Effect of pain catastrophizing on prescription opioid craving

项目总结/摘要 慢性疼痛和阿片类药物过量是美国两个严重的公共卫生问题。约2500万成年人（11%） 患有慢性日常疼痛，多达800万人使用阿片类药物来治疗慢性疼痛。不幸的是，46人 每天死于过量的处方阿片类药物对于慢性疼痛的安全慢性阿片类药物治疗，医生 监测患者对处方阿片类药物的依从性，并根据指示减少或停止处方。然而， 对于一些患者来说，坚持和停止并不容易，其中一个原因是阿片类药物的渴望，强烈的欲望或 使用阿片类药物。我们的初步数据显示，大约32%的慢性阿片类药物治疗患者报告了渴望。 渴望与阿片类药物滥用和负面健康结果密切相关。到目前为止，我们还没有完全 了解慢性疼痛患者对处方阿片类药物渴望的潜在机制， 治疗目标是减少渴望。根据我们的初步调查，患者赞同渴望报告更大的痛苦 比那些赞同无渴望的人更可怕。我们的另一项调查研究也报告了 慢性疼痛状况的慢性阿片类药物治疗患者的疼痛灾难化和阿片类药物渴求。虽然 这些发现提出了一种可能性，即降低疼痛灾难化可能会减少阿片类药物的渴望，交叉， 部分观察性研究在调查因果关系方面受到限制。潜在的，灾难性的疼痛 增强压力诱导的阿片类药物渴求，因为压力诱导的阿片类药物渴求是一个公认的 成瘾研究中的现象，疼痛灾难化与更大的疼痛和情绪有关。 慢性疼痛患者的痛苦。因此，拟议的项目旨在确定：a）疼痛的影响 在接受慢性阿片类药物治疗的慢性疼痛患者中对处方阿片类药物渴望的灾难化，和B） 心理（负面情绪）和生理（皮质醇，去甲肾上腺素）困扰作为潜在的中介 变量拟议的研究将使用先前验证的方案暂时诱导和减轻疼痛 灾难化和评估阿片类药物渴望，负面影响和压力激素的变化前后 痛苦的灾难性操纵此外，本拟定研究前瞻性地实施方案， 通过每天思考和排练应对声明，持续7天，并监测 每日对阿片类药物的渴望，阿片类药物的使用和滥用，以及14天的负面影响。目前的项目预计将 描述疼痛灾难化在阿片类药物渴望和阿片类药物滥用中的作用，以及疼痛灾难化作为一种 减少处方阿片类药物渴求和改善处方的关键心理治疗目标 坚持。此外，操纵疼痛灾难化的协议可以促进未来的研究， 涉及疼痛灾难化的因果机制和快速稳定疼痛灾难化的方案可以 临床上用于改善服用处方阿片类药物治疗慢性疼痛的患者的健康结果。

Project Summary/Abstract Chronic pain and opioid overdose are two critical public health problems in the US. About 25 million adults (11%) suffer from chronic daily pain and up to 8 million use opioids to manage chronic pain. Unfortunately, 46 people die daily from overdose of prescription opioids. For safe chronic opioid therapy for chronic pain, physicians monitor patients’ adherence to prescription opioids, and reduce or discontinue the prescription as indicated. Yet, adherence and cessation are not easy for some patients and one reason is opioid craving, a strong desire or urge to use opioids. Our preliminary data show about 32% of patients on chronic opioid therapy report craving. Craving is strongly associated with opioid misuse and negative health outcomes. To date, we do not fully understand the underlying mechanisms of prescription opioid craving in chronic pain sufferers, and psychological treatment targets to reduce craving. Based on our pilot survey, patients endorsing craving reported greater pain catastrophizing than those endorsing no craving. Our other survey study also reported a positive link between pain catastrophizing and opioid craving in patients on chronic opioid therapy for chronic pain conditions. Although these findings propose a possibility that lowering pain catastrophizing may decrease opioid craving, cross- sectional observational studies are limited in investigating a causal association. Potentially, pain catastrophizing enhances stress-induced opioid craving because stress-induced opioid craving is a well-established phenomenon in studies of addiction, and pain catastrophizing is associated with greater pain and emotional distress in patients with chronic pain. Therefore, the proposed project seeks to determine: a) the effect of pain catastrophizing on prescription opioid craving in patients on chronic opioid therapy for chronic pain and b) psychological (negative affect) and physiological (cortisol, norepinephrine) distress as potential mediating variables. The proposed study will use the previously validated protocol to temporarily induce and reduce pain catastrophizing and assess changes in opioid craving, negative affect, and stress hormones before and after pain catastrophizing manipulation. Additionally, this proposed study prospectively administers the protocol to reduce pain catastrophizing by thinking about and rehearsing a coping statement daily for 7 days and monitor daily opioid craving, opioid use and misuse, and negative affect for 14 days. The current project is expected to characterize the role of pain catastrophizing in opioid craving and opioid misuse, and pain catastrophizing as a critical psychological treatment target for reducing prescription opioid craving and improving prescription adherence. Furthermore, the protocol to manipulate pain catastrophizing can facilitate future research to study causal mechanisms involved in pain catastrophizing and the protocol to rapidly stabilize pain catastrophizing can be used clinically to improve the health outcome of patients taking prescription opioid for chronic pain.