Day-To-Day Pain Symptoms Are Only Weakly Associated with Opioid Craving among Patients with Chronic Pain Prescribed Opioid Therapy
HIGHLIGHTS
- 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.
BACKGROUND:
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.
OBJECTIVE:
The
main objective of this study was to examine the day-to-day association between
pain and opioid craving.
METHODS:
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.
RESULTS:
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.
CONCLUSION:
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.
- 1Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA. Electronic address: momartel.bwh.harvard@outlook.com.
- 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.
- Drug Alcohol Depend. 2016 Mar 18. pii: S0376-8716(16)00153-8. doi: 10.1016/j.drugalcdep.2016.02.047
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