Oberleitner Lindsay M S, Lumley Mark A, Grekin Emily R, M Z Smith Kathryn, Loree Amy M, Carty Jennifer N, Valentino Deborah
a Department of Psychology , Wayne State University , New Haven, Michigan , USA.
b Department of Psychiatry , Yale University School of Medicine , New Haven , Connecticut , USA.
Subst Use Misuse. 2019;54(3):495-505. doi: 10.1080/10826084.2018.1521426. Epub 2018 Oct 31.
Factors associated with prescription opioid misuse in a chronic pain treatment population are limited, and increasing our understanding of associated factors could lead to improved targeting of prevention and intervention efforts.
The aim of this study was to evaluate factors associated with problematic prescription opioid use in patients with chronic pain, and whether assessing emotional processes - alexithymia, ambivalence over emotional expression (AEQ), and emotional approach coping - improves understanding of problematic prescription opioid use beyond traditional risk factors.
Participants were 100 patients with chronic pain (mean age = 47.57 years, SD = 11.57; 53% female; 81% African American) who were receiving a self-administered opioid medication through a local pain clinic. We assessed traditional risk factors (substance use history, pain, psychiatric distress, and pain catastrophizing), the three emotional processes, and problematic prescription opioid-related outcomes.
Zero-order correlations revealed that alexithymia was significantly, positively related to problematic prescription opioid use behaviors (PDUQ), and AEQ was significantly positively related to both prescription opioid misuse behaviors and opioid use disorder symptoms. Multiple regressions that included traditional risk factors and the three emotional processes indicated that AEQ was a unique correlate of problematic opioid use behaviors (β=.27, p=.04) and prescription opioid-related symptoms of abuse and dependence (β=.37, p=.01); history of substance use disorders was also associated.
In addition to personal history of substance use problems, AEQ is a modifiable risk factor - and thus potential treatment target - for prescription opioid misuse and opioid use disorders.
在慢性疼痛治疗人群中，与处方阿片类药物滥用相关的因素有限，加深对相关因素的理解可能有助于更精准地开展预防和干预工作。
本研究旨在评估慢性疼痛患者中与问题性处方阿片类药物使用相关的因素，以及评估情绪过程——述情障碍、情绪表达矛盾（AEQ）和情绪应对方式——是否能在传统风险因素之外，增进对问题性处方阿片类药物使用的理解。
研究对象为100名慢性疼痛患者（平均年龄 = 47.57岁，标准差 = 11.57；53%为女性；81%为非裔美国人），他们通过当地一家疼痛诊所接受自我给药的阿片类药物治疗。我们评估了传统风险因素（物质使用史、疼痛、精神困扰和疼痛灾难化）、这三种情绪过程以及与问题性处方阿片类药物相关的结果。
零阶相关分析显示，述情障碍与问题性处方阿片类药物使用行为（PDUQ）显著正相关，AEQ与处方阿片类药物滥用行为及阿片类药物使用障碍症状均显著正相关。纳入传统风险因素和这三种情绪过程的多元回归分析表明，AEQ是问题性阿片类药物使用行为（β = 0.27，p = 0.04）以及与处方阿片类药物相关的滥用和依赖症状（β = 0.37，p = 0.01）的唯一相关因素；物质使用障碍史也与之相关。
除了物质使用问题的个人史外，AEQ是处方阿片类药物滥用和阿片类药物使用障碍的一个可改变的风险因素，因此也是潜在的治疗靶点。
