Faculty of Dentistry, McGill University.
Department of Anesthesiology, Harvard Medical School, Brigham and Women's Hospital.
Am Psychol. 2020 Sep;75(6):772-783. doi: 10.1037/amp0000632.
There is a pressing need to better understand the factors contributing to prescription opioid misuse among patients with chronic pain. Cross-sectional studies have been conducted in this area, but longitudinal studies examining the determinants of prescription opioid misuse repeatedly over the course of opioid therapy have yet to be conducted. The main objective of this study was to examine the relative contribution of pain and psychological factors to the occurrence of opioid misuse among patients with chronic pain prescribed opioids. Of particular interest was to examine whether pain intensity and psychological factors were more strongly associated with certain types of opioid misuse behaviors. Patients with chronic pain (n = 194) prescribed long-term opioid therapy enrolled in this longitudinal observational cohort study. Patients completed baseline measures and were then followed for 6 months. Opioid misuse was assessed once a month using self-report measures, and urine toxicology screens complemented patients' reports of opioid misuse. Heightened pain intensity levels were associated with a greater likelihood of opioid misuse (p = .014). However, pain intensity was no longer significantly associated with opioid misuse when controlling for psychological factors (i.e., negative affect, catastrophizing). Subsequent analyses revealed that higher levels of catastrophizing were associated with a greater likelihood of running out of opioid medication early, even after controlling for patients' levels of pain intensity and negative affect (p = .016). Our findings provide new insights into the determinants of prescription opioid misuse and have implications for the nature of interventions that may be used to reduce specific types of opioid misuse behaviors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
目前迫切需要更好地了解导致慢性疼痛患者处方类阿片药物滥用的因素。该领域已经开展了横断面研究，但尚未开展长期研究，以反复检查阿片类药物治疗过程中决定处方类阿片药物滥用的因素。本研究的主要目的是检查疼痛和心理因素对慢性疼痛且正在接受阿片类药物治疗的患者发生阿片类药物滥用的相对影响。特别感兴趣的是检查疼痛强度和心理因素是否与某些类型的阿片类药物滥用行为更密切相关。这项纵向观察性队列研究纳入了 194 名慢性疼痛且正在接受长期阿片类药物治疗的患者。患者完成基线测量，然后随访 6 个月。每月使用自我报告测量法评估阿片类药物滥用情况，尿液毒理学筛查补充了患者对阿片类药物滥用的报告。疼痛强度增加与阿片类药物滥用的可能性更大有关（p =.014）。然而，当控制心理因素（即负面情绪、灾难化）时，疼痛强度与阿片类药物滥用不再显著相关。后续分析显示，即使在控制患者的疼痛强度和负面情绪水平后，更高水平的灾难化与更有可能提前用完阿片类药物有关（p =.016）。我们的研究结果为处方类阿片药物滥用的决定因素提供了新的见解，并对可能用于减少特定类型的阿片类药物滥用行为的干预措施的性质具有启示意义。（PsycInfo 数据库记录（c）2020 APA，保留所有权利）。
