A multi-method examination of contrast avoidance and opioid misuse in patients with chronic pain

项目摘要。慢性疼痛是一种非常普遍的致残性疾病，与 阿片类药物使用障碍和过量的风险增加。1-4鉴于目前的阿片类药物流行，5必须 确定可能与慢性疼痛患者阿片类药物滥用加剧有关的因素，并可能 成为潜在的新的治疗目标，以减少这一高危人群中滥用和过量用药的风险。的 注意，慢性疼痛状况的特征是情感变化无常，导致频繁、突然的从 从积极到消极的情绪状态，通常是疼痛恶化的结果。14，15而之前的研究已经 研究了负面情绪状态和阿片类药物结果之间的关联，16，17种情绪变异性有 被忽视了。这是文献中的一个重要缺口，因为对情绪变化的反应可能会导致 长期的负面情绪状态，使患者面临更糟糕的阿片类药物结果的风险。为了填补这一空白， 本研究将对情绪加工结构中的对比回避(CA)进行新的研究 患有慢性疼痛的患者。CA被定义为1)从积极情绪转变为负面情绪的不适(即， 对比)和2)参与战略以减少或避免对比(例如，避免与 关于CA的研究表明，对比在焦虑的人中是令人厌恶和令人无法接受的， 从而导致对遵循对比状态的不愉快事件的更大情绪反应(例如， 同样，在一种反差--即愉快--状态之后所经历的疼痛也是可以经历的 比中性状态下的疼痛更令人厌恶和突出。对造影剂后疼痛的高度反应性 可能会导致更大的阿片类药物渴望和滥用来应对对比，而不仅仅是为了止痛。 阿片类药物的滥用也可能反映出想要创造稳定的情绪状态并先发制人地避免对比的愿望。 也就是说，患有慢性疼痛的人采用减少对比的策略(例如，钝化他们的 在疼痛威胁下的人可能更有可能使用阿片类药物来 人为地稳定他们的情绪。这项研究将首次测试CA和阿片类药物之间的联系 慢性疼痛患者误用。具体地说，本研究将：a)调查自我和自我之间的关系 在接受处方阿片类药物治疗的慢性疼痛患者中，报告的CA和阿片类药物滥用决定了 阿片类药物滥用者在对比(即愉快状态)后对疼痛的更大反应性比非阿片类药物滥用者更高 误用者c)确定阿片类药物误用者是否更有可能采用减少对比度的策略， 主要是在疼痛威胁下对愉快刺激的接触变得迟钝。在审查CA时，我们将利用 神经生理学测量，允许对情绪反应性和注意力突出性进行指标化 不能仅通过自我报告来捕获。这项奖学金将提供无价的心理生理学培训。 方法学和慢性疼痛研究，将为申请人作为独立临床医生的职业生涯做好准备 研究慢性疼痛和物质使用障碍之间关系的科学家。

Project Summary. Chronic pain is a highly prevalent and disabling condition that is associated with heightened risk for opioid use disorder and overdose.1-4 Given the current opioid epidemic,5 it is essential to identify factors that could be associated with heightened opioid misuse in patients with chronic pain and could be potential novel treatment targets to reduce the risk of misuse and overdose in this at-risk population. Of note, chronic pain conditions are characterized by affective variability, resulting in frequent, sudden shifts from positive to negative affective states, often as the result of pain worsening.14,15 While previous research has examined the association between negative affective states and opioid outcomes,16, 17 affective variability has been overlooked. This is a crucial gap in the literature, given that reactivity to emotional shifts may lead to the prolonged negative affective states that put patients at risk for worse opioid outcomes. To fill this gap, the present proposal will be a novel examination of the emotional processing construct contrast avoidance (CA) in patients with chronic pain. CA is defined as 1) discomfort with shifts from positive to negative emotion (i.e., contrasts) and 2) engagement in strategies to reduce or avoid contrasts (e.g., avoiding engagement with positive emotion).9 Research on CA has shown that contrasts are aversive and disabling in anxious individuals, leading to greater emotional reactivity toward unpleasant events that follow a contrasting state (e.g., relaxation).10,11 Similarly, pain experienced following a contrasting – i.e., pleasant – state, could be experienced as more aversive and salient than pain following a neutral state. Heightened reactivity to post-contrast pain could lead to greater opioid craving and misuse to cope with the contrast, rather than for analgesia alone. Opioid misuse could also reflect a desire to create a stable emotional state and preemptively avoid contrasts. That is, individuals with chronic pain who engage in contrast-reducing strategies (e.g., blunting their engagement with pleasant states) under threat of pain may be those who are more likely to use opioids to artificially stabilize their affect. The present study will be the first to test the association between CA and opioid misuse in patients with chronic pain. Specifically, this study will: a) Investigate the association between self- reported CA and opioid misuse in chronic pain patients receiving prescription opioids b) Determine whether greater reactivity to pain following a contrasting (i.e., pleasant state) is higher in opioid misusers than non- misusers c) Determine whether opioid misusers are more likely to engage in a contrast-reducing strategy, mainly blunting of engagement with pleasant stimuli under threat of pain. In examining CA, we will utilize neurophysiological measures that allow for the indexing of emotional reactivity and attentional salience that cannot be captured by self-report alone. This fellowship will provide invaluable training in psychophysiological methodology and chronic pain research that will prepare the applicant for a career as an independent clinical scientist examining the association between chronic pain and substance use disorders.