Distress Intolerance and Prescription Opioid Abuse in Chronic Pain Patients

描述(申请人提供)：近年来，处方阿片类药物滥用已成为美国一个严重的公共卫生问题，其使用率仅次于大麻，相关死亡率高于海洛因和可卡因。阿片类药物是治疗慢性疼痛的一线药物，尽管许多患者能够坚持处方药物方案，但30%-50%的患者最终会滥用这些药物。鉴于需要充分治疗慢性疼痛，有疼痛状况的个人特别容易发展成处方阿片类药物滥用，这突显了确定这一人群中阿片类药物滥用风险因素的重要性。这一领域的早期研究已经开始发现 疼痛患者处方阿片类药物滥用的危险因素，以便于监测、早期发现和干预。然而，目前对可能使慢性疼痛患者容易滥用阿片类药物的风险因素知之甚少，也很少有研究研究这种情况可能发生的潜在机制。到目前为止，其他物质使用障碍的病史是处方阿片类药物滥用的最强预测因素；然而，这可能是由于共同的脆弱性因素，通常可能会增加有害物质使用模式的风险。拟议的研究旨在研究这样一个因素，它可能会增加慢性疼痛患者滥用阿片类药物的风险。具体地说，这项研究将检查痛苦不耐受--物质使用障碍的一个重要易感性因素--是否与慢性疼痛患者的处方阿片类药物滥用有关。痛苦不耐受，即被认为无法忍受负面的身体和情绪状态，是物质使用障碍的一个重要风险和维持因素，与使用水平、使用动机、是否存在物质使用障碍和治疗结果有关。痛苦不耐受是有害的回避行为(例如，使用药物)的强大动机，可以从痛苦的状态中提供强有力的、立即的缓解。对于高度不能忍受痛苦的人来说，在没有替代策略的情况下，提供快速减少痛苦的行为成为调节痛苦的依赖。在慢性疼痛中，无法忍受疼痛和对疼痛的情绪反应(如愤怒、焦虑)可能会导致滥用阿片类药物来试图避免这些感觉。拟议的研究将检查痛苦不耐受是否与慢性疼痛患者中存在阿片类药物滥用有关。此外，它还将测试对痛苦的耐受性是否会导致对疼痛更敏感，对疼痛的情感反应更强，以及在经历疼痛时对阿片类药物的渴望更大。在疼痛管理诊所接受长期阿片类药物治疗的慢性疼痛患者将接受痛苦不耐受和阿片类药物滥用措施，并将接受疼痛敏感性、对疼痛的情绪反应和对阿片类药物的渴望测试。这项研究的结果将提供有关处方阿片类药物滥用和慢性疼痛性质的重要信息，可用于制定监测、预防和治疗这一常见和致残疾病的战略。 公共卫生相关性：处方阿片类药物滥用在慢性疼痛患者中非常普遍，并与严重的痛苦和残疾有关。该项目旨在更好地了解可能会增加疼痛患者处方阿片类药物滥用风险的机制。这项研究的结果有可能为监测、预防和治疗这一重大公共卫生问题提供信息。

DESCRIPTION (provided by applicant): Prescription opioid abuse has emerged as a significant public health problem in the United States in recent years, with rates of use second only to marijuana and greater associated mortality than both heroin and cocaine. Opioids are a front-line treatment for chronic pain and although many patients are able to adhere to prescribed medication regimens, between 30-50% will eventually abuse these medications. Given the need to adequately treat chronic pain, individuals with pain conditions are particularly vulnerable to the development of prescription opioid abuse, highlighting the importance of the identification of risk factors for opioid abuse in this population. Early research in this area has begun to identify risk factors for prescription opioid abuse in pain patients to facilitate monitoring, early detectin, and intervention. However, little is known at this time about risk factors that may predispose chronic pain patients to opioid abuse and few studies have examined potential mechanisms by which this may occur. A history of other substance use disorders has been the strongest predictor of prescription opioid abuse to date; yet, this is likely attributable to a shared vulnerability factor that may generally increase risk for harmful substance use patterns. The proposed study aims to examine such a factor that may confer risk for opioid abuse in chronic pain patients. Specifically, this study will examine whether distress intolerance--an important vulnerability factor in substance use disorders--is associated with prescription opioid abuse in chronic pain patients. Distress intolerance, the perceived inability to tolerate negative physical and emotional states, is an important risk and maintaining factor in substance use disorders that is associated with levels of use, motivation for use, presence of substance use disorders, and treatment outcome. Distress intolerance is a powerful motivator of harmful avoidance behaviors (e.g., substance use) that provide strong and immediate relief from distressing states. For someone who is highly intolerant of distress, behaviors that provide rapid reduction of distress become relied upon to regulate distress in the absence of alternative strategies. In chronic pain, the inability to tolerate pain and emotional responses to pain (e.g., anger, anxiety) may lead to the abuse of opioids to attempt to avoid these sensations. The proposed study will examine whether distress intolerance is associated with the presence of opioid abuse in chronic pain patients. Additionally, it will test whether intolerance of distress leads to greater sensitivity t pain, stronger emotional responses to pain, and greater craving for opioids when experiencing pain. Patients receiving long- term opioid therapy for chronic pain conditions in a pain management clinic will be administered measures of distress intolerance and opioid abuse, and will undergo testing of pain sensitivity, emotional response to pain, and craving for opioids. The results from this study will provide important information on the nature of prescription opioid abuse and chronic pain, which can be used to develop strategies for monitoring, preventing and treating this common and disabling condition. PUBLIC HEALTH RELEVANCE: Prescription opioid abuse is highly prevalent among patients with chronic pain and is associated with significant distress and disability. This project aims to better understand mechanisms that may confer greater risk for the development of prescription opioid abuse in pain patients. The results of this study have the potential to inform monitoring, prevention, and treatment of this significant public health problem.