Barrado-Moreno Victoria, Esteve Rosa, McCracken Lance M, Ramírez-Maestre Carmen
Facultad de Psicología y Logopedia, Universidad de Málaga, Málaga, Spain.
Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain.
Eur J Pain. 2025 Jul;29(6):e70048. doi: 10.1002/ejp.70048.
The prescription of opioid medication is a frequent therapeutic approach in chronic noncancer pain, as is misuse of prescribed opioids. There is previous evidence for associations between personal variables such as impulsivity and opioid misuse. Psychological flexibility and inflexibility have also been associated with pain-related outcomes and opioid misuse. The aim of this cross-sectional study was to examine the combined role of a dispositional variable (impulsivity) along with psychological factors (Psychological Flexibility and Inflexibility) in pain outcomes and opioid misuse.
The sample comprised 155 people with chronic noncancer pain. A hypothetical model was tested using correlation and structural equation modelling analyses.
The results show significant associations between impulsivity and Psychological Flexibility, Psychological Inflexibility and opioid misuse. Psychological Flexibility and Inflexibility were related to pain intensity, interference and opioid misuse. Structural equation modelling showed significant associations between impulsivity, Psychological Inflexibility and pain interference, and opioid misuse. Associations between Psychological Flexibility and pain interference and opioid misuse were nonsignificant. These results support the hypothesis that impulsivity and Psychological Inflexibility are factors that contribute to pain interference and opioid misuse, but do not support the hypothesis that Psychological Flexibility reduces opioid misuse.
It is recommended to assess these psychological aspects prior to the prescription of opioid medication, and, if necessary, offering Acceptance and Commitment and Mindfulness Based Therapies could be desirable.
The results of this study provide further evidence of the role of trait impulsivity as a transdiagnostic antecedent variable in opioid misuse, both by a direct association and through psychological inflexibility. It can be drawn from these results that psychological transdiagnostic variables, rather than pain outcomes alone, would be key factors influencing opioid misuse. These findings underscore the need for comprehensive psychological assessments prior to the prescription of opioids.
阿片类药物处方是慢性非癌性疼痛常见的治疗方法，同时处方阿片类药物的滥用现象也很常见。先前有证据表明，冲动性等个人变量与阿片类药物滥用之间存在关联。心理灵活性和心理僵化也与疼痛相关结果及阿片类药物滥用有关。这项横断面研究的目的是探讨一个特质变量（冲动性）与心理因素（心理灵活性和心理僵化）在疼痛结果及阿片类药物滥用中的联合作用。
样本包括155名慢性非癌性疼痛患者。使用相关性分析和结构方程模型分析对一个假设模型进行了检验。
结果显示冲动性与心理灵活性、心理僵化及阿片类药物滥用之间存在显著关联。心理灵活性和心理僵化与疼痛强度、干扰及阿片类药物滥用有关。结构方程模型显示冲动性、心理僵化与疼痛干扰及阿片类药物滥用之间存在显著关联。心理灵活性与疼痛干扰及阿片类药物滥用之间的关联不显著。这些结果支持了冲动性和心理僵化是导致疼痛干扰及阿片类药物滥用的因素这一假设，但不支持心理灵活性可减少阿片类药物滥用这一假设。
建议在开具阿片类药物处方之前评估这些心理因素，如有必要，提供基于接受与承诺及正念的疗法可能是可取的。
本研究结果进一步证明了特质冲动性作为阿片类药物滥用的跨诊断先行变量的作用，这一作用既通过直接关联，也通过心理僵化体现。从这些结果可以得出，心理跨诊断变量而非单纯的疼痛结果将是影响阿片类药物滥用的关键因素。这些发现强调了在开具阿片类药物处方之前进行全面心理评估的必要性。
