Affective and Inflammatory Reactivity to Pain in Opioid Use Disorder

项目摘要/摘要 我们建议调查疼痛反应性对阿片类药物使用障碍和成人预后的影响。 慢性疼痛。疼痛一直是非药物处方阿片类药物急剧增加的关键因素 止痛药滥用和阿片类药物使用障碍的流行。在阿片类药物使用障碍的人中，疼痛是 与阿片类药物渴求增加和复发风险相关。对慢性疼痛患者的研究发现 疼痛反应，而不是疼痛本身，是造成负面结果的关键因素。疼痛反应--尤其是 对疼痛刺激的情感反应--与慢性疼痛的阿片类药物渴求和药物滥用有关 病人。阿片类镇痛剂能有效缓解疼痛的情感成分，因此对 在负面情绪高涨的背景下，负面强化。因此，在那些使用阿片类药物的人中 精神障碍，对疼痛的情感反应增强可能会增加使用阿片类药物缓解的动机，尽管 负面后果(例如，失业、失去家庭支持、吸毒过量)。此外，外设PRO- 炎性细胞因子在疼痛后增加，并与对疼痛的更大情感反应有关，如 以及增强阿片类药物的增强性能。然而，情感和情感的增强的影响 阿片类药物使用障碍对疼痛的炎症反应结果尚不清楚。值得注意的是，两者都很有感情 可通过干预改变反应性和外周血炎性细胞因子水平。因此，理解 这些因素对负面结果的贡献可以被用来指导那些 有阿片类药物使用障碍。因此，我们的目标是调查疼痛反应性和短期(阿片类药物) 阿片类药物使用障碍成年人的长期(阿片类药物复发)结果。今年NIDA的夏天 研究实习安置将支持开展阿片类药物使用障碍研究的培训，包括 疼痛在阿片类药物滥用中的作用，人类受试者研究中的伦理和程序考虑，以及 风险机制研究。

Project Summary/Abstract We propose to investigate the contribution of pain reactivity to outcomes in adults with opioid use disorder and chronic pain. Pain has been a critical factor in the dramatic escalation of nonmedical prescription opioid analgesic misuse and the epidemic of opioid use disorder. Among those with opioid use disorder, pain is associated with increased opioid craving and risk for relapse. Studies in chronic pain patients have found that pain reactivity, rather than pain itself, is a key contributor to negative outcomes. Pain reactivity--particularly affective responding to painful stimuli--is associated with opioid craving and medication misuse in chronic pain patients. Opioid analgesics provide powerful relief of the affective component of pain, and thus are highly negatively reinforcing in the context of elevated negative affect. Accordingly, among those with opioid use disorder, heightened affective reactivity to pain may increase motivation to use opioids for relief, despite negative consequences (e.g., unemployment, loss of family supports, overdose). Furthermore, peripheral pro- inflammatory cytokines increase following pain, and are associated with greater affective reactivity to pain as well as enhanced reinforcing properties of opioids. However, the impact of heightened affective and inflammatory reactivity to pain on opioid use disorder outcomes remains unknown. Notably, both affective reactivity and peripheral inflammatory cytokine levels can be modified with intervention. Thus, understanding of the contribution of these factors to negative outcomes can be used to inform treatment development for those with opioid use disorder. Therefore, our objective is to investigate pain reactivity and both short- (opioid craving) and long-term (opioid relapse) outcomes in adults with opioid use disorder. This NIDA Summer Research Internship placement will support training in the conduct of research in opioid use disorder, including the role of pain in opioid misuse, ethical and procedural considerations in human subjects research, and the study of risk mechanisms.