Exploring the Psychometric Properties of the Current Opioid Misuse Measure Among Adults With Chronic Pain and Opioid Use

2020 ◽  
Vol 36 (8) ◽  
pp. 578-583 ◽  
Author(s):  
Andrew H. Rogers ◽  
Matthew W. Gallagher ◽  
Robert N. Jamison ◽  
Michael J. Zvolensky
Keyword(s):  
Chronic Pain ◽  
Psychometric Properties ◽  
Opioid Misuse ◽  
Opioid Use

scholarly journals Social Media as an Emerging Tool for Reducing Prescription Opioid Misuse Risk Factors (Preprint)

2018 ◽  
Author(s):  
Sean Young ◽  
Sung-Jae Lee ◽  
Hendry Perez ◽  
Navkiran Gill ◽  
Lillian Gelberg ◽  
...  
Keyword(s):  
Social Media ◽  
Chronic Pain ◽  
Online Community ◽  
Prescription Opioid ◽  
Control Group ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Online Behavior ◽  
Prescription Opioid Misuse

BACKGROUND Interventions are urgently needed to reduce prescription opioid misuse risk factors, including anxiety and concomitant use of sedatives. However, only 5 randomized controlled opioid intervention trials have been conducted, with none showing improvements in anxiety. OBJECTIVE We sought to determine the feasibility of using an online behavior change community, compared to a control Facebook group, to reduce anxiety and opioid misuse among chronic pain patients. METHODS 51 high-risk non-cancer chronic pain patients were randomly assigned to either a Harnessing Online Peer Education (HOPE) peer-led online behavior change intervention or a control group (no peer leaders) on Facebook for 12 weeks. Inclusion criteria were: 18 years or older, a UCLA Health System patient, prescribed an opioid for non-cancer chronic pain between 3 and 12 months ago, and a score of ≥ 9 on the Current Opioid Misuse Measure (COMM) and/or concomitant use of benzodiazepines. Participation in the online community was voluntary. Patients completed baseline and follow-up assessments on Generalized Anxiety Disorder screener (GAD-7), COMM, and frequency of social media discussions about pain and opioid use. RESULTS Compared to control group participants, intervention participants showed a baseline-to-follow-up decrease in anxiety, and more frequently used social media to discuss pain, prescription opioid use, coping strategies, places to seek help, and alternative therapies for pain. Both groups showed a baseline to follow-up decrease in COMM score. CONCLUSIONS Results support the feasibility of using an online community interventions as a low-cost tool to decrease risk for prescription opioid misuse and its complications. CLINICALTRIAL ClinicalTrials.gov: NCT02735785

Psychosocial interventions for chronic pain and comorbid prescription opioid use disorders: A narrative review of the literature

2018 ◽  
Vol 14 (5) ◽  
pp. 345-358 ◽  
Author(s):  
Valerie Hruschak, MSW ◽  
Gerald Cochran, PhD ◽  
Ajay D. Wasan, MD, MSc
Keyword(s):  
Chronic Pain ◽  
Psychosocial Interventions ◽  
Treatment Modalities ◽  
Prescription Opioid ◽  
Future Research ◽  
Motivational Enhancement Therapy ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Opioid Use Disorders

Objective: Opioid misuse in the context of chronic noncancer pain (CNCP) is a multifaceted and complex issue. As opioid misuse and corresponding rates of addiction and overdose deaths exceed epidemic proportions, there is an urgent need for research in this area. The objective of this review is to evaluate the literature addressing psychosocial interventions targeting CNCP and prescription opioid misuse.Design: A systematic search of PubMed, MEDLINE, PsychINFO, ClinicalTrials. gov was conducted to identify studies evaluating psychosocial interventions targeting CNCP and prescription opioid misuse. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Results: 56 peer-reviewed research articles from 1993 to July, 2016, which included studies of psychosocial interventions for CNCP and opioid use disorders. Studies that examined psychosocial interventions for CNCP, treatment modalities included: cognitive behavioral therapy (CBT), acceptance and commitment therapy, mindfulness-based cognitive therapy and mindfulness-based stress reduction, and chronic pain self-management programs. The psychosocial interventions for opioid misuse included: CBT and relapse prevention, motivational enhancement therapy and stages of change, contingency management, and self-help and peer support-based groups.Conclusions: The findings of this review offer clinical insight and reinforce the importance of psychosocial interventions in CNCP and opioid use disorders. However, little empirical data are available to guide practitioners in treating patients with CNCP who misuse opioid medications, and thus future research on integrated approaches, is needed.

scholarly journals Anhedonia in chronic pain and prescription opioid misuse

2019 ◽  
Vol 50 (12) ◽  
pp. 1977-1988 ◽  
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.

scholarly journals Anhedonia in chronic pain and prescription opioid misuse

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.

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

2019 ◽  
Author(s):  
Ryan Carpenter ◽  
Sean Patrick Lane ◽  
Stephen Bruehl ◽  
Timothy J Trull
Keyword(s):  
Chronic Pain ◽  
Negative Affect ◽  
Multilevel Models ◽  
Negative Reinforcement ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Opioid Dose ◽  
Chronic Pain Patients ◽  
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)

Borderline Personality Disorder Features and Risk for Prescription Opioid Misuse in a Chronic Pain Sample: Roles for Identity Disturbances and Impulsivity

2019 ◽  
pp. 1-18 ◽  
Author(s):  
Caleb J. Reynolds ◽  
Noel Vest ◽  
Sarah L. Tragesser
Keyword(s):  
Chronic Pain ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Chronic Pain Patients ◽  
Prescription Opioid Misuse ◽  
Pain Patients

Although borderline personality disorder (BPD) is associated with both chronic pain and substance abuse, little research examines how BPD features in chronic pain patients may constitute a risk factor for misuse of prescription opioids, and no prior research has examined which particular component(s) of BPD might put chronic pain patients at risk—an oversight that undermines prevention and treatment of such problematic opioid use. In a cross-sectional study of patients in treatment for chronic pain (N = 147), BPD features were associated with several measures of prescription opioid misuse, even controlling for pain severity and interference. Specifically, the identity disturbances and self-harmful impulsivity facets of BPD were most consistently associated with opioid misuse, and exploratory analyses suggested that these factors may be interactive in their effects. Together, these results suggest that BPD features—especially unstable identity and self-harmful impulsivity—play a unique role in problematic prescription opioid use in chronic pain settings.

Managing Pain in Patients with a History of a Substance Use Disorder

2018 ◽  
Author(s):  
Martin D. Cheatle
Keyword(s):  
Chronic Pain ◽  
Substance Use ◽  
Opioid Use Disorder ◽  
Mitigation Strategies ◽  
Scholarly Activity ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Health Crisis ◽  
Prescription Opioid Misuse

Patients with chronic pain tend to be complex and can present with multiple comorbidities, including anxiety, depression, functional disabilities, and substance misuse or abuse. The burgeoning rate of prescription opioid misuse and abuse and opioid-related fatalities has generated a great deal of scholarly activity on understanding the etiology of opioid misuse/abuse and developing risk assessment and mitigation strategies to curb this public health crisis. Balancing effective pain management and reducing the risk of opioid misuse/abuse and diversion can be a daunting endeavor, as is controlling pain in patients with pain and concomitant substance use disorders. This chapter provides an overview of the prevalence of opioid misuse/abuse in patients with chronic pain. It covers pharmacologic and nonpharmacologic therapies for patients with pain and co-occurring opioid use disorder and also discusses the challenges and opportunities to improve pain care and reduce misuse and abuse of opioids.

Retrospective analysis on the effect of spinal cord stimulation on opioid consumption

2020 ◽  
Author(s):  
Awinita Barpujari ◽  
Michael A Erdek
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Retrospective Analysis ◽  
Spinal Cord Stimulation ◽  
Alternative Therapy ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Number Of Patients ◽  
Chronic Pain Conditions ◽  
Post Trial

Aim: Spinal cord stimulation (SCS) is used to clinically manage and/or treat several chronic pain etiologies. A limited amount is known about the influence on patients' use of opioid pain medication. This retrospective analysis evaluated SCS effect on opioid consumption in patients presenting with chronic pain conditions. Materials & methods: Sixty-seven patients underwent a temporary trial device, permanent implant or both. Patients were divided for assessment based on the nature of their procedure(s). Primary outcome was change in morphine equivalent dose (MED), ascertained from preoperative and postoperative medication reports. Results: Postoperative MED was significantly lower in patients who received some form of neuromodulation therapy. Pretrial patients reported an average MED of 41.01 ± 10.23 mg per day while post-trial patients reported an average of 13.30 ± 5.34 mg per day (p < 0.001). Pre-implant patients reported an average MED of 39.14 ± 13.52 mg per day while post-implant patients reported an average MED of 20.23 ± 9.01 mg per day (p < 0.001). There were no significant differences between pre-trial and pre-implant MED, nor between post-trial and post-implant MED. Of the 42 study subjects who reported some amount of pre-intervention opioid use, 78.57% indicated a lower MED (n = 33; p < 0.001), 16.67% indicated no change (n = 7) and 4.76% (n = 2) indicated a higher MED, following intervention. Moreover, SCS therapy resulted in a 26.83% reduction (p < 0.001) in the number of patients with MED >50 mg per day. Conclusion: Spinal cord stimulation may reduce opioid use when implemented appropriately. Neuromodulation may represent alternative therapy for alleviating chronic pain which may avoid a number of deleterious side effects commonly associated with opioid consumption.

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