Sunday, April 3, 2016

Day-To-Day Pain Symptoms Are Only Weakly Associated with Opioid Craving among Patients with Chronic Pain Prescribed Opioid Therapy

  • There is a weak association between chronic pain intensity and opioid craving.
  • Patients do not crave opioids simply because they experience high levels of pain.
  • Opioid craving is heightened among patients with a history of substance use problems.
  • Opioid craving is also heightened among patients with high levels of negative affect.
Over the past decade, there has been a substantial rise in the use of opioids for the treatment of chronic noncancer pain. Despite the potential benefits of opioid therapy, the rise in the use of opioids has been accompanied by escalating rates of prescription opioid misuse and addiction. There is now a growing body of evidence indicating that opioid craving (i.e., the subjective desire to consume opioids) is one of the strongest determinants of opioid misuse among patients with chronic pain prescribed opioids. Although research has elucidated some of the factors associated with opioid craving, the contribution of patients' levels of pain to opioid craving remains unclear.

The main objective of this study was to examine the day-to-day association between pain and opioid craving.

In this longitudinal cohort study, patients with chronic pain prescribed opioid therapy completed baseline measures and were then asked to provide daily reports of pain intensity and opioid craving for a period of 14 days.

Multilevel analyses indicated that day-to-day elevations in patients' levels of pain were associated with heightened opioid craving. That is, on more painful days, patients reported higher levels of craving. Within-person changes in pain intensity, however, explained less than 5% of the variance in patients' reports of craving.

Findings from this study suggest that patients with chronic pain do not crave their opioid medications simply because they experience high levels of pain. The theoretical and clinical implications of our findings are discussed.

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  • 1Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA. Electronic address:
  • 2Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • 3Division of Alcohol and Drug Abuse, Harvard Medical School, McLean Hospital, Belmont, MA, USA.
  • 4Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA.
  • 5Departments of Anesthesiology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. 
  •  2016 Mar 18. pii: S0376-8716(16)00153-8. doi: 10.1016/j.drugalcdep.2016.02.047

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