CANUE: A Theoretical Model of Pain as an Antecedent for Substance Use
CANUE: A Theoretical Model of Pain as an Antecedent for Substance Use
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DOI：
10.1093/abm/kaaa072
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发表时间：
2021-05-01
影响因子：
3.8
通讯作者：
Boissoneault, Jeff
中科院分区：
文献类型：
--
作者：
Ferguson, Erin;Zale, Emily;Boissoneault, Jeff
背景疼痛和物质使用经常是共病的，并且已经显示出产生双向影响。通过物质使用自我治疗疼痛和痛苦是常见的，可以通过负强化来理解，最终加强疼痛与物质使用之间的途径。因此，一个潜在的可修改的候选机制的可测试的模型，潜在的疼痛物质使用pathway is needed.Purpose本综述提出了一个可测试的疼痛模型作为物质使用的前因，以指导未来的研究和告知临床实践。结果灾难化、焦虑、消极紧迫感和期望（CANUE）模型强调了物质使用自我治疗疼痛的可改变的风险因素，包括增加的消极影响和适应不良的疼痛相关态度（即，疼痛灾难化、疼痛焦虑和对疼痛的恐惧）、消极紧迫感以及对缓解疼痛和增强疼痛应对的药物相关结果预期。结论针对这些因素的有针对性的行为和心理干预措施可能会促进更适应性的疼痛应对反应，从而减少疼痛对药物使用的影响。该模型的有效性和临床实用性有待系统研究。
Background Pain and substance use are frequently comorbid and have been shown to exert bidirectional effects. Self-medication of pain and distress via substance use is common and can be understood via negative reinforcement, ultimately strengthening the pathway between pain to substance use over time. As such, a testable model of the potentially modifiable candidate mechanisms that underlie the pain to substance use pathway is needed.Purpose This review proposes a testable model of pain as an antecedent to substance use to guide future research and inform clinical practice.Methods An integrative review of current evidence regarding pain, substance use, and associated risk factors (i.e., negative affect, pain-related attitudes, negative urgency, and substance use outcome expectancies) was conducted.Results The Catastrophizing, Anxiety, Negative Urgency, and Expectancy (CANUE) model highlights modifiable risk factors for self-medicating pain with substance use, including increased negative affect and maladaptive pain-related attitudes (i.e., pain catastrophizing, pain anxiety, and fear of pain), negative urgency, and substance-related outcome expectancies for pain relief and enhanced pain coping.Conclusions Targeted behavioral and psychological interventions that address these factors may facilitate more adaptive pain-coping responses, thereby reducing the impacts of pain on substance use. Systematic research is needed to evaluate the validity and clinical utility of this model.