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Rogers AH, Palermo TM, Groenewald CB, Murray CB. Adolescent predictors of substance use in young adulthood among individuals with childhood-onset chronic pain: A follow-up study. Eur J Pain 2024. [PMID: 39248201 DOI: 10.1002/ejp.4724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 08/26/2024] [Accepted: 08/29/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Adolescent chronic pain is a substantial public health problem, and pain symptoms often persist into adulthood. Young adults with chronic pain are at elevated risk for more frequent tobacco, alcohol and cannabis use, and cross-sectional research highlights the importance of psychosocial vulnerability factors. Limited research has examined how adolescent predictors, including mental health symptoms, pain, sleep and family functioning, impact later, young adult substance use. METHODS A prospective cohort of 229 young adults (77.3% female; Mage = 21.0, SD = 1.6) with childhood-onset chronic pain completed measurements in adolescence and a follow-up assessment in young adulthood of past 3-month substance use frequency. RESULTS Adolescent sleep quality and male sex were associated with more frequent tobacco use; adolescent depression was associated with more frequent alcohol use, and adolescent pain severity was associated with less frequent, and male sex was associated with more frequent cannabis use. CONCLUSIONS Adolescent predictors of young adult substance use among youth with childhood-onset chronic pain represent important factors that may inform assessment, prevention and treatment of substance use in this population. Identifying and testing psychological interventions that target these vulnerability factors may reduce overall substance use risk in young adulthood. SIGNIFICANCE This prospective observational study of young adults with childhood-onset chronic pain identified adolescent depression and sleep quality as vulnerability factors associated with substance use. Given the increasing risk for substance use during adolescence and young adulthood, these findings highlight the potential importance of early intervention to reduce substance use among young adults with childhood-onset chronic pain.
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Affiliation(s)
- Andrew H Rogers
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Cornelius B Groenewald
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Caitlin B Murray
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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2
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Short NA, Patidar S, Margolies S, Goetzinger A, Chidgey B, Austin AE. Identifying patterns of pain, depression, anxiety, interpersonal trauma exposure, and nonmedical prescription opioid use: Latent class analysis among patients with chronic pain. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:275-282. [PMID: 38092363 PMCID: PMC10988286 DOI: 10.1093/pm/pnad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Chronic pain in the context of certain factors may be associated with potential for nonmedical prescription opioid use; however, identifying this risk can be challenging and complex. Several variables alone have been associated with non-prescribed opioid use, including depression, anxiety, pain interference, and trauma exposure. Prior research has often failed to integrate these assessments together, which is important as these factors may cluster together in important and complex ways. The current study aimed to identify classes of patients with chronic pain who have differential risk for use of nonmedical prescription opioid use, depression and anxiety, and pain severity, interference, and catastrophizing, and interpersonal violence exposure. METHODS Self-report and medical record data from patients (N = 211; Mage = 48, 69.0% women, 69.0% white) at a pain management center were collected. RESULTS Latent class analysis revealed 3 classes with (1) low probability of clinically significant depression, anxiety, pain, and nonmedical prescription opioid use (44.7%), (2) high probability of clinically significant depression, anxiety, pain, pain catastrophizing, trauma, and nonmedical prescription opioid use (41.3%), and (3) high probability of severe pain and nonmedical prescription opioid use (14.0%). CONCLUSIONS High-risk classes had either high levels of depression and anxiety, pain catastrophizing, and interpersonal violence exposure, or pain severity and interference. Future research should continue to explore these classes in large, diverse samples, and prospective study designs. Finally, results underscore that opioid use is complex, not easily identified by a single factor, and may be motivated by complex unmet clinical needs.
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Affiliation(s)
- Nicole A Short
- Department of Psychology, University of Nevada Las Vegas, NV 89154, United States
| | - Seema Patidar
- Department of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill, NC 27599, United States
| | - Skye Margolies
- Department of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill, NC 27599, United States
| | - Amy Goetzinger
- Department of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill, NC 27599, United States
| | - Brooke Chidgey
- Department of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill, NC 27599, United States
| | - Anna E Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC 27599, United States
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, NC 27599, United States
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3
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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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4
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Tam CC, Benotsch EG, Li X, Zhou Y, Shen Z. Prescription Opioid Misuse, Pain Interference, Resilience, and Anxiety Among Chinese People Living with HIV: A Moderated Mediation Model. AIDS Behav 2023; 27:3508-3514. [PMID: 37074629 DOI: 10.1007/s10461-023-04066-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/20/2023]
Abstract
Prescription opioid misuse (POM) is a concern in people living with HIV (PLWH). Pain interference is a robust factor, and its influences would occur through anxiety and resilience. Limited POM studies attend to Chinese PLWH. This study examined POM and its underlying psychological mechanism using data of PLWH with pain (n = 116) from a cohort study in Guangxi. The PROCESS macro was employed to examine a hypothesized moderated mediation model among pain interference, resilience, anxiety, and POM. Results showed 10.3% PLWH engaged in past-three-month POM. After controlling for demographics, HIV-related clinical outcomes, and pain severity, anxiety mediated the association between pain interference and POM (β = 0.46, 95% CI = 0.01 to 10.49), and the mediation was moderated by resilience (moderated mediation index = - 0.02, 95% CI = - 0.784 to - 0.001). Chinese PLWH seem to misuse opioids to cope with pain-related anxiety. Resilience appears to offer protection.
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Affiliation(s)
- Cheuk Chi Tam
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Discovery I, Suite 413, 915 Greene Street, 29208, Columbia, SC, USA.
| | - Eric G Benotsch
- Department of Psychology, Virginia Commonwealth University, 23284, Richmond, VA, PO Box 842018, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Discovery I, Suite 413, 915 Greene Street, 29208, Columbia, SC, USA
| | - Yuejiao Zhou
- Guangxi Zhuang Autonomous Region Center for Diseases Control and Prevention, Nanning, China
| | - Zhiyong Shen
- Guangxi Zhuang Autonomous Region Center for Diseases Control and Prevention, Nanning, China
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5
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Garland EL, Gullapalli BT, Prince KC, Hanley AW, Sanyer M, Tuomenoksa M, Rahman T. Zoom-Based Mindfulness-Oriented Recovery Enhancement Plus Just-in-Time Mindfulness Practice Triggered by Wearable Sensors for Opioid Craving and Chronic Pain. Mindfulness (N Y) 2023; 14:1-17. [PMID: 37362184 PMCID: PMC10205566 DOI: 10.1007/s12671-023-02137-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 06/28/2023]
Abstract
Objective The opioid crisis in the USA remains severe during the COVID-19 pandemic, which has reduced access to evidence-based interventions. This Stage 1 randomized controlled trial (RCT) assessed the preliminary efficacy of Zoom-based Mindfulness-Oriented Recovery Enhancement (MORE) plus Just-in-Time Adaptive Intervention (JITAI) prompts to practice mindfulness triggered by wearable sensors (MORE + JITAI). Method Opioid-treated chronic pain patients (n = 63) were randomized to MORE + JITAI or a Zoom-based supportive group (SG) psychotherapy control. Participants completed ecological momentary assessments (EMA) of craving and pain (co-primary outcomes), as well as positive affect, and stress at one random probe per day for 90 days. EMA probes were also triggered when a wearable sensor detected the presence of physiological stress, as indicated by changes in heart rate variability (HRV), at which time participants in MORE + JITAI were prompted by an app to engage in audio-guided mindfulness practice. Results EMA showed significantly greater reductions in craving, pain, and stress, and increased positive affect over time for participants in MORE + JITAI than for participants in SG. JITAI-initiated mindfulness practice was associated with significant improvements in these variables, as well as increases in HRV. Machine learning predicted JITAI-initiated mindfulness practice effectiveness with reasonable sensitivity and specificity. Conclusions In this pilot trial, MORE + JITAI demonstrated preliminary efficacy for reducing opioid craving and pain, two factors implicated in opioid misuse. MORE + JITAI is a promising intervention that warrants investigation in a fully powered RCT. Preregistration This study is registered on ClinicalTrials.gov (NCT04567043).
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Affiliation(s)
- Eric L. Garland
- University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112 USA
- Salt Lake VA Medical Center, Salt Lake City, USA
| | | | - Kort C. Prince
- University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112 USA
| | - Adam W. Hanley
- University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112 USA
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Yang L, Pan YL, Liu CZ, Guo DX, Zhao X. A retrospective comparative study of local anesthesia only and local anesthesia with sedation for percutaneous endoscopic lumbar discectomy. Sci Rep 2022; 12:7427. [PMID: 35523922 PMCID: PMC9076919 DOI: 10.1038/s41598-022-11393-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/20/2022] [Indexed: 12/28/2022] Open
Abstract
It is still an unsolved problem to achieve both immediate intraoperative feedback and satisfactory surgical experience in percutaneous endoscopic lumbar discectomy under local anesthesia for lumbar disk herniation (LDH) patients. Herein, we compared the analgesic and sedative effects of local anesthesia alone and local anesthesia with conscious sedation in LDH patients during percutaneous endoscopic lumbar discectomy. Ninety-two LDH patients were enrolled and divided into the following groups: control group (Con Group), dexmedetomidine group (Dex Group), oxycodone group (Oxy Group), and dexmedetomidine + oxycodone group (Dex + Oxy Group). Various signs, including mean arterial pressure (MAP), heart rate (HR), pulse oximeter oxygen saturation (SpO2) and Ramsay score, were compared before anesthesia (T1), working cannula establishment (T2), nucleus pulposus removal (T3), and immediately postoperation (T4). Clinical outcomes, including VAS score, operation time, hospitalization period, Macnab criteria, and SF-36 score, were also evaluated. The Dex + Oxy Group showed the most stable MAP and HR at T2 and T3 in all groups. The clinical outcomes, such as VAS, hospitalization period, Macnab criteria, and SF-36 score, have no significant differences among groups (p > 0.05). Local anesthesia combined with conscious sedation is a safe and effective method to improve the surgical experience and achieve satisfying clinical outcomes for LDH patients during percutaneous endoscopic lumbar discectomy.
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Affiliation(s)
- Liu Yang
- Department of Spinal Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, Henan Province, China
| | - Yu-Lin Pan
- Department of Spinal Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, Henan Province, China
| | - Chun-Zhi Liu
- Department of Spinal Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, Henan Province, China
| | - De-Xin Guo
- Department of Spinal Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, Henan Province, China
| | - Xin Zhao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
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Rogers AH, Kauffman BY, Garey L, Asmundson GJ, Zvolensky MJ. Pain-Related Anxiety among Adults with Obesity and Chronic Pain: Relations with Pain, Opioid Misuse, and Mental Health. Behav Med 2022; 48:198-206. [PMID: 33052745 PMCID: PMC8044262 DOI: 10.1080/08964289.2020.1809337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Obesity affect a significant proportion of the population in the United States, and is associated with numerous health consequences including anxiety, depression, and chronic pain. Additionally, pain among adults with obesity has been associated with greater mental health problems and substance use problems. Yet little work has examined psychological vulnerability factors associated with these relations, and pain-related anxiety may be one candidate psychological correlate of these relations. Therefore, the current study examined the association of pain-related anxiety with pain intensity, disability, opioid misuse, anxiety, and depression among 164 adults (81.7% female, Mage = 40.13 years, SD = 10.85) with obesity (MBMI= 37.21, SD = 6.70) and chronic pain. Results suggested that pain-related anxiety was significantly associated with all outcomes, and these results suggest that pain-related anxiety may play an important role in physical health, mental health, and substance use outcomes among adults with obesity and chronic pain.
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Affiliation(s)
| | | | - Lorra Garey
- Department of Psychology, University of Houston
| | | | - Michael J. Zvolensky
- Department of Psychology, University of Houston,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center,HEALTH Institute, University of Houston
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8
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Kauffman BY, Kroeger R, Rogers AH, Garey L, Ditre JW, Zvolensky MJ. Anxiety sensitivity and modifiable cardiovascular disease risk factors: the role of pain intensity among individuals with chronic pain. J Behav Med 2021; 45:297-305. [PMID: 34739661 PMCID: PMC10062191 DOI: 10.1007/s10865-021-00262-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
Chronic pain is often comorbid with modifiable cardiovascular disease risk factors, such as obesity and tobacco use. Among individuals with chronic pain, psychological risk factors may increase pain which, in turn, may increase risk for modifiable cardiovascular disease correlates. Thus, the current study examined the explanatory role of pain intensity in the relationship between anxiety sensitivity and two well-documented modifiable cardiovascular disease risk factors. Participants included 396 adults with chronic pain who completed an online survey from a larger study examining chronic pain-mental health relations. Results revealed that higher levels of anxiety sensitivity were related to higher levels of body mass index (BMI) through greater levels of pain intensity. Bi-directional relations were observed between anxiety sensitivity and pain intensity for tobacco risk. The current study highlights a potential transdiagnostic cognitive vulnerability factor, anxiety sensitivity, which may be an important treatment target to reduce modifiable cardiovascular disease risk factors via reductions in pain intensity.
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Affiliation(s)
- Brooke Y Kauffman
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Ryan Kroeger
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
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9
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Martel MO, Bruneau A, Edwards RR. Mind-body approaches targeting the psychological aspects of opioid use problems in patients with chronic pain: evidence and opportunities. Transl Res 2021; 234:114-128. [PMID: 33676035 DOI: 10.1016/j.trsl.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 12/27/2022]
Abstract
Opioids are commonly prescribed for the management of patients with chronic noncancer pain. Despite the potential analgesic benefits of opioids, long-term opioid therapy (LTOT) may be accompanied by problems such as opioid misuse and opioid use disorder (OUD). In this review, we begin with a description of opioid misuse and OUD and the patient-specific factors associated with these problems among patients with chronic pain. We will focus primarily on highlighting the predominant role played by psychological factors in the occurrence of opioid misuse and OUD in these patients. Several psychological factors have been found to be associated with opioid use problems in patients with chronic pain, and evidence indicates that patients presenting with psychological disturbances are particularly at risk of transitioning to long-term opioid use, engaging in opioid misuse behaviors, and developing OUD. The biological factors that might underlie the association between psychological disturbances and opioid use problems in patients with chronic pain have yet to be fully elucidated, but a growing number of studies suggest that dysfunctions in reward, appetitive, autonomic, and neurocognitive systems might be involved. We end with an overview of specific types of psychological interventions that have been put forward to prevent or reduce the occurrence of opioid misuse and OUD in patients with chronic pain who are prescribed LTOT.
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Affiliation(s)
- Marc O Martel
- Faculty of Dentistry & Department of Anesthesiology, McGill University, Montreal, Canada; Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Alice Bruneau
- Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Robert R Edwards
- Department of Anesthesiology & Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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10
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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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11
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The Relationship between Higher Chronic Opioid Therapy Dose and Specific Personality Traits in Individuals with Chronic Pain. Pain Res Manag 2021; 2021:9946067. [PMID: 34257765 PMCID: PMC8261182 DOI: 10.1155/2021/9946067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/17/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the relationship between opioid use and specific personality traits among individuals with chronic pain stratified by morphine equivalent doses (MEQ). Design Observational cohort study. Setting. Chronic pain outpatient clinic in Canada (2017-2019). Patients. Participants were included if they (1) were at least 18 years old, (2) had been diagnosed with chronic pain (pain >3 months), and (3) were able to read and write in English. Interventions. None. Main Outcome Measures. Completion of the following outcome measures: Acceptance and Action Questionnaire, Anxiety Sensitivity Index, Brief-Coping with Problems Experience 28-item, Brief Pain Inventory Short Form, CAGE-AID substance misuse screening tool, EuroQol-5D, Generalized Anxiety Disorder 7-item, and Patient Health Questionnaire 9-item. One-way analysis of variance compared outcomes between MEQ groups. Results 215 individuals (64.2% female) were included with a mean age of 52.7 ± 11.7 years and time since pain onset of 14.1 ± 10.2 years (range 1-45). There were no significant differences between MEQ groups with respect to sociodemographic and clinical health variables except for gender and employment status and time since pain onset. After controlling for gender, time since pain onset, and average pain severity, patients with MEQ 90+ mg had significantly higher scores for experiential avoidance and anxiety sensitivity in addition to increased pain interference, greater depressive and anxiety symptoms, more dysfunctional coping, and poorer QoL than those with MEQ 1-89 mg or MEQ 0 mg. Conclusions Compared to individuals using no or lower-dose opioids to treat chronic pain, those using high-dose opioids had higher scores on two maladaptive personality traits (i.e., anxiety sensitivity and experiential avoidance) which was associated with poorer mood, greater pain interference, lower quality of life, and dysfunctional coping. These maladaptive personality traits may help to explain how individuals with chronic pain utilize higher doses of opioid analgesics.
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12
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Shepherd JM, Rogers AH, Garey L, Ditre JW, Smit T, Fogle BM, Bakhshaie J, Zvolensky MJ. Tobacco use severity in relation to opioid misuse and dependence among adult tobacco users with chronic pain: The moderating role of pain-related anxiety. Addict Behav 2021; 117:106844. [PMID: 33545622 DOI: 10.1016/j.addbeh.2021.106844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
The opioid epidemic is a significant public health crisis that is often linked to chronic pain management. One ensuing consequence of long-term opioid use for chronic pain is a high potential for opioid misuse and dependence. Although tobacco is commonly used among individuals with chronic pain, it is associated with an increased risk for opioid-related problems. Given the deleterious outcomes of tobacco use in the context of chronic pain, identifying individual difference factors involved in tobacco-opioid relations is of public health importance. Pain-related anxiety, or a tendency to respond to pain sensations with anxiety and fear, maybe an especially important mechanistic factor associated with the relationship between tobacco use severity and opioid misuse. Therefore, the current study examined the moderating role of pain-related anxiety on the relationship between tobacco use severity and opioid misuse and dependence. Participants were 258 tobacco-using adults who endorsed moderate to severe chronic pain and current use of an opioid medication (72.1% female, Mage = 37.19 years, SD = 10.17). Two hierarchical linear regression analyses were conducted to test main and interactive effects of tobacco use severity and pain-related anxiety for current opioid misuse and severity of opioid dependence. Results indicated a significant moderation effect, such that the relationship between tobacco use severity and opioid misuse and dependence was stronger among individuals with higher (but not lower) pain-related anxiety. These findings build upon the extant literature by demonstrating an interactive effect of tobacco use severity and pain-related anxiety in terms of opioid-related outcomes and suggest that current tobacco users with elevated levels of pain-related anxiety may be at increased risk for opioid misuse and dependence.
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Affiliation(s)
| | - Andrew H Rogers
- Department of Psychology, University of Houston, United States
| | - Lorra Garey
- Department of Psychology, University of Houston, United States
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, United States
| | - Tanya Smit
- Department of Psychology, University of Houston, United States
| | - Brienna M Fogle
- Department of Psychology, University of Houston, United States
| | - Jafar Bakhshaie
- Department of Psychiatry, Massachusetts General Hospital, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, United States; HEALTH Institute, University of Houston, United States.
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13
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Chen Z, Wang R, Zhang M, Wang Y, Ren Y. Acupuncture combined with medication for opioid use disorder in adults: a protocol for systematic review and meta-analysis. BMJ Open 2020; 10:e034554. [PMID: 32565455 PMCID: PMC7310998 DOI: 10.1136/bmjopen-2019-034554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/27/2020] [Accepted: 05/06/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Opioid use disorder (OUD) is a worldwide health problem. Clinical trials indicated that acupuncture combined with medication is effective in OUD, however, there are different conclusions presented by previous trials. This study is designed to evaluate the efficacy and safety of acupuncture combined with medication in OUD. METHODS AND ANALYSIS PubMed, CENTRAL, Embase, Web of Science, CINAHL, PsycINFO, ProQuest Dissertation and Theses, AMED, OpenGrey, Clinicaltrials.gov and who.int/trialsearch will be searched in September 2019 without a language restriction. Randomised controlled trials (RCTs) and quasi-RCTs which included participants with OUD receiving acupuncture therapy combined with medication versus control group will be included in this study. Two reviewers will independently screen studies, extract data, assess risk of bias by the Cochrane risk of bias assessment tool and assess quality of evidence by Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Any disagreements will be arbitrated by the third reviewer. Data synthesis and analysis will be conducted by using RevMan V.5.3. Subgroup analyses, sensitivity analysis, meta-regression and reporting bias assessment will be conducted if necessary and appropriate. ETHICS AND DISSEMINATION On account of the nature of this systematic review and meta-analysis, ethical approval is not required. The results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019123436.
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Affiliation(s)
- Zhihan Chen
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rui Wang
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Min Zhang
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yitong Wang
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yulan Ren
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Zvolensky MJ, Shepherd JM, Bakhshaie J, Garey L, Viana AG, Peraza N. Emotion dysregulation and cigarette dependence, perceptions of quitting, and problems during quit attempts among Spanish-speaking Latinx adult smokers. Addict Behav 2019; 96:127-132. [PMID: 31077888 DOI: 10.1016/j.addbeh.2019.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/15/2019] [Accepted: 05/01/2019] [Indexed: 02/08/2023]
Abstract
Latinx smokers in the United States (U.S.) represent an understudied health disparities group in terms of tobacco use. Despite scientific interest to elucidate individual difference risk factors for smoking, there is limited understanding of how emotional dysregulation relates to smoking outcomes among Spanish-speaking Latinx smokers. The purpose of the present investigation was therefore to explore emotion dysregulation in relation to cigarette dependence, perceived barriers for quitting, and severity of problems experienced during prior quit attempts. Participants were 363 Spanish-speaking Latinx daily smokers (58.7% female, Mage = 33.3 years, SD = 9.81). Results indicated that emotion dysregulation was significantly related to cigarette dependence, perceived barriers for quitting, and problems experienced during past quit attempts. Notably, the effects accounted for 7% to 15% of variance and were evident after adjusting for gender, income, education, number of medical conditions, depression symptoms, non-alcohol drug use, and alcohol consumption. The findings provide novel evidence that emotion dysregulation may represent an important individual difference factor for better understanding smoking-related outcomes among Latinx smokers and supports the need for greater attention to this affective vulnerability during smoking cessation treatment.
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