A Reciprocal Model of Pain and Substance Use: Transdiagnostic Considerations, Clinical Implications, and Future Directions
A Reciprocal Model of Pain and Substance Use: Transdiagnostic Considerations, Clinical Implications, and Future Directions
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DOI：
10.1146/annurev-clinpsy-050718-095440
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发表时间：
2019-01-01
期刊：
影响因子：
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通讯作者：
LaRowe, Lisa R.
中科院分区：
文献类型：
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作者：
Ditre, Joseph W.;Zale, Emily L.;LaRowe, Lisa R.
疼痛和物质使用是高度普遍和共同发生的条件，继续获得越来越多的临床和经验的兴趣。虽然尼古丁和烟草、酒精和大麻都具有急性镇痛作用，但频繁或大量使用可能会导致慢性疼痛的发展和进展，并且在禁欲期间疼痛可能会加剧。此外，疼痛可能是物质自我给药的一个强有力的动机，它可能导致使用升级和物质相关治疗结果较差。我们整合了收敛的证据线，提出了一个互惠模型，其中假设疼痛和物质使用以正反馈循环的方式相互作用，导致两种情况随着时间的推移而恶化和维持。本文综述了双向疼痛-物质使用关系的理论机制，包括负强化、社会认知过程和重叠神经回路中的非稳态负荷。最后，候选transdiagnosis因素确定，我们的结论与临床意义和未来的研究方向进行了讨论。
Pain and substance use are highly prevalent and co-occurring conditions that continue to garner increasing clinical and empirical interest. Although nicotine and tobacco, alcohol, and cannabis each confer acute analgesic effects, frequent or heavy use may contribute to the development and progression of chronic pain, and pain may be heightened during abstinence. Additionally, pain can be a potent motivator of substance self-administration, and it may contribute to escalating use and poorer substance-related treatment outcomes. We integrated converging lines of evidence to propose a reciprocal model in which pain and substance use are hypothesized to interact in the manner of a positive feedback loop, resulting in the exacerbation and maintenance of both conditions over time. Theoretical mechanisms in bidirectional pain-substance use relations are reviewed, including negative reinforcement, social cognitive processes, and allostatic load in overlapping neural circuitry. Finally, candidate transdiagnostic factors are identified, and we conclude with a discussion of clinical implications and future research directions.