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

项目摘要。慢性疼痛是一种高度流行和致残的疾病，与 阿片类药物使用障碍和过量的风险增加。1 -4鉴于目前阿片类药物流行， 确定可能与慢性疼痛患者阿片类药物滥用增加相关的因素， 成为潜在的新型治疗靶点，以降低该高危人群中误用和过量的风险。的 注意，慢性疼痛状况的特征是情感的可变性，导致频繁的，突然的转变， 积极到消极的情感状态，通常是疼痛的结果。 研究了消极情感状态和阿片类药物结果之间的关联，16，17情感变异性 被忽视了这是文献中的一个关键空白，因为对情绪变化的反应可能导致 长期的负面情感状态，使患者面临更糟糕的阿片类药物结局的风险。为了填补这一空白， 本提案将是一个新的审查的情绪处理结构对比回避（CA）， 慢性疼痛患者。CA被定义为1）从积极情绪转变为消极情绪的不适（即， 对比）和2）参与减少或避免对比的策略（例如，避免与 积极情绪）。9对CA的研究表明，对比在焦虑的个体中是令人厌恶和禁用的， 导致对在对比状态之后的不愉快事件的更大的情绪反应（例如， 类似地，在对照之后经历的疼痛-即，愉快的状态，可以体验 比中性状态下的疼痛更令人厌恶和突出。对造影后疼痛的反应性增强 可能导致更大的阿片类药物渴望和滥用，以科普对比，而不是单独镇痛。 阿片类药物滥用也可能反映了一种创造稳定情绪状态和先发制人避免对比的愿望。 也就是说，患有慢性疼痛的人谁从事对比度降低策略（例如，钝化他们的 在痛苦的威胁下，那些更有可能使用阿片类药物的人可能是那些更有可能使用阿片类药物的人。 人为地稳定他们的情绪本研究将是第一个测试CA和阿片类药物之间的联系 在慢性疼痛患者中滥用。具体而言，本研究将：a）调查自我与 接受处方阿片类药物的慢性疼痛患者中报告的CA和阿片类药物滥用B）确定是否 在对比（即，在阿片类药物滥用者中， c）确定阿片类药物滥用者是否更有可能采用降低对比度的策略， 主要是在疼痛的威胁下对愉快刺激的参与变得迟钝。在研究CA时，我们将利用 神经生理学的措施，允许索引的情绪反应和注意力的显着性， 不能仅仅通过自我报告来描述。该奖学金将提供宝贵的培训，在心理生理学 方法和慢性疼痛研究，这将准备申请人的职业生涯作为一个独立的临床 研究慢性疼痛和物质使用障碍之间联系的科学家。

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.