Temporal preference in individuals reporting chronic pain: discounting of delayed pain-related and monetary outcomes.
Temporal preference in individuals reporting chronic pain: discounting of delayed pain-related and monetary outcomes.
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DOI：
10.1097/j.pain.0000000000000576
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发表时间：
2016-08
期刊：
影响因子：
7.4
通讯作者：
Johnson MW
中科院分区：
文献类型：
--
作者：
Tompkins DA;Johnson PS;Smith MT;Strain EC;Edwards RR;Johnson MW
阿片类药物治疗疼痛与物质使用障碍(SUD)的风险增加有关。这项研究的目的是确定阿片类药物滥用倾向(筛查和阿片类药物评估患者疼痛-修订；SOAPP-R)与延迟折扣之间的联系，延迟折扣是与SUD有关的一个行为过程，它量化了由于延迟而导致结果贬值的程度。报告慢性疼痛的参与者(PRCP N=249)回答了疼痛和阿片类药物使用问题，然后完成了四项延迟折扣任务。这些任务中的每一项都评估了金钱或痛苦的后果，要么是奖励，要么是惩罚。每项任务都涉及在即时较小的结果和延迟的较大结果之间做出假设选择。现有的货币选择问卷(McQ)评估了金钱奖励的延迟贴现，修改后的版本评估了金钱损失的贴现(即时损失较小的损失与较大的延迟损失)。基于McQ，新的止痛选择问卷(PRCQ)评估了在即刻短期止痛和较长时间止痛之间的选择。同样，新的额外疼痛选择问卷(APCQ)评估了即刻短期额外疼痛和较长时间额外疼痛之间的选择。对额外的疼痛和金钱损失的折扣与SOAPP-R的高得分显著相关--表明与低风险的参与者相比，阿片类药物滥用的风险最大的参与者对未来的惩罚而不是未来的奖励进行折扣。延迟折扣的措施可能有助于更准确地识别在慢性阿片类药物治疗期间阿片类药物滥用的最高风险人群。
Opioid therapy for pain is associated with an increased risk for substance use disorders (SUD). This study’s purpose was to determine the association between opioid misuse propensity (Screener and Opioid Assessment for Patients in Pain-Revised; SOAPP-R) and delay discounting, a behavioral process linked to SUD which quantifies the extent to which outcomes are devalued due to their delay. Participants reporting chronic pain (PRCP N=249) answered pain and opioid use questions, and then completed four delay discounting tasks. Each of these tasks assessed either money or pain consequences, framed as either rewards or punishments. Each task involved hypothetical choices between immediate smaller vs. delayed larger consequences. The extant Monetary Choice Questionnaire (MCQ) assessed delay discounting of money rewards, and a modified version assessed discounting of money losses (immediate smaller loss vs. larger delayed loss). Based on the MCQ, the novel Pain Relief Choice Questionnaire (PRCQ) assessed choices between an immediate short duration of pain relief vs. a longer duration of pain relief. Similarly, the novel Additional Pain Choice Questionnaire (APCQ) assessed choices between an immediate short duration of additional pain vs. a longer duration of additional pain. Discounting of both additional pain and money losses were significantly associated with high SOAPP-R scores – indicating participants at greatest risk for opioid misuse discount future punishments rather than future rewards compared to those at low risk. Measures of delay discounting may have promise in more accurately identifying individuals at highest risk for opioid misuse during chronic opioid therapy.