Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA.
Addiction. 2021 Jul;116(7):1794-1804. doi: 10.1111/add.15344. Epub 2020 Dec 29.
To assess the role of momentary pain on opioid craving and illicit opioid use among individuals receiving opioid agonist treatment.
Observational study using ecological momentary assessment.
The National Institute of Drug Abuse Intramural Research Program in the United States.
Fifty-six adults who qualified for opioid agonist treatment.
Participants completed randomly prompted assessments of pain severity, stress, negative mood, opioid craving and illicit opioid use for a mean of 66 days [standard deviation (SD) = 27]. Urine samples were collected two to three times/week throughout.
Almost 70% of participants reported moderate average pain severity in the past 24 hours at intake and 35% of participants reported chronic pain. There were no significant differences in percent of opioid-positive urine samples (P = 0.73) and average level of opioid craving during the study period (P = 0.91) among opioid agonist treatment only patients versus opioid agonist treatment patients with chronic pain. However, momentary pain severity significantly predicted concurrent opioid craving [B = 0.02, 95% confidence interval (CI) = 0.01, 0.04], over and above stress and negative mood. Momentary opioid craving, in turn, significantly predicted illicit opioid use that was assessed in the next moment [odds ratio (OR) = 1.72, 95% CI = 1.12, 2.64), while controlling for autocorrelation and the effects of pain, negative mood and stress. Momentary opioid craving significantly mediated the prospective association between momentary pain and illicit opioid use (95% CI = 0.003, 0.032). Exploratory analysis revealed that momentary pain severity also significantly moderated the momentary association between stress and opioid craving (B = 0.02, 95% CI = 0.00, 0.04), such that when momentary pain severity increased, the association between the two intensified.
Among people receiving opioid agonist treatment, momentary pain appears to be indirectly associated with illicit opioid use via momentary opioid craving.
评估个体接受阿片类激动剂治疗时瞬间疼痛对阿片类物质渴求及非法使用阿片类物质的作用。
使用生态瞬时评估的观察性研究。
美国国家药物滥用研究所的院内研究计划。
56 名符合阿片类激动剂治疗条件的成年人。
参与者在平均 66 天[标准差（SD）=27]的时间内完成随机提示的疼痛严重程度、压力、负性情绪、阿片类物质渴求及非法使用阿片类物质的评估。整个过程中每周采集 2-3 次尿液样本。
入组时，近 70%的参与者报告过去 24 小时内存在中度平均疼痛严重程度，35%的参与者报告存在慢性疼痛。在整个研究期间，仅接受阿片类激动剂治疗的患者与同时接受阿片类激动剂治疗和慢性疼痛的患者之间，阿片类物质阳性尿液样本的百分比（P=0.73）和研究期间平均阿片类物质渴求水平（P=0.91）均无显著差异。然而，瞬间疼痛严重程度显著预测同时发生的阿片类物质渴求[B=0.02，95%置信区间（CI）=0.01，0.04]，超过压力和负性情绪的影响。反之，瞬间阿片类物质渴求显著预测下一刻评估的非法阿片类物质使用[比值比（OR）=1.72，95%CI=1.12，2.64]，同时控制自相关和疼痛、负性情绪和压力的影响。瞬间阿片类物质渴求显著介导瞬间疼痛与非法阿片类物质使用之间的前瞻性关联（95%CI=0.003，0.032）。探索性分析显示，瞬间疼痛严重程度也显著调节瞬间压力与阿片类物质渴求之间的关联（B=0.02，95%CI=0.00，0.04），即当瞬间疼痛严重程度增加时，两者之间的关联增强。
在接受阿片类激动剂治疗的人群中，瞬间疼痛似乎通过瞬间阿片类物质渴求与非法阿片类物质使用间接相关。
