Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA.
Department of Psychology, University of Oslo, USA.
Drug Alcohol Depend. 2022 Apr 1;233:109361. doi: 10.1016/j.drugalcdep.2022.109361. Epub 2022 Feb 24.
Individuals who use illicit substances exhibit cue-elicited craving and autonomic cue-reactivity when exposed to cues associated with past drug use. However, little is known about this phenomenon among chronic pain patients on long-term opioid therapy (LTOT). Negative cognitive-emotional reactivity in general (e.g., distress) and cognitive-emotional reactivity specific to pain (e.g., pain catastrophizing) might drive cue-reactivity independent of pain severity. Here we examined emotional distress and pain catastrophizing as predictors of cue-reactivity among a sample of chronic pain patients receiving LTOT. We also tested whether associations between distress, catastrophizing, and cue-reactivity differed as a function of opioid misuse status.
Patients receiving LTOT (N = 243) were classified as exhibiting aberrant behavior consistent with opioid misuse (MISUSE+, n = 145) or as using opioids as prescribed (MISUSE-, n = 97). Participants completed assessments of pain catastrophizing and emotional distress and then participated in an opioid cue-reactivity task one week later. Cue-elicited opioid craving and autonomic cue-reactivity were measured with craving ratings and high-frequency heart rate variability (HRV), respectively.
Distress and catastrophizing predicted cue-elicited craving and HRV, whereas pain severity did not. Misuser status moderated the relationship between emotional distress and self-reported craving, such that higher levels of distress predicted craving among the MISUSE+ group, but not among the MISUSE- group. No moderating effects were found for catastrophizing.
Findings suggest that although opioids are prescribed for analgesia, the exacerbating influence of negative cognitive-emotional reactivity, both in general and specific to pain, on cue-elicited opioid craving extends beyond the effects of pain severity alone.
使用非法药物的个体在接触与过去用药相关的线索时，会表现出线索诱发的渴求以及自主神经线索反应。然而，长期接受阿片类药物治疗（LTOT）的慢性疼痛患者中，人们对这种现象知之甚少。一般的负性认知-情绪反应（如痛苦）和特定于疼痛的认知-情绪反应（如疼痛灾难化）可能会驱动线索反应，而与疼痛严重程度无关。在这里，我们研究了情绪困扰和疼痛灾难化是否可以预测接受 LTOT 的慢性疼痛患者样本中的线索反应。我们还测试了痛苦、灾难化与线索反应之间的关联是否因阿片类药物滥用状况而异。
接受 LTOT 的患者（N=243）被分为表现出与阿片类药物滥用一致的异常行为（MISUSE+，n=145）或按规定使用阿片类药物（MISUSE-，n=97）。参与者完成了疼痛灾难化和情绪困扰的评估，一周后参加了阿片类药物线索反应任务。通过渴望评分和高频心率变异性（HRV）分别测量线索诱发的阿片类药物渴求感和自主神经线索反应。
痛苦和灾难化预测了线索诱发的渴求感和 HRV，而疼痛严重程度则没有。滥用者状态调节了情绪困扰与自我报告的渴求感之间的关系，即较高的情绪困扰水平预示着 MISUSE+组的渴求感，但在 MISUSE-组中则不然。未发现灾难化的调节作用。
研究结果表明，尽管阿片类药物是为了镇痛而开的，但无论是一般的还是特定于疼痛的负性认知-情绪反应的加剧作用，对线索诱发的阿片类药物渴求感的影响不仅限于疼痛严重程度的影响。
