Bush
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, FL
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
| | - Yan Wang
- Department of Epidemiology, University of Florida, Gainesville, FL
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
| | - Natalie Chichetto
- Department of Epidemiology, University of Florida, Gainesville, FL
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
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18
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Wilson M, McKennon S, Remsberg CM, Bindler RJ, Anderson J, Klein TA, Kobayashi R, Miller JC, DeWitt DE. Interprofessional Education to Address Substance Use among Adults with Persistent Pain: A Pre-Post Program Evaluation. Pain Manag Nurs 2023; 24:558-566. [PMID: 37455185 DOI: 10.1016/j.pmn.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Substance use disorders (SUDs) are highly prevalent among adults with persistent pain. Yet, standard competencies for integrating pain and SUD content are lacking across health science student curricula. Additionally, pharmacotherapies to treat SUDs are underutilized. AIM To address these gaps, a team of health science faculty created an interprofessional simulation activity using a standardized patient and evaluated learner outcomes related to assessment and treatment of comorbid persistent pain and substance use. METHODS A total of 304 health science students representing nursing, medicine, pharmacy, and social work programs attended virtual learning sessions. Interprofessional student teams developed a team-based care plan for an adult with musculoskeletal pain who takes prescribed opioids while using alcohol. Pre- and post-activity surveys assessing knowledge and confidence were matched for 198 students. Descriptive statistics summarized survey data with inferential analysis of paired data. RESULTS The largest significant improvements between pre- and post-activity knowledge were observed in items specific to pharmacotherapy options for alcohol and opioid use disorders. Similar gains were noted in students' confidence regarding pharmacotherapies. No significant differences were noted on pre-post-activity knowledge scores between the three main profession groups (medicine, nursing, and pharmacy). CONCLUSIONS Students attending this interprofessional simulation demonstrated improved knowledge and confidence, particularly in pharmacotherapies for alcohol and opioid use disorders. Replication of such programs can be used to provide consistent content across health science disciplines to heighten awareness and receptivity to medications available to treat SUDs in people treated for persistent pain. The curriculum is freely available from the corresponding author.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington.
| | - Skye McKennon
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Connie M Remsberg
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington
| | - Ross J Bindler
- College of Nursing, Washington State University, Spokane, Washington
| | - Jennifer Anderson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Tracy A Klein
- College of Nursing, Washington State University, Vancouver, Washington
| | - Rie Kobayashi
- School of Social Work, Eastern Washington University, Cheney, Washington
| | - Jennifer C Miller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington
| | - Dawn E DeWitt
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
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19
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Frohe T, Janssen T, Garner BR, Becker SJ. Examining Changes in Pain Interference via Pandemic-Induced Isolation Among Patients Receiving Medication for Opioid Use Disorder: A Secondary Data Analysis. RESEARCH SQUARE 2023:rs.3.rs-3158420. [PMID: 37609151 PMCID: PMC10441456 DOI: 10.21203/rs.3.rs-3158420/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background Early in the pandemic, the United States population experienced a sharp rise in the prevalence rates of opioid use, social isolation, and pain interference. Given the high rates of pain reported by patients on medication for opioid use disorder (MOUD), the pandemic presented a unique opportunity to disentangle the relationship between opioid use, pain, and social isolation in this high-risk population. We tested the hypothesis that pandemic-induced isolation would partially mediate change in pain interference levels experienced by patients on MOUD, even when controlling for baseline opioid use. Such work can inform the development of targeted interventions for a vulnerable, underserved population. Methods Analyses used data from a cluster randomized trial (N = 188) of patients on MOUD across eight opioid treatment programs. As part of the parent trial, participants provided pre-pandemic data on pain interference, opioid use, and socio-demographic variables. Research staff re-contacted participants between May and June 2020 and 133 participants (71% response rate) consented to complete a supplemental survey that assessed pandemic-induced isolation. Participants then completed a follow-up interview during the pandemic that again assessed pain interference and opioid use. A path model assessed whether pre-pandemic pain interference had an indirect effect on pain interference during the pandemic via pandemic-induced isolation. Results Consistent with hypotheses, we found evidence that pandemic-induced isolation partially mediated change in pain interference levels among MOUD patients during the pandemic. Higher levels of pre-pandemic pain interference and opioid use were both significantly associated with higher levels of pandemic-induced isolation. In addition, pre-pandemic pain interference was significantly related to levels of pain interference during the pandemic, and these pain levels were partially explained by the level of pandemic-induced isolation reported. Conclusions Patients on MOUD with higher use of opioids and higher rates of pain pre-pandemic were more likely to report feeling isolated during COVID-related social distancing and this, in turn, partially explained changes in levels of pain interference. These results highlight social isolation as a key risk factor for patients on MOUD and suggest that interventions promoting social connection could be associated with reduced pain interference, which in turn could improve patient quality of life.
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Affiliation(s)
| | - Tim Janssen
- Brown University School of Public Health Providence
| | - Bryan R Garner
- Ohio State University, The Ohio State University College of Medicine
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20
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Koob GF, Vendruscolo L. Theoretical Frameworks and Mechanistic Aspects of Alcohol Addiction: Alcohol Addiction as a Reward Deficit/Stress Surfeit Disorder. Curr Top Behav Neurosci 2023. [PMID: 37421551 DOI: 10.1007/7854_2023_424] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Alcohol use disorder (AUD) can be defined by a compulsion to seek and take alcohol, the loss of control in limiting intake, and the emergence of a negative emotional state when access to alcohol is prevented. Alcohol use disorder impacts multiple motivational mechanisms and can be conceptualized as a disorder that includes a progression from impulsivity (positive reinforcement) to compulsivity (negative reinforcement). Compulsive drug seeking that is associated with AUD can be derived from multiple neuroadaptations, but the thesis argued herein is that a key component involves the construct of negative reinforcement. Negative reinforcement is defined as drug taking that alleviates a negative emotional state. The negative emotional state that drives such negative reinforcement is hypothesized to derive from the dysregulation of specific neurochemical elements that are involved in reward and stress within basal forebrain structures that involve the ventral striatum and extended amygdala, respectively. Specific neurochemical elements in these structures include decreases in reward neurotransmission (e.g., decreases in dopamine and opioid peptide function in the ventral striatum) and the recruitment of brain stress systems (e.g., corticotropin-releasing factor [CRF]) in the extended amygdala, which contributes to hyperkatifeia and greater alcohol intake that is associated with dependence. Glucocorticoids and mineralocorticoids may play a role in sensitizing the extended amygdala CRF system. Other components of brain stress systems in the extended amygdala that may contribute to the negative motivational state of withdrawal include norepinephrine in the bed nucleus of the stria terminalis, dynorphin in the nucleus accumbens, hypocretin and vasopressin in the central nucleus of the amygdala, and neuroimmune modulation. Decreases in the activity of neuropeptide Y, nociception, endocannabinoids, and oxytocin in the extended amygdala may also contribute to hyperkatifeia that is associated with alcohol withdrawal. Such dysregulation of emotional processing may also significantly contribute to pain that is associated with alcohol withdrawal and negative urgency (i.e., impulsivity that is associated with hyperkatifeia during hyperkatifeia). Thus, an overactive brain stress response system is hypothesized to be activated by acute excessive drug intake, to be sensitized during repeated withdrawal, to persist into protracted abstinence, and to contribute to the compulsivity of AUD. The combination of the loss of reward function and recruitment of brain stress systems provides a powerful neurochemical basis for a negative emotional state that is responsible for the negative reinforcement that at least partially drives the compulsivity of AUD.
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Affiliation(s)
- George F Koob
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA.
| | - Leandro Vendruscolo
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
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21
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Witkiewitz K, Vowles KE. Everybody Hurts: Intersecting and Colliding Epidemics and the Need for Integrated Behavioral Treatment of Chronic Pain and Substance Use. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2023; 32:228-235. [PMID: 37645017 PMCID: PMC10465109 DOI: 10.1177/09637214231162366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Chronic pain and substance use disorders are both common, debilitating, and often persist over the longer term. On their own, each represents a significant health problem, with estimates indicating a substantial proportion of the adult population has chronic pain or a substance use disorder (SUD), and their co-occurrence is increasing. Chronic pain and SUD are also both often invisible, stigmatized disorders and persons with both regularly have difficulty accessing evidence-based treatments, particularly those that offer coordinated and integrated treatment for both conditions. But there is hope. Research is unraveling the mechanisms of chronic pain and substance use, as well as their co-occurrence, integrated behavioral treatment options based on acceptance- and mindfulness-based approaches are increasingly being developed and tested, government agencies are devoting more funds and resources to increase research on chronic pain and SUD, and there have been growing efforts in training, dissemination, and implementation of evidence-based treatments. At the very heart of the matter, though, is to recognize that everybody hurts sometimes, and treatments must empower people to life effectively with these experiences of being human.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance use, And Addictions University of New Mexico
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22
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Cucinello-Ragland JA, Edwards S. The hidden risks of alcohol use for pain relief. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:209-210. [PMID: 36575055 PMCID: PMC9992007 DOI: 10.1111/acer.15005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/28/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Affiliation(s)
| | - Scott Edwards
- Department of Physiology, LSU Health-New Orleans
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health-New Orleans
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23
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Ferguson E, Fiore A, Yurasek AM, Cook RL, Boissoneault J. Association of therapeutic and recreational reasons for alcohol use with alcohol demand. Exp Clin Psychopharmacol 2023; 31:106-115. [PMID: 35201830 PMCID: PMC9399303 DOI: 10.1037/pha0000554] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Motives for alcohol use and behavioral economic measures of demand are associated with alcohol consumption and alcohol-related problems. However, it is unclear how differences in reasons for alcohol use may affect alcohol demand. Additionally, although alcohol is commonly used to self-manage conditions such as pain and sleep problems, the impact of these reasons for alcohol use on alcohol demand is not well characterized. The present study addressed this gap. Participants were adults recruited via Amazon Mechanical Turk as part of a larger study investigating health behaviors. Analyses included participants who reported alcohol use in the past year (N = 637). Participants were categorized as having recreational, therapeutic, or both recreational and therapeutic reasons for using alcohol. A brief, three-item measure of alcohol demand was administered. Multivariate analysis of variance (MANOVA) analyses revealed that alcohol drinkers endorsing both recreational and therapeutic reasons for use had significantly higher average intensity, Omax, and breakpoint indices compared to those who only reported recreational or therapeutic drinking motives (ps < .05; Cohen's d = .09-.17). Secondary analyses revealed differences in demand according to therapeutic reason for alcohol use endorsed. Significant main effects were found for use to relieve pain and anxiety/depression/stress, while interactive effects were detected for use to relieve pain and improve sleep and use to relieve pain and anxiety/depression/stress. Overall, results suggest that alcohol demand is highest in drinkers who consume alcohol for both therapeutic and recreational reasons. This group may be at elevated risk for alcohol use disorder and alcohol-related consequences. Continued research is necessary to examine this possibility. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Erin Ferguson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL USA
| | - Andrew Fiore
- Department of Epidemiology, University of Florida, Gainesville, FL USA
| | - Ali M. Yurasek
- Department of Health Education and Behavior, University of Florida, Gainesville, FL USA
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, FL USA
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL USA
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24
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Ferguson E, Vitus D, Williams M, Anderson M, LaRowe L, Ditre JW, Stennett B, Boissoneault J. Sex differences in associations between delay discounting and expectancies for alcohol analgesia. Exp Clin Psychopharmacol 2022; 30:862-872. [PMID: 34410797 PMCID: PMC8857303 DOI: 10.1037/pha0000517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Self-medication of pain with alcohol is prevalent, and expectancies for alcohol analgesia likely influence pain relief and alcohol consumption. Hazardous alcohol use has been associated with greater delay discounting rates; however, little is known about the relationship between delay discounting and expectancies for alcohol analgesia. Therefore, the present study examined sex differences in associations between delay discounting and expectancies for alcohol analgesia. Healthy drinkers without chronic pain (N = 53) completed measures of expectancies for alcohol analgesia, alcohol use, and alcohol outcome expectancies. A five-trial adjusting-delay discounting task (DDT) for monetary outcomes was also administered. Regression analyses revealed that sex moderated the relationship between delay discounting and expectancies for alcohol analgesia. Steeper delay discounting rates were associated with weaker expectancies for alcohol analgesia among men when adjusting for average alcohol consumption. Among women, nonsignificant associations between delay discounting rates and expectancies for alcohol analgesia were observed. These findings provide initial evidence of sex differences in associations between delay discounting and expectancies for alcohol analgesia. The directionality of these associations was unexpected and may have implications for patterns of self-medication with alcohol. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Erin Ferguson
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University
of Florida, Gainesville, FL USA
| | - Darya Vitus
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University
of Florida, Gainesville, FL USA
| | - Michelle Williams
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University
of Florida, Gainesville, FL USA
| | - Molly Anderson
- Department of Psychology, University of Florida,
Gainesville, FL, USA
| | - Lisa LaRowe
- Department of Psychology, Syracuse University, Syracuse,
NY, USA
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse,
NY, USA
| | - Bethany Stennett
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University
of Florida, Gainesville, FL USA
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University
of Florida, Gainesville, FL USA
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25
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Votaw VR, Tuchman FR, Piccirillo ML, Schwebel FJ, Witkiewitz K. Examining Associations Between Negative Affect and Substance Use in Treatment-Seeking Samples: A Review of Studies Using Intensive Longitudinal Methods. CURRENT ADDICTION REPORTS 2022; 9:445-472. [PMID: 37063461 PMCID: PMC10101148 DOI: 10.1007/s40429-022-00441-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/27/2022]
Abstract
Purpose of Review Understanding dynamic relationships between negative affect and substance use disorder (SUD) outcomes, including craving, may help inform adaptive and personalized interventions. Recent studies using intensive longitudinal methods were reviewed to examine relationships between negative affect and the outcomes of either craving or substance use during and following SUD treatment. Recent Findings Results on associations between negative affect and craving/substance use were mixed and difficult to synthesize, given methodological differences across studies. The strength and direction of these relationships varied across outcomes, subgroups, contexts, and time course. Summary The current literature is mixed concerning negative affect and craving/substance use associations during and following SUD treatment. Researchers should increasingly recruit diverse individuals, for example, samples of varying racial and ethnic backgrounds and those reporting co-occurring disorders and polysubstance use. Experimental, qualitative, and person-specific methods will improve our understanding of relationships between negative affect and substance-related outcomes during SUD treatment.
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Affiliation(s)
- Victoria R Votaw
- Department of Psychology, University of New Mexico, Albuquerque, NM
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM
| | - Felicia R Tuchman
- Department of Psychology, University of New Mexico, Albuquerque, NM
- Department of Psychology, Northwestern University, Evanston, IL
| | | | - Frank J Schwebel
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM
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26
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Vitus D, Williams MK, Rizk M, Neubert JK, Robinson M, Boissoneault J. Analgesic effects of alcohol in adults with chronic jaw pain. Alcohol Clin Exp Res 2022; 46:1515-1524. [PMID: 35989585 PMCID: PMC9427671 DOI: 10.1111/acer.14883] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although recent literature provides promising support for the analgesic properties of alcohol, potential differences in alcohol analgesia as a function of chronic pain status are not well understood. Thus, this study examined chronic pain status as a potential moderator of alcohol analgesia and distinguished between multiple aspects of pain experience and sensitivity: pain threshold, pain intensity, pain unpleasantness, and perceived relief. METHODS Social drinkers with (N = 19) and without (N = 29) chronic jaw pain completed two testing sessions in a counterbalanced order: alcohol (target BrAC = 0.08 g/dl) and placebo. In each, pressure algometry was performed at the insertion of the masseter. Alcohol analgesia was assessed by examining the main and interactive effects of beverage condition, pressure level (4, 5, or 6 pound-feet [lbf]), and chronic jaw pain status (chronic pain vs. pain-free control) on quantitative sensory testing measures and pain relief ratings following noxious stimuli. RESULTS Analyses indicated significant increases in pain threshold and pain relief and reductions in pain unpleasantness and pain intensity, under the alcohol condition. Chronic pain participants demonstrated lower pain thresholds and greater pain intensity and pain unpleasantness ratings than controls. There were no interactive effects of alcohol and pain conditions on any pain measure. CONCLUSIONS Findings provide experimental evidence of alcohol's analgesic and pain-relieving effects and suggest that these effects do not significantly differ by chronic pain status. Individuals, who self-medicate pain via alcohol consumption, irrespective of pain status, may be at increased risk to engage in hazardous drinking patterns and thus experience adverse alcohol-related consequences.
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Affiliation(s)
- Darya Vitus
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, 32610
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, 32610
| | - Michelle K. Williams
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, 32610
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, 32610
| | - Mehdi Rizk
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, 32610
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, 32610
| | - John K. Neubert
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, 32610
- Department of Orthodontics, University of Florida, Gainesville, FL, 32610
| | - Michael Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, 32610
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, 32610
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, 32610
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, 32610
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27
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Bush NJ, Schick MR, Spillane NS, Boissoneault J. Stress Mediates the Association Between Pain and Alcohol Use in College Students. J Pain Res 2022; 15:757-766. [PMID: 35356267 PMCID: PMC8958199 DOI: 10.2147/jpr.s351837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Alcohol use in young adults is highly prevalent and associated with numerous consequences, including academic difficulties and motor vehicle accidents. Pain is one factor that has been increasingly shown to be associated with higher rates of alcohol consumption and riskier patterns of drinking among undergraduate students. Although pain has traditionally been viewed as a lesser concern for young adults, current research demonstrates that pain may be more prevalent in younger populations than originally thought. However, little is known about how common psychosocial factors, such as stress and subjective social status (SSS), influence the association between pain and alcohol consumption in college students. Objective The study's goal was to examine the effect of stress and SSS on the relationship between pain and alcohol consumption. Participants and Methods Participants (N = 445, 39.3% women, Mage = 22.98) were 18- to 25-year-old college students who completed an online questionnaire. Results Pain was significantly associated with total weekly alcohol consumption (r(445) = .22, p < 0.001); this association was significantly mediated by stress (b = 0.15, SE = 0.04, 95% CI = [.07,0.23]). SSS was significantly positively associated with alcohol consumption (r(445) = .22, p < 0.001) but was not found to significantly moderate the relationship between stress and alcohol use. Conclusion Results suggest that efforts to reduce college student alcohol use should include assessment of pain and stress given their association with alcohol consumption. Further, findings suggest that future studies are warranted to prospectively examine pain as an antecedent for alcohol use and to examine the utility of incorporating stress management techniques in pain-focused interventions to indirectly target alcohol use.
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Affiliation(s)
- Nicholas J Bush
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Melissa R Schick
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Nichea S Spillane
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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28
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Pester BD, Edwards RR, Martel MO, Gilligan CJ, Meints SM. Mind-body approaches for reducing the need for post-operative opioids: Evidence and opportunities. JOURNAL OF CLINICAL ANESTHESIA AND INTENSIVE CARE 2022; 3:1-5. [PMID: 36590137 PMCID: PMC9802583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Bethany D. Pester
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Robert R. Edwards
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA,Author for correspondence:
| | - Marc O. Martel
- Faculty of Dentistry and Department of Anesthesiology, McGill University, Montreal, Canada
| | - Christopher J. Gilligan
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Samantha M. Meints
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
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29
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Zale EL, Powers JM, Ditre JW. Cognitive-Affective Transdiagnostic Factors Associated With Vulnerability to Alcohol and Prescription Opioid Use in the Context of Pain. Alcohol Res 2021; 41:08. [PMID: 34306903 PMCID: PMC8289456 DOI: 10.35946/arcr.v41.1.08] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The use of alcohol and prescription opioids is common among people in pain and poses significant public health burdens. This review identifies factors associated with motivation to use alcohol and prescription opioids in the context of pain. Pain-relevant, cognitive-affective, transdiagnostic vulnerability factors-expectancies/motives, pain catastrophizing, pain-related anxiety, distress intolerance, anxiety sensitivity, and perceived interrelations-were selected from theoretical conceptualizations of pain and substance use. Searches conducted in PubMed, PsycINFO, and Embase returned 25 studies that examined associations between identified variables of interest and the use of alcohol and prescription opioids in the context of pain. Consistent with a larger literature on pain and substance use, the studies included in this review demonstrated that people with chronic pain are motivated to use alcohol and opioids in response to negative affect and hold expectancies/motives for coping with pain. Vulnerabilities that engender difficulty managing aversive internal states (distress intolerance and anxiety sensitivity) and maladaptive responses to pain (pain-related anxiety and pain catastrophizing) also were implicated in motivation for alcohol and opioid use. Although one study found that pain-related anxiety was associated with co-use of alcohol and opioids, no studies examined simultaneous use. Future research directions that can explicate causal associations, identify patterns of alcohol and opioid co-use, clarify the role of pain in cessation processes, and inform treatment development are discussed.
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Affiliation(s)
- Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, New York
| | - Jessica M Powers
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, New York
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