The Effect of Chronic Pain on Delay Discounting in Methadone Patients

慢性疼痛对美沙酮患者延迟折扣的影响

• 批准号: 10020379
• 负责人: David Andrew Tompkins
• 金额: $ 21.14万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10020379
• 关键词: AIDS/HIV problem; Abstinence; Acute; Affect; Attention; Buprenorphine; Characteristics; Chronic; Clinical Trials; Decision Making; Development; Double-Blind Method; Dropout; Drug usage; Emotional; Epidemic; Evidence based treatment; Future; Height; Impulsivity; Individual; Injections; Intervention; Intramuscular; Investigation; Measures; Methadone; Modeling; Naloxone; Normal saline; Overdose; Pain; Pain management; Patients; Persons; Play; Population; Primary Prevention; Procedures; Public Health; Relapse; Research Project Grants; Rewards; Role; Secondary Prevention; Severities; Sleep Deprivation; Substance Use Disorder; Surrogate Endpoint; Testing; Time; Treatment Efficacy; Treatment outcome; United States; Withdrawal; chronic musculoskeletal pain; chronic pain; chronic pain patient; clinical practice; cognitive process; coping; discount; discounting; drug relapse; experience; experimental study; follow-up; improved; insight; medication-assisted treatment; methadone patient; methadone treatment; opioid epidemic; opioid mortality; opioid use; opioid use disorder; opioid withdrawal; pain catastrophizing; pain relief; pain sensation; primary outcome; recruit; standard of care; stressor; trait

PROJECT SUMMARY / ABSTRACT This R21 resubmission proposes to systematically study the association between chronic musculoskeletal pain, delay discounting, opioid withdrawal and pain catastrophizing in patients on methadone maintenance for opioid use disorder (OUD). The epidemic of opioid overdose deaths continues to rise, killing more persons in 2017 then at the height of the HIV/AIDS epidemic. Medication assisted treatment, utilizing methadone or buprenorphine, is the standard of care for the treatment of OUD. However, co-occurring chronic pain can reduce treatment efficacy and is associated with relapse and poor retention in treatment. Mechanisms by which chronic pain may influence the impulsive decision-making (e.g., drug relapse) in persons with OUD have not been well characterized. Two factors that can influence decisions to use drugs are impulsivity and acute opioid withdrawal. Delay discounting is a model of impulsive decision-making and refers to the observation that delaying a consequence reduces its subjective value. Though delay discounting was originally thought to be trait-like, situational stressors have recently been shown to increase discounting, including acute opioid withdrawal. It is not known if a chronic stressor (i.e., chronic pain) has a similar effect on discounting or whether there are greater changes to discounting in the presence of both an acute and chronic stressor than either stressor alone. Trait pain catastrophizing is thought to increase attention and focus on pain and influence the choice of coping strategies used to respond to pain. It could play an important role in the impulsive decision to use drugs for immediate pain relief at the expense of abstinence, especially as a function of chronic pain. This proposal will test how chronic pain is associated with increases in impulsive decision-making in OUD, whether impulsive decision-making is greater when undergoing opioid withdrawal for OUD patients with and without chronic pain, and how catastrophizing may modify the association between chronic pain and impulsive decision- making. The proposed study will recruit two groups of patients maintained on methadone for OUD – individuals with (PAIN) and without (NO PAIN) chronic musculoskeletal pain, matched on characteristics that can influence delay discounting. Each group will have two double-blind experimental sessions in counterbalanced order: 1) control condition [intramuscular (IM) injection of normal saline] during peak methadone effects and 2) IM naloxone-precipitated opioid withdrawal. The same delay discounting tasks will be measured during each session. The specific aims are to: (1) Determine the effect of aversive stressors on delay discounting in persons in methadone maintenance; and (2) Investigate the degree to which trait pain catastrophizing modifies the association between opioid withdrawal and delay discounting. If withdrawal and catastrophizing were found to affect impulsive decision-making, future research could extend the study of these variables to determine if they play an explicitly causal role in decisions to use opioids or to relapse, and to develop interventions to remediate impulsivity leading to relapse, thereby improving treatment outcomes.

项目总结/摘要 这份R21重新提交的文件建议系统地研究慢性疾病与慢性炎症之间的关系。 美沙酮患者的肌肉骨骼疼痛、延迟折扣、阿片类戒断和疼痛灾难化 阿片类药物使用障碍（OUD）。阿片类药物过量死亡的流行继续上升， 在2017年，艾滋病毒/艾滋病疫情最严重的时候，药物辅助治疗，利用 美沙酮或丁丙诺啡是治疗OUD的标准护理。然而，共同发生的慢性 疼痛会降低治疗效果，并与治疗中的复发和不良保持有关。机制 由此慢性疼痛可能影响冲动决策（例如，药物复吸） 还没有得到很好的描述。两个因素可以影响决定使用药物是冲动和急性 阿片类药物戒断延迟折扣是一种冲动决策的模型，它指的是这样一种观察： 延迟一个结果会降低其主观价值。虽然延迟折扣最初被认为是 最近的研究表明，类似特质的情境压力源会增加折扣，包括急性阿片类药物 戒断尚不清楚慢性应激源（即，慢性疼痛）对贴现或是否 在同时存在急性和慢性应激源的情况下， 单独的压力源。特质痛苦灾难化被认为会增加对痛苦的关注， 选择应对疼痛的策略。它可能在冲动的决定中扮演重要角色， 以禁欲为代价使用药物立即缓解疼痛，特别是作为慢性疼痛的功能。这 一项提案将测试慢性疼痛如何与OUD中冲动决策的增加相关， 冲动决策是更大的，当经历阿片类药物戒断OUD患者， 慢性疼痛，以及灾难化如何改变慢性疼痛和冲动决策之间的关联- 制作。这项拟议的研究将招募两组患者，这些患者因OUD而继续接受美沙酮治疗-个体 伴有（疼痛）和不伴有（无疼痛）慢性肌肉骨骼疼痛，匹配可影响 延迟折扣每组将有两个双盲实验阶段，以平衡顺序进行：1） 对照条件[在美沙酮效应峰值期间肌肉内（IM）注射生理盐水]和2）IM 纳洛酮促使阿片类药物戒断。将在每个时间段测量相同的延迟折扣任务， 上网时段具体目的是：（1）确定厌恶性压力源对延迟折扣的影响 在美沙酮维持中;和（2）调查特质疼痛灾难化在多大程度上改变了 阿片类药物戒断与延迟折扣之间的关系。如果发现退缩和灾难化 影响冲动决策，未来的研究可以扩展这些变量的研究，以确定他们是否 在决定使用阿片类药物或复吸方面发挥明确的因果作用，并制定干预措施， 冲动导致复发，从而改善治疗效果。