Martel Marc O, Finan Patrick H, McHugh R Kathryn, Issa Mohammed, Edwards Robert R, Jamison Robert N, Wasan Ajay D
Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Drug Alcohol Depend. 2016 May 1;162:130-6. doi: 10.1016/j.drugalcdep.2016.02.047. Epub 2016 Mar 18.
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.
在过去十年中，阿片类药物用于治疗慢性非癌性疼痛的情况大幅增加。尽管阿片类药物治疗有潜在益处，但阿片类药物使用的增加伴随着处方阿片类药物滥用和成瘾率的不断上升。现在有越来越多的证据表明，阿片类药物渴求（即服用阿片类药物的主观欲望）是开具阿片类药物的慢性疼痛患者中阿片类药物滥用的最强决定因素之一。虽然研究已经阐明了一些与阿片类药物渴求相关的因素，但患者疼痛程度对阿片类药物渴求的影响仍不明确。
本研究的主要目的是探讨疼痛与阿片类药物渴求之间的日常关联。
在这项纵向队列研究中，接受阿片类药物治疗的慢性疼痛患者完成了基线测量，然后被要求在14天内每天报告疼痛强度和阿片类药物渴求情况。
多层次分析表明，患者疼痛程度的日常升高与阿片类药物渴求增加有关。也就是说，在疼痛更严重的日子里，患者报告的渴求程度更高。然而，患者疼痛强度的个体内变化在其渴求报告的方差中所占比例不到5%。
本研究结果表明，慢性疼痛患者并非仅仅因为经历了高水平的疼痛就渴求其阿片类药物。我们讨论了研究结果的理论和临床意义。
