Chronic pain, negative affect, and prescription opioid abuse
Section snippets
Introduction: background and overview of pain issues
Chronic pain is considered a public health priority due to its high prevalence globally. It is estimated that over 10% of the world's population are afflicted with chronic pain [1], and in the United States alone, 100 million people experience chronic pain annually, which is more than cancer, diabetes, and coronary heart disease combined [2••]. Chronic pain accounts for 21% of emergency department visits, 25% of annual missed workdays, and $560 to $635 billion in annual direct and indirect
Overview of opioids for pain
Brief definitions of key terms used in this article can be useful in clarifying issues around use of opioids prescribed for chronic pain. Definitions for substance misuse, substance abuse, addiction, physical dependence, tolerance, and aberrant drug-related behavior are presented in Table 2.
Addiction encompasses compulsive use of the drug that leads to physical, psychological, and social harm to the user. It is generally understood to be a chronic condition from which recovery is possible.
Negative affect and pain
Negative affect is characterized by negative emotionality, high distress, dissatisfaction, nervousness, and anger [28]. Persons high on negative affect present with depression, anxiety, recurrent worried thoughts and irritability. Affective disorders encompassing depression or anxiety are frequent co-morbidities among chronic pain patients [3], [29], [30], [31], [32]. Some have suggested that chronic pain can cause depression [33], [34], that depression can increase chronic pain [35], and that
Risks factors for prescriptions opioid abuse
Patients who are typically at a lower risk for misusing opioids include those who are older, are generally compliant, have a record of rarely misusing any medication, show stable mood, and display rationality and thoughtfulness. Conversely, risk factors for opioid misuse include (1) family or personal history of substance abuse, (2) younger age, (3) history of criminal activity and/or legal problems, (4) frequent contact with high-risk individuals or environments, (5) history of previous
Risk assessment strategies
Many physicians struggle with providing appropriate pain relief for patients while minimizing the misuse of prescription opioids. In response, concerted efforts have been made to identify those individuals at risk for abuse of prescription opioids [81], [82]. Structured interview measures have been published for assessment of alcoholism and drug use disorder based on DSM-IV criteria [83], [84], but these measures have not been validated in individuals with chronic pain. Such assessments may not
Interventions for high risk patients
Potential solutions to the continuing rise in opioid abuse, misuse, and diversion have become an ongoing focus in regulatory, legal, and governmental action. Prescription Drug Monitoring Programs (PDMPs), one of the first diversion control tools established, monitor and analyze electronic prescription data transferred from pharmacies and practitioners. PDMPs are one facet of a universal precautions approach that has been implemented clinically over recent years. Universal precautions assumes a
Future considerations
As we become an aging population, greater attention will be given to managing medical comorbidities, which include chronic pain. The practice of managing persons with chronic pain will likely change within the next ten to twenty years. First, research into genetics testing holds much promise for the identification of markers for potential mood disorder and pain. There will likely be breakthroughs and a greater understanding of the role of inherited predispositions for chronic pain based on
Summary and conclusions
Chronic pain including chronic noncancer pain is a multifaceted global health problem that requires multiple modes of intervention. Despite the apparent physical pathology of pain, it has been implicated that psychiatric comorbidities such as depression and anxiety disorders significantly affect pain intensity, level of functioning, and pain outcome. Corresponding to the dramatic increase in opioid prescriptions, psychiatric comorbidity is now associated with opioid misuse, abuse, and/or
Conflict of interest statement
There are no conflicts of interest to the best of the author's knowledge.
References and recommended reading
Papers of particular interest, published within the period of review, have been highlighted as:
• of special interest
•• of outstanding interest
References (110)
- et al.
Potent opioids for chronic musculoskeletal pain: flying blind?
Pain
(2004) - et al.
Living with a woman with fibromyalgia from the perspective of the husband
J Adv Nurs
(2003) - et al.
Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia
Neurology
(1998) - et al.
Opioid therapy for chronic noncancer back pain: a randomized prospective study
Spine
(1998) - Substance Abuse and Mental Health Services Administration: Results from the 2009 National Survey on Drug Use and...
- et al.
Back pain in primary care, Outcomes at 1 year
Spine
(1993) - et al.
Chronic widespread musculoskeletal pain with or without fibromyalgia: psychological distress in a representative community adult sample
J Rheum
(2002) - et al.
Pain predicts longer time to remission during treatment of recurrent depression
J Clin Psychiatry
(2005) - et al.
Randomized trial of oral morphine for chronic non-cancer pain
Lancet
(1996) Approaches to treatment decisions for psychiatric comorbidity in the management of the chronic pain patient
Med Clin North Amer
(1999)
Pretreatment psychosocial variables as predictors of outcomes frollowing lumbar surgery and spinal cord stimulation: a systematic review and literature synthesis
Pain Med
Substance abuse and bipolar comorbidty
Psychiatry Clin North Am
Gabapentin treatment of alcohol withdrawal
Am J Psychiatry
Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substance abuse
Annals Family Med
Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the opioid risk tool
Pain Med
Craving of prescription opioids in patients with chronic pain: a longitudinal outcomes trial
J Pain
Craving's place in addiction theory: contributions of the major models
Neurosci Biobehav Rev
Stress and drug-cue-induced craving in opioid-dependent individuals in naltrexone treatment
Exp Clin Psychopharmacol
Stress-induced cocaine craving and hypothalamic-pituitary-adrenal responses are predictive of cocaine relapse outcomes
Arch Gen Psychiatry
The clinical significance of drug craving
Annals N Y Acad Sci
Altered quantitative sensory testing outcome in subjects with opioid therapy
Pain
Associations between heat pain perception and opioid dose among patients with chronic pain undergoing opioid tapering
Pain Medicine
The Diagnostic Interview Schedule: its development, evaluations, and use
Soc Psychiatry Psychiatric Epidem
Screening for problematic prescription opioid use
Clin J Pain
Universal precautions in pain medicine: a rational approach to the treatment of chronic pain
Pain Med
Urine toxicology screening among chronic pain patients on opioid therapy: frequency and predictability of abnormal findings
Clin J Pain
Pain as a global public health priority
BMC Public Health
Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research
Depression and pain comorbidity: a literature review
Arch Int Med
Treatment of osteoarthritis pain with controlled release oxycodone or fixed combination oxycodone plus acetominophen added to nonsteroidal antiinflammatory drugs: a double blind, randomized, multicenter, placebo controlled trial
J Rheum
Morphine responsiveness, efficacy and tolerability in patients with chronic non-tumor pain — results of a double-blind placebo-controlled trial (MONTAS)
Pain
Predictors of surgical outcome in degenerative lumbar spinal stenosis
Spine
The use of opioids for the treatment of chronic pain: a consensus statement from the American Academy of Pain Medicine and American Pain Society
Clin J Pain
Abuse-deterrent and tamper-resistant opioids: how valuable are novel formulations in thwarting non-medical use?
Expert Opin Drug Deliv
Survey of select practice behaviors by primary care physicians on the use of opioids for chronic pain
Curr Med Res Opin
Definitions related to the use of opioids for the treatment of pain: a consensus document from the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine
ASAM
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders
What does it mean that addiction is a brain disease?
Monitor Psychol
Efficacy of controlled-release codeine in chronic non-malignant pain: a randomized, placeo-controlled clinical trial
Pain
Double blind randomized placebo control trial of controlled release codeine in the treatment of osteoarthritis of the hip or knee
J Rheumatol Suppl
Controlled-release oxycodone for pain in diabetic neuropathy: a randomized controlled trial
Neurology
Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy
Pain
Analgesic efficacy and safety of tramadol/acetaminophen combination tablets (Ultracet) in treatment of chronic low back pain: a multicenter, outpatient, randomized, double blind, placebo controlled trial
J Rheumatol
Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects
Can Med Assoc J
Opioids in chronic non-cancer pain: systematic review of efficacy and safety
Pain
Opioid guidelines in the management of chronic non-cancer pain
Pain Phys
The burden of the nonmedical use of prescription opioid analgesics
Pain Med
How Insurance Fraud Finances Theft and Abuse of Addictive Prescription Drugs
Negative affectivity: the disposition to experience aversive emotional states
Psychol Bull
Depression and anxiety associated with three pain conditions: results from a nationally representative sample
Pain
Cited by (2)
Evaluating the Relationship Between Emotion Regulation and Pain Self-efficacy with Psychosocial Adjustment in Athletes with Chronic Pain Considering the Mediating Role of Mental Fatigue
2022, Jundishapur Journal of Chronic Disease Care