Psychological dependence and prescription opioid misuse and abuse.
Psychological dependence and prescription opioid misuse and abuse.
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心理依赖和处方阿片类药物误用和滥用。
DOI：
10.1111/pme.12419
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Cheatle,MartinD
中科院分区：
文献类型：
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作者：
Cheatle,MartinD
人们对处方阿片类药物滥用、滥用和致命过量的流行率不断上升表示明显关切。大量的学术活动致力于确定阿片类药物误用/滥用的风险因素，而在发现可改变的因素以减轻风险方面的努力较少。在这一期的《疼痛医学》中，Elander及其同事[1]对112名患有疼痛并在上个月使用过非处方药（OTC）和处方止痛药的普通人群进行了在线调查。他们评估了典型的疼痛因素（频率，强度，疼痛类型和病因），基于经验证的风险评估措施的阿片类药物滥用风险，疼痛患者的筛选和阿片类药物评估（SOAPP），情绪和焦虑障碍，以及OTC和处方镇痛药的频率和使用。此外，他们还收集了一些心理学指标，其中一些非常新颖（述情障碍、正念、自我同情），沿着已知的可能的疼痛和药物滥用中介（疼痛灾难化、疼痛接受、疼痛自我效能）。镇痛药依赖（基于改良的利兹依赖问卷）与疼痛、情绪和异常药物相关行为（ADRB）（SOAPP）和其他心理因素之间关系的统计分析显示，镇痛药依赖的最佳单一预测因子是SOAPP。其他独立的因素预测依赖性的频率使用止痛药和接受疼痛的水平。SOAPP是镇痛药依赖性的最强预测因子，这并不奇怪，因为它可能是所有ADRB指标中最好的心理测量指标[2]，ADRB被认为是可能成瘾的替代品。然而，正如作者所指出的，SOAPP评分与疼痛频率或强度无显著相关性，这表明SOAPP测量的物质依赖风险与疼痛无关。频繁使用止痛药独立预测依赖性的发现在直觉上也并不令人惊讶。Edlund et al. [3]评估了一项全国代表性调查（N= 9，279）的结果，发现处方阿片类药物的经常使用者与非使用者相比，阿片类药物和非阿片类药物滥用率较高。
There has been notable concern regarding the rising prevalence of prescription opioid misuse, abuse, and fatal overdoses. A great deal of scholarly activity has been devoted to identifying risk factors for opioid misuse/abuse and less effort on discovering modifiable factors to mitigate risk. In this issue of Pain Medicine, Elander and colleagues [1] conducted an online survey of 112 individuals in the general population who had pain and had used over-the-counter (OTC) and prescription analgesics in the last month. They assessed typical pain factors (frequency, intensity, pain type, and etiology), opioid abuse risk based on a validated risk assessment measure, the Screener and Opioid Assessment for Patients with Pain (SOAPP), mood and anxiety disorders, and frequency and use of OTC and prescription analgesics. In addition, they collected a number of psychological measures, some very novel (alexithymia, mindfulness, self-compassion), along with known possible pain and substance abuse mediators (pain catastrophizing, pain acceptance, pain self-efficacy). Statistical analysis of the relationship between analgesic dependence (based on a modified Leeds Dependence Questionnaire) and the measures of pain, mood, and aberrant drug-related behavior (ADRB)(SOAPP) and other psychological factors revealed that the best single predictor of analgesic dependence was the SOAPP. Other independent factors predictive of dependence were the frequency of analgesic use and the level of acceptance of pain. A number of other interesting psychological variables and interactions were identified.It is not surprising that the SOAPP was the strongest predictor of analgesic dependence as it has probably the best psychometrics of all measures of ADRBs [2], which are considered to be surrogates of possible addiction. However, as noted by the authors, SOAPP scores were not significantly correlated with pain frequency or intensity suggesting that the SOAPP measures the risk of substance dependence independent of pain. The finding that frequent use of analgesics independently predicted dependence is also not intuitively surprising. A study by Edlund et al.[3] evaluated results of a nationally represented survey (N= 9,279) and found that regular users of prescription opioids as compared with nonusers had a higher rate of opioid and nonopioid abuse.