Anhedonia in chronic pain and prescription opioid misuse
Anhedonia in chronic pain and prescription opioid misuse
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DOI：
10.1017/s0033291719002010
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发表时间：
2020-09-01
影响因子：
6.9
通讯作者：
Leknes, Siri
中科院分区：
文献类型：
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作者：
Garland, Eric L.;Trostheim, Martin;Leknes, Siri
急性疼痛和慢性疼痛都能干扰奖赏加工。此外，长期使用处方阿片类药物和抑郁情绪在慢性疼痛样本中很常见。尽管这些危险因素为快感缺乏的患病率，鲜为人知的是快感缺乏在慢性painpopulation.Methods我们进行了大规模的，系统的研究快感缺乏在慢性pain. Methods，专注于其与阿片类药物的使用/滥用，疼痛的严重程度，抑郁症的关系。四个不同样本的慢性疼痛患者（N = 488）完成了Snaith-Hamilton快乐量表（SHAPS），阿片类药物使用，疼痛严重程度和抑郁的测量，以及当前阿片类药物滥用测量（COMM）。我们使用了荟萃分析的方法，以确定在健康样本的快感缺乏的参考水平，跨越不同的国家和不同的年龄组，提取SHAPS分数从58个已发表的研究，共2664精神健康的participators.Results相比，健康的样本，慢性疼痛患者表现出更高的快感缺乏水平，与类似的25%的患者得分高于标准的快感缺乏截止。这种差异主要不是由抑郁水平驱动的，抑郁水平解释了不到25%的快感缺失评分变异。阿片类药物使用时间、剂量和疼痛严重程度均与快感缺乏无显著相关性。然而，阿片类药物滥用有明显的影响，阿片类药物滥用者（COMM >= 13）报告的快感缺失比非滥用者更严重。阿片类药物滥用仍然是一个显着的预测快感缺失，即使在控制疼痛的严重程度，抑郁症和阿片类药物dose.Conclusions研究结果表明，慢性疼痛和阿片类药物滥用有助于快感缺失，这可能反过来，驱动进一步的疼痛和滥用。
Background Both acute and chronic pain can disrupt reward processing. Moreover, prolonged prescription opioid use and depressed mood are common in chronic pain samples. Despite the prevalence of these risk factors for anhedonia, little is known about anhedonia in chronic pain populations.Methods We conducted a large-scale, systematic study of anhedonia in chronic pain, focusing on its relationship with opioid use/misuse, pain severity, and depression. Chronic pain patients across four distinct samples (N = 488) completed the Snaith-Hamilton Pleasure Scale (SHAPS), measures of opioid use, pain severity and depression, as well as the Current Opioid Misuse Measure (COMM). We used a meta-analytic approach to determine reference levels of anhedonia in healthy samples spanning a variety of countries and diverse age groups, extracting SHAPS scores from 58 published studies totaling 2664 psychiatrically healthy participants.Results Compared to healthy samples, chronic pain patients showed higher levels of anhedonia, with similar to 25% of patients scoring above the standard anhedonia cut-off. This difference was not primarily driven by depression levels, which explained less than 25% of variance in anhedonia scores. Neither opioid use duration, dose, nor pain severity alone was significantly associated with anhedonia. Yet, there was a clear effect of opioid misuse, with opioid misusers (COMM >= 13) reporting greater anhedonia than non-misusers. Opioid misuse remained a significant predictor of anhedonia even after controlling for pain severity, depression and opioid dose.Conclusions Study results suggest that both chronic pain and opioid misuse contribute to anhedonia, which may, in turn, drive further pain and misuse.