Prescription opioid misusing chronic pain patients exhibit dysregulated context-dependent associations: Investigating associative learning in addiction with the cue-primed reactivity task

Abstract Background Among opioid-treated chronic pain patients, deficient response inhibition in the context of emotional distress may contribute to maladaptive pain coping and prescription opioid misuse. Interventions that aim to bolster cognitive control and reduce emotional reactivity (e.g., mindfulness) may remediate response inhibition deficits, with consequent clinical benefits. Purpose To test the hypothesis that a mindfulness-based intervention, Mindfulness-Oriented Recovery Enhancement (MORE), can reduce the impact of clinically relevant, negative affective interference on response inhibition function in an opioid-treated chronic pain sample. Methods We examined data from a controlled trial comparing adults with chronic pain and long-term prescription opioid use randomized to either MORE (n = 27) treatment or to an active support group comparison condition (n = 30). Participants completed an Emotional Go/NoGo Task at pre- and post-treatment, which measured response inhibition in neutral and clinically relevant, negative affective contexts (i.e., exposure to pain-related visual stimuli). Results Repeated-measures analysis of variance indicated that compared with the support group, participants in MORE evidenced significantly greater reductions from pre- to post-treatment in errors of commission on trials with pain-related distractors relative to trials with neutral distractors, group × time × condition F(1,55) = 4.14, p = .047, η2partial = .07. Mindfulness practice minutes and increased nonreactivity significantly predicted greater emotional response inhibition. A significant inverse association was observed between improvements in emotional response inhibition and treatment-related reductions in pain severity by 3-month follow-up. Conclusions Study results provide preliminary evidence that MORE enhances inhibitory control function in the context of negative emotional interference.

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Prevalence of Prescription Opioid-Use Disorder Among Chronic Pain Patients: Comparison of the DSM-5 vs. DSM-4 Diagnostic Criteria

Journal of Addictive Diseases ◽

10.1080/10550887.2011.581961 ◽

2011 ◽

Vol 30 (3) ◽

pp. 185-194 ◽

Cited By ~ 94

Author(s):

Joseph A. Boscarino ◽

Margaret R. Rukstalis ◽

Stuart N. Hoffman ◽

John J. Han ◽

Porat M. Erlich ◽

...

Keyword(s):

Chronic Pain ◽

Diagnostic Criteria ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Opioid Use ◽

Dsm 5 ◽

Chronic Pain Patients ◽

Prescription Opioid Use ◽

Pain Patients

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Supplemental Material for Concurrent and Lagged Associations of Prescription Opioid Use With Pain and Negative Affect in the Daily Lives of Chronic Pain Patients

Journal of Consulting and Clinical Psychology ◽

10.1037/ccp0000402.supp ◽

2019 ◽

Keyword(s):

Chronic Pain ◽

Negative Affect ◽

Prescription Opioid ◽

Opioid Use ◽

Daily Lives ◽

Chronic Pain Patients ◽

Prescription Opioid Use ◽

Pain Patients

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Physicians' Role in Curbing the Worst Drug Crisis in America: Prescription Opioid Abuse

10.2310/fm.15031 ◽

2018 ◽

Author(s):

Sairam Atluri ◽

Gururau Sudarshan

Keyword(s):

Chronic Pain ◽

Opioid Abuse ◽

Screening Tools ◽

Prescription Drug Abuse ◽

Prescription Opioid ◽

Dose Limitation ◽

Chronic Pain Patients ◽

Urine Drug ◽

Pain Patients ◽

Prescription Opioid Abuse

Opioids have an important role in the management of acute, cancer, and chronic pain. However, their indiscriminate use in chronic pain has led, in part, to the epidemic of prescription drug abuse, resulting in a dramatic increase in morbidity and mortality in America. Most of this abuse originates from legitimate prescriptions by physicians. Prescribing opioids to chronic pain patients while restricting them to those who abuse them is very challenging, and physicians seek appropriate and unbiased prescribing guidelines. Our review, based on analysis of the available literature, focuses on striking a balance between overprescribing and underprescribing. The core concept of this strategy relies in using screening tools to identify patients who are at high risk for opioid abuse along with diligent monitoring using prescription monitoring programs and urine drug screens, while also limiting opioid doses. Hopefully, using these principles, physicians can more confidently prescribe opioids to those who would benefit from these powerful drugs and at the same time keep opioids away from those who could potentially be harmed. Key Words: abuse, addiction, chronic pain, dose limitation, misuse, monitoring, opioids, overdose, screening

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Physicians' Role in Curbing the Worst Drug Crisis in America: Prescription Opioid Abuse

10.2310/tywc.15031 ◽

2018 ◽

Author(s):

Sairam Atluri ◽

Gururau Sudarshan

Keyword(s):

Chronic Pain ◽

Opioid Abuse ◽

Screening Tools ◽

Prescription Drug Abuse ◽

Prescription Opioid ◽

Dose Limitation ◽

Chronic Pain Patients ◽

Urine Drug ◽

Pain Patients ◽

Prescription Opioid Abuse

Opioids have an important role in the management of acute, cancer, and chronic pain. However, their indiscriminate use in chronic pain has led, in part, to the epidemic of prescription drug abuse, resulting in a dramatic increase in morbidity and mortality in America. Most of this abuse originates from legitimate prescriptions by physicians. Prescribing opioids to chronic pain patients while restricting them to those who abuse them is very challenging, and physicians seek appropriate and unbiased prescribing guidelines. Our review, based on analysis of the available literature, focuses on striking a balance between overprescribing and underprescribing. The core concept of this strategy relies in using screening tools to identify patients who are at high risk for opioid abuse along with diligent monitoring using prescription monitoring programs and urine drug screens, while also limiting opioid doses. Hopefully, using these principles, physicians can more confidently prescribe opioids to those who would benefit from these powerful drugs and at the same time keep opioids away from those who could potentially be harmed. Key Words: abuse, addiction, chronic pain, dose limitation, misuse, monitoring, opioids, overdose, screening

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Behavioral preference for viewing drug v. pleasant images predicts current and future opioid misuse among chronic pain patients

Psychological Medicine ◽

10.1017/s0033291719000461 ◽

2019 ◽

Vol 50 (4) ◽

pp. 644-652 ◽

Cited By ~ 1

Author(s):

Scott J. Moeller ◽

Adam W. Hanley ◽

Eric L. Garland

Keyword(s):

Chronic Pain ◽

Choice Behavior ◽

Longitudinal Design ◽

Choice Task ◽

Prescription Opioid ◽

Opioid Misuse ◽

Chronic Pain Patients ◽

Pain Patients ◽

Insight Into

AbstractBackgroundThe USA is currently enduring an opioid crisis. Identifying cost-effective, easy-to-implement behavioral measures that predict treatment outcomes in opioid misusers is a crucial scientific, therapeutic, and epidemiological goal.MethodsThe current study used a mixed cross-sectional and longitudinal design to test whether a behavioral choice task, previously validated in stimulant users, was associated with increased opioid misuse severity at baseline, and whether it predicted change in opioid misuse severity at follow-up. At baseline, data from 100 prescription opioid-treated chronic pain patients were analyzed; at follow-up, data were analyzed in 34 of these participants who were non-misusers at baseline. During the choice task, participants chose under probabilistic contingencies whether to view opioid-related images in comparison with affectively pleasant, unpleasant, and neutral images. Following previous procedures, we also assessed insight into choice behavior, operationalized as whether (yes/no) participants correctly self-reported the image category they chose most often.ResultsAt baseline, the higher choice for viewing opioid images in direct comparison with pleasant images was associated with opioid misuse and impaired insight into choice behavior; the combination of these produced especially elevated opioid-related choice behavior. In longitudinal analyses of individuals who were initially non-misusers, higher baseline opioid v. pleasant choice behavior predicted more opioid misuse behaviors at follow-up.ConclusionsThese results indicate that greater relative allocation of behavior toward opioid stimuli and away from stimuli depicting natural reinforcement is associated with concurrent opioid misuse and portends vulnerability toward future misuse. The choice task may provide important medical information to guide opioid-prescribing practices.

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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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