Risk for opioid misuse in chronic pain patients is associated with endogenous opioid system dysregulation

Abstractµ-Opioid receptors (MOR) are a major target of endogenous and exogenous opioids, including opioid pain medications. The µ-opioid neurotransmitter system is heavily implicated in the pathophysiology of chronic pain and opioid use disorder and, as such, central measures of µ-opioid system functioning are increasingly being considered as putative biomarkers for risk to misuse opioids. To explore the relationship between MOR system function and risk for opioid misuse, 28 subjects with chronic nonspecific back pain completed a clinically validated measure of opioid misuse risk, the Pain Medication Questionnaire (PMQ), and were subsequently separated into high (PMQ > 21) and low (PMQ ≤ 21) opioid misuse risk groups. Chronic pain patients along with 15 control participants underwent two separate [11C]-carfentanil positron emission tomography scans to explore MOR functional measures: one at baseline and one during a sustained pain-stress challenge, with the difference between the two providing an indirect measure of stress-induced endogenous opioid release. We found that chronic pain participants at high risk for opioid misuse displayed higher baseline MOR availability within the right amygdala relative to those at low risk. By contrast, patients at low risk for opioid misuse showed less pain-induced activation of MOR-mediated, endogenous opioid neurotransmission in the nucleus accumbens. This study links human in vivo MOR system functional measures to the development of addictive disorders and provides novel evidence that MORs and µ-opioid system responsivity may underlie risk to misuse opioids among chronic pain patients.

Validation and Cross-Cultural Adaptation of the Spanish Version of the Pain Sensitivity Questionnaire (PSQ-S)

Experimental pain testing requires specific equipment and may be uncomfortable for patients. The Pain Sensitivity Questionnaire (PSQ) was developed to assess pain sensitivity, based on the pain intensity ratings (range: 0–10) of painful situations that occur in daily life. The main objective of this study was to carry out a cross-cultural adaptation and validation of the Spanish version of the PSQ (PSQ-S). A total of 354 subjects (296 healthy and 58 chronic pain patients) filled in the PSQ-S. A subgroup of 116 subjects performed experimental pain testing, including two modalities (cold and pressure), with different measures: pain intensity rating, pressure pain threshold, and tolerance. The validation results showed two factors: PSQ-S-moderate and PSQ-S-minor and, for the total scale and the two factors, an excellent internal consistency (Cronbach’s alpha coefficient > 0.9) and a substantial reliability (Intraclass Correlation Coefficient > 0.8). We obtained strong correlations with all the experimental pain rating parameters, catastrophizing, and depression variables, as well as moderate correlations with anxiety, central sensibilization, and impact on the quality of life. Chronic pain patients received elevated PSQ-S scores compared to healthy controls, and three cut-off values (PSQ-S-total = 7.00, PSQ-S-moderate = 7.57, and PSQ-S-minor = 6.29) based on ROC curve analyses were shown to be able to discriminate between healthy adults and adults with chronic pain. Therefore, PSQ-S may be a simple alternative to experimental pain procedures for clinical and experimental pain research.

Keep Your Hopes Up: An Examination of Racial Differences in the Association Between Hope and Pain

Hope has been associated with increased pain tolerance (Snyder et al., 2005) and has been incorporated in interventions targeting chronic pain (Howell et al., 2015; Katsimigos et al., 2020). Research suggests that African Americans with osteoarthritis (OA) pain experience greater pain severity and disability compared to non-Hispanic White individuals (Vaughn et al., 2019). Although the literature is limited, there is some evidence to suggest racial/ethnic differences in hope (Chang & Banks, 2007). The current study examined race as a moderator of the association between hope and pain in a sample of older adults. Experience sampling (ESM) data was used from a multi-site study examining non-Hispanic White and African American individuals with knee osteoarthritis (OA). Participants completed the Adult Hope Scale (Snyder et al., 1991) during baseline interviews and self-reported momentary pain during 28 ESM calls. Multilevel models revealed a significant interaction between hope and race (p = .04). Specifically, greater hope was associated with decreased momentary pain, and this association was stronger for African American compared to non-Hispanic White individuals. Results suggest that high levels of hope may be particularly protective for African American chronic pain patients. These findings can help inform existing and future interventions focused on enhancing hope in chronic pain populations. (Supported by AG041655, P. Parmelee and D. Smith, Co-PIs)

A(pp)ceptance: Increasing physicians’ acceptance for chronic pain apps (Preprint)

BACKGROUND Chronic pain is one of the most costly and widespread medical conditions in the world. Despite effective forms of treatment, there is an urgent need to optimize therapies. Studies on the effectiveness of health apps for chronic pain patients are increasing and show promising results as a treatment adjunct or stand-alone treatment. Nevertheless, physicians’ acceptance of electronic health interventions has been somewhat reluctant, resulting in low prescription rates of health apps. OBJECTIVE The aim of our study was to determine and enhance physicians’ acceptance, performance expectancy and credibility of health apps for chronic pain patients. We further investigated predictors of acceptance. METHODS In a repeated measures design, 248 physicians were randomly assigned to either an experimental group (short educational video about health apps) or a control group (short video about chronic pain). Primary outcome measure was acceptance. Performance expectancy and the credibility of health apps were secondary outcomes. In addition, we assessed 101 medical students to evaluate the effectiveness of the video intervention in young professionals. RESULTS In general, physicians' acceptance of health apps for chronic pain patients was moderate (M=9.51, SD=3.53, scale ranges from 3-15). All primary and secondary outcomes were enhanced by the video intervention: A repeated-measures ANOVA yielded a significant interaction effect for acceptance (F(1, 246)=15.28, P=.01), performance expectancy (F(1, 246)=6.10, P=.01) and credibility (F(1, 246)=25.61, P<.001). The same pattern of results was evident among medical students. Linear regression analysis revealed credibility (β=.34, P<.001) and performance expectancy (β .30, P<.001) as the two strongest factors influencing acceptance, followed by skepticism (β=-.18, P<.001) and intuitive appeal (β=.11, P=.03). CONCLUSIONS Physicians’ acceptance of health apps was moderate, and was strengthened by a three minutes video. Besides performance expectancy, credibility seems to be a promising factor associated with acceptance. Future research should focus on ways to implement acceptability-increasing interventions into routine care. CLINICALTRIAL Open Science Framework: https://osf.io/x693r Registration DOI: 10.17605/OSF.IO/X693R

The Impact of Multidisciplinary Conferences on Healthcare Utilization in Chronic Pain Patients

Approximately 100 million adults in the United States have chronic pain, though only a subset utilizes the vast majority of healthcare resources. Multidisciplinary care has been shown to improve outcomes in a variety of clinical conditions. There is concern that multidisciplinary care of chronic pain patients may overwhelm existing resources and increase healthcare utilization due to the volume of patients and the complexity of care. We report our findings on the use of multidisciplinary conferences (MDC) to facilitate care for the most complex patients seen at our tertiary center. Thirty-two of nearly 2,000 patients seen per year were discussed at the MDC, making up the top 2% of complex patients in our practice. We evaluated patients' numeric rating score (NRS) of pain, medication use, hospitalizations, emergency department visits, and visits to pain specialists prior to their enrollment in MDC and 1 year later. Matched samples were compared using Wilcoxon's signed rank test. Patients' NRS scores significantly decreased from 7.64 to 5.54 after inclusion in MDC (p &lt; 0.001). A significant decrease in clinic visits (p &lt; 0.001) and healthcare utilization (p &lt; 0.05) was also observed. Opioid and non-opioid prescriptions did not change significantly (p = 0.43). 83% of providers agreed that MDC improved patient care. While previous studies have shown the effect of multi-disciplinary care, we show notable improvements with a team established around a once-a-month MDC.

Severe urinary retention secondary to intrathecal morphine pain pump: a case report

An elderly female with multiple comorbidities presented with acute onset of severe urinary retention immediately following placement of an intrathecal morphine pain pump. This case highlights the need to closely monitor chronic pain patients with complex medical histories who may be uniquely predisposed to opioid-mediated severe urinary retention.