Supportive Oncology & Survivorship Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States; College of Social Work, University of Utah, Salt Lake City, UT, United States.
Neurosci Biobehav Rev. 2013 Dec;37(10 Pt 2):2597-607. doi: 10.1016/j.neubiorev.2013.08.006. Epub 2013 Aug 26.
Prescription opioid misuse and addiction among chronic pain patients are emerging public health concerns of considerable significance. Estimates suggest that more than 10% of chronic pain patients misuse opioid analgesics, and the number of fatalities related to nonmedical or inappropriate use of prescription opioids is climbing. Because the prevalence and adverse consequences of this threat are increasing, there is a pressing need for research that identifies the biobehavioral risk chain linking chronic pain, opioid analgesia, and addictive behaviors. To that end, the current manuscript draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to prescription opioid misuse and addiction among chronic pain patients receiving opioid analgesic pharmacotherapy. Addictive use of opioids is described as the outcome of a cycle initiated by chronic pain and negative affect and reinforced by opioidergic-dopamingeric interactions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. Implications for clinical practice are discussed; multimodal, mindfulness-oriented treatment is introduced as a potentially effective approach to disrupting the downward spiral and facilitating recovery from chronic pain and opioid addiction.
慢性疼痛患者中处方阿片类药物滥用和成瘾是当前相当重要的公共卫生关注问题。据估计，超过 10%的慢性疼痛患者滥用阿片类镇痛药，与非医疗或不当使用处方阿片类药物相关的死亡人数正在攀升。由于这种威胁的普遍性和不良后果不断增加，因此迫切需要开展研究，以确定将慢性疼痛、阿片类镇痛和成瘾行为联系起来的生物行为风险链。为此，本文借鉴当前的神经精神药理学研究，为接受阿片类药物镇痛药物治疗的慢性疼痛患者中导致处方阿片类药物滥用和成瘾的下行螺旋提供一个概念框架。阿片类药物的成瘾性使用被描述为慢性疼痛和负性情绪引发的循环的结果，并受到阿片类-多巴胺能相互作用的强化，导致对疼痛和药物线索的注意力过度警觉，大脑中自我参照和认知控制网络之间的功能连接障碍，以及应激和奖励回路的适应不良调节。讨论了对临床实践的影响；引入了多模式、正念为导向的治疗方法，作为一种可能有效的方法，可以打破下行螺旋，促进慢性疼痛和阿片类药物成瘾的康复。
