The Association Between Negative Affect and Prescription Opioid Misuse in Patients With Chronic Pain: The Mediating Role of Opioid Craving
The Association Between Negative Affect and Prescription Opioid Misuse in Patients With Chronic Pain: The Mediating Role of Opioid Craving
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DOI：
10.1016/j.jpain.2013.09.014
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发表时间：
2014-01-01
期刊：
影响因子：
4
通讯作者：
Wasan, Ajay D.
中科院分区：
文献类型：
--
作者：
Martel, Marc O.;Dolman, Andrew J.;Wasan, Ajay D.
在过去的十年中，大量的研究表明，经历高水平负面影响（NA）的慢性疼痛患者滥用处方阿片类药物的风险增加。本研究的主要目的是研究慢性疼痛患者中NA与处方阿片类药物滥用之间关联的因素。在这项研究中，82名服用阿片类药物的慢性肌肉骨骼疼痛患者完成了当前阿片类药物滥用测量，这是一份经过验证的自我报告问卷，旨在评估处方阿片类药物滥用。患者还被要求完成疼痛强度、NA和阿片类药物渴望的自我报告。采用自举多重中介分析，检验患者疼痛强度和阿片渴望在NA与处方阿片滥用之间的中介作用。与之前的研究一致，我们发现NA与处方阿片类药物滥用之间存在显著关联。有趣的是，结果显示阿片类药物的渴望，而不是疼痛强度，介导NA和阿片类药物滥用之间的关联。讨论了潜在的心理和神经生物学因素，这些因素可能导致疼痛患者NA、阿片类药物渴望和处方阿片类药物滥用之间的相互关系。我们的发现的临床意义也进行了讨论。观点：我们的研究为慢性疼痛患者的负面情绪和处方阿片类药物滥用之间的关联因素提供了新的见解。我们的研究结果可能具有重要的临床意义，特别是对于正在服用阿片类药物的患者，以及减少疼痛患者滥用阿片类药物的比率。(C) 2014年由美国疼痛学会出版
Over the past decade, considerable research has accumulated showing that chronic pain patients experiencing high levels of negative affect (NA) are at increased risk for prescription opioid misuse. The primary objective of the present study was to examine the factors that underlie the association between NA and prescription opioid misuse among patients with chronic pain. In this study, 82 patients with chronic musculoskeletal pain being prescribed opioid medication completed the Current Opioid Misuse Measure, a well-validated self-report questionnaire designed to assess prescription opioid misuse. Patients were also asked to complete self-report measures of pain intensity, NA, and opioid craving. A bootstrapped multiple mediation analysis was used to examine the mediating role of patients' pain intensity and opioid craving in the association between NA and prescription opioid misuse. Consistent with previous research, we found a significant association between NA and prescription opioid misuse. Interestingly, results revealed that opioid craving, but not pain intensity, mediated the association between NA and opioid misuse. The Discussion addresses the potential psychological and neurobiological factors that might contribute to the interrelationships among NA, opioid craving, and prescription opioid misuse in patients with pain. The clinical implications of our findings are also discussed.Perspective: Our study provides new insights into the factors that underlie the association between negative affect and prescription opioid misuse in patients with chronic pain. Our findings could have important clinical implications, particularly for patients being prescribed opioid medication, and for reducing rates of opioid misuse in patients with pain. (C) 2014 by the American Pain Society