Concurrent and lagged associations of prescription opioid use with pain and negative affect in the daily lives of chronic pain patients.

Objective: Prescribed opioids for chronic pain management contribute significantly to the opioid crisis. There is a need to understand the real-world benefits that, despite risks, lead chronic pain patients to persist in opioid use. Negative reinforcement models of addiction posit that individuals use substances to reduce aversive states but have seldom been applied to prescribed opioids. Using ecological momentary assessment, we examined reciprocal associations between opioid use and physical pain, for which opioids are prescribed, and negative affect (NA), for which they are not. Method: Chronic low back pain patients on long-term opioid therapy (n = 34) without significant past-year opioid misuse reported multiple times daily via smartphone over 2 weeks (nobservations = 2,285). We hypothesized that pain and NA would be positively associated with subsequent opioid use, and that use would be negatively associated with subsequent pain and NA. Results: Time-lagged multilevel models indicated that participants were more likely to use opioids and in larger doses following elevated pain and NA. There was also an interaction of concurrent pain and NA on opioid dose. In turn, participants reported reduced pain and NA following larger doses. Additionally, individuals at high risk for opioid misuse, compared with low risk, took larger doses following pain, but also experienced smaller subsequent pain and NA reductions. Conclusions: Opioid use was bidirectionally associated with pain and NA. Findings fit negative reinforcement models associated with risk of developing opioid use disorder. Educating patients and providers about negative reinforcement may help reduce opioid use and opioid-associated risks. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

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Patients with Substance Abuse and Chronic Pain

10.1093/med/9780190271787.003.0032 ◽

2018 ◽

Author(s):

Dmitri Souza ◽

Denis Snegovskikh ◽

Julia K. Hunter

Keyword(s):

Substance Abuse ◽

Chronic Pain ◽

Multimodal Analgesia ◽

Pain Tolerance ◽

Prescription Opioid ◽

Opioid Use ◽

Medication Assisted Treatment ◽

Chronic Pain Patients ◽

Prescription Opioid Use ◽

Pain Patients

Treating chronic pain in patients with a substance abuse history is challenging. Patients abusing opioids may have a high pain tolerance, making pain control difficult. Available treatments for acute pain include regional and multimodal analgesia. Non-opioid and nonpharmacological analgesia (including interventional modalities, physical rehabilitation, chiropractic manipulations, and pain psychology) can be used to treat chronic pain. Patients’ past and present opioid use—illicit drug or nonmedical prescription opioid use, maintenance on medication-assisted treatment, or abstinence—should be taken into consideration when choosing between chronic pain treatments. Consultation with an addictionologist can facilitate this population’s successful treatment.

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Evaluation and comparison of tools for diagnosing problematic prescription opioid use among chronic pain patients

International Journal of Methods in Psychiatric Research ◽

10.1002/mpr.1542 ◽

2016 ◽

Vol 26 (4) ◽

pp. e1542 ◽

Cited By ~ 1

Author(s):

Merav Kovatch ◽

Daniel Feingold ◽

Odelia Elkana ◽

Shaul Lev-Ran

Keyword(s):

Chronic Pain ◽

Prescription Opioid ◽

Opioid Use ◽

Chronic Pain Patients ◽

Prescription Opioid Use ◽

Pain Patients

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Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study

PLoS ONE ◽

10.1371/journal.pone.0187795 ◽

2017 ◽

Vol 12 (11) ◽

pp. e0187795 ◽

Cited By ~ 40

Author(s):

Jacob M. Vigil ◽

Sarah S. Stith ◽

Ian M. Adams ◽

Anthony P. Reeve

Keyword(s):

Chronic Pain ◽

Cohort Study ◽

Prescription Opioid ◽

Medical Cannabis ◽

Opioid Use ◽

Chronic Pain Patients ◽

Prescription Opioid Use ◽

Pain Patients

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Anhedonia in chronic pain and prescription opioid misuse

Psychological Medicine ◽

10.1017/s0033291719002010 ◽

2019 ◽

Vol 50 (12) ◽

pp. 1977-1988 ◽

Cited By ~ 5

Author(s):

Eric L. Garland ◽

Martin Trøstheim ◽

Marie Eikemo ◽

Gernot Ernst ◽

Siri Leknes

Keyword(s):

Chronic Pain ◽

Large Scale ◽

Reward Processing ◽

Pain Severity ◽

Prescription Opioid ◽

Opioid Misuse ◽

Opioid Use ◽

Study Results ◽

Chronic Pain Patients ◽

Pain Patients

AbstractBackgroundBoth acute and chronic pain can disrupt reward processing. Moreover, prolonged prescription opioid use and depressed mood are common in chronic pain samples. Despite the prevalence of these risk factors for anhedonia, little is known about anhedonia in chronic pain populations.MethodsWe conducted a large-scale, systematic study of anhedonia in chronic pain, focusing on its relationship with opioid use/misuse, pain severity, and depression. Chronic pain patients across four distinct samples (N = 488) completed the Snaith–Hamilton Pleasure Scale (SHAPS), measures of opioid use, pain severity and depression, as well as the Current Opioid Misuse Measure (COMM). We used a meta-analytic approach to determine reference levels of anhedonia in healthy samples spanning a variety of countries and diverse age groups, extracting SHAPS scores from 58 published studies totaling 2664 psychiatrically healthy participants.ResultsCompared to healthy samples, chronic pain patients showed higher levels of anhedonia, with ~25% of patients scoring above the standard anhedonia cut-off. This difference was not primarily driven by depression levels, which explained less than 25% of variance in anhedonia scores. Neither opioid use duration, dose, nor pain severity alone was significantly associated with anhedonia. Yet, there was a clear effect of opioid misuse, with opioid misusers (COMM ⩾13) reporting greater anhedonia than non-misusers. Opioid misuse remained a significant predictor of anhedonia even after controlling for pain severity, depression and opioid dose.ConclusionsStudy results suggest that both chronic pain and opioid misuse contribute to anhedonia, which may, in turn, drive further pain and misuse.

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Anhedonia in chronic pain and prescription opioid misuse

10.31234/osf.io/ghrdb ◽

2019 ◽

Author(s):

Eric Garland ◽

Martin Trøstheim ◽

Marie Eikemo ◽

Gernot Ernst ◽

Siri Leknes

Keyword(s):

Chronic Pain ◽

Large Scale ◽

Age Groups ◽

Reward Processing ◽

Pain Severity ◽

Prescription Opioid ◽

Opioid Misuse ◽

Opioid Use ◽

Chronic Pain Patients ◽

Pain Patients

BACKGROUND:Both acute and chronic pain can disrupt reward processing. Moreover, prolonged prescription opioid use and depressed mood are common in chronic pain samples. Despite the prevalence of these risk factors for anhedonia, little is known about anhedonia in chronic pain populations.METHODS:We conducted a large-scale, systematic study of anhedonia in chronic pain, focusing on its relationship with opioid use/misuse, pain severity, and depression. Chronic pain patients across four distinct samples (N = 488) completed the Snaith-Hamilton Pleasure Scale (SHAPS), measures of opioid use, pain severity and depression, as well as the Current Opioid Misuse Measure (COMM). We used a meta-analytic approach to determine reference levels of anhedonia in healthy samples spanning a variety of countries and diverse age groups, extracting SHAPS scores from 58 published studies totaling 2664 psychiatrically healthy participants.RESULTS:Compared to healthy samples, chronic pain patients showed higher levels of anhedonia, with ~25% of patients scoring above the standard anhedonia cut-off. This difference was not primarily driven by depression levels, which explained less than 25% of variance in anhedonia scores. Neither opioid use duration, dose, nor pain severity alone was significantly associated with anhedonia. Yet, there was a clear effect of opioid misuse, with opioid misusers (COMM ⩾13) reporting greater anhedonia than non-misusers. Opioid misuse remained a significant predictor of anhedonia even after controlling for pain severity, depression and opioid dose.CONCLUSIONS:Study results suggest that both chronic pain and opioid misuse contribute to anhedonia, which may, in turn, drive further pain and misuse.

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