Department of Psychiatry.
APT Foundation Pain Treatment Services, New Haven, CT.
Clin J Pain. 2020 Sep;36(9):641-647. doi: 10.1097/AJP.0000000000000848.
This study examined the cross-sectional associations among pain intensity, pain catastrophizing, and sleep disturbance among patients receiving methadone maintenance treatment (MMT) for opioid use disorder (OUD) and reporting co-occurring chronic pain.
Participants were 89 individuals with OUD and chronic pain drawn from a larger cross-sectional study of 164 MMT patients who completed a battery of self-report measures. The authors conducted 6 mediation models to test all possible pathways (ie, each variable tested as an independent variable, mediator, or dependent variable).
The only significant mediation effect was an indirect effect of sleep disturbance on pain intensity through pain catastrophizing. That is, greater sleep disturbance was associated with greater pain catastrophizing, which in turn was associated with greater pain intensity.
Altogether, findings suggest that the sleep disturbance to pain catastrophizing to pain intensity pathway may be a key mechanistic pathway exacerbating pain issues among MMT patients with OUD and chronic pain. These results suggest that interventions targeting sleep disturbance may be warranted among MMT patients with OUD and chronic pain. Future work in this area with longitudinal data is warranted.
本研究考察了接受美沙酮维持治疗（MMT）治疗阿片类药物使用障碍（OUD）且报告合并慢性疼痛的患者中疼痛强度、疼痛灾难化和睡眠障碍之间的横断面关联。
参与者为 89 名患有 OUD 和慢性疼痛的个体，他们来自对 164 名 MMT 患者进行的更大横断面研究的一部分，这些患者完成了一系列自我报告措施。作者进行了 6 个中介模型来测试所有可能的途径（即，每个变量都作为自变量、中介变量或因变量进行测试）。
唯一显著的中介效应是睡眠障碍通过疼痛灾难化对疼痛强度的间接影响。也就是说，睡眠障碍越严重，疼痛灾难化越严重，进而疼痛强度越大。
总的来说，研究结果表明，睡眠障碍到疼痛灾难化到疼痛强度的途径可能是加剧 MMT 患者 OUD 和慢性疼痛中疼痛问题的关键机制途径。这些结果表明，针对睡眠障碍的干预措施可能是患有 OUD 和慢性疼痛的 MMT 患者所需要的。在这个领域需要有纵向数据的进一步研究。
