Affective and Inflammatory Reactivity to Pain in Opioid Use Disorder

项目总结/摘要 我们建议调查疼痛反应性对阿片类药物使用障碍成年人结局的贡献， 慢性疼痛疼痛一直是非医疗处方阿片类药物急剧增加的关键因素 镇痛剂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患者中，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， 疼痛反应性，而不是疼痛本身，是负面结果的关键因素。疼痛反应，特别是 对疼痛刺激的情感反应-与慢性疼痛中的阿片类药物渴求和药物滥用有关 患者阿片类镇痛剂提供了对疼痛的情感成分的有力缓解，并且因此是高度可接受的。 在负面情绪升高的背景下，负面强化。因此，在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，过量）。此外，外设Pro 炎性细胞因子在疼痛后增加，并且与对疼痛的更大的情感反应性相关， 以及阿片类药物增强的增强性能。然而，提高情感和 阿片类药物使用障碍结果的炎症反应性疼痛仍然是未知的。值得注意的是， 反应性和外周炎性细胞因子水平可以通过干预来改变。因此， 这些因素对负面结果的贡献可以用来为那些 阿片类药物使用障碍因此，我们的目标是研究疼痛反应性和短-（阿片类） 渴望）和长期（阿片类药物复吸）的结果在成人阿片类药物使用障碍。今年夏天， 研究实习安排将支持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， 研究风险机制。

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.