1
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Ware OD, Huhn AS, Ellis JD, Bird HE, Mun CJ, Dunn KE. Intersectional Risk and the Significant Gap in Care for Persons With Co-occurring Chronic Pain and Opioid Withdrawal. J Addict Med 2024; 18:256-261. [PMID: 38315737 DOI: 10.1097/adm.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Persons with chronic pain and women tend to enter treatment for opioid use disorder with greater opioid withdrawal severity than persons without chronic pain and men, respectively. This study examined characteristics of facilities with opioid withdrawal treatment, including gender-based services, as a function of whether they reported having a tailored pain management program. METHODS The National Survey of Substance Abuse Treatment Services 2020 was used to examine 3942 facilities with opioid withdrawal treatment in the United States. Using a multivariable binary logistic regression model, facilities were examined for the presence of a tailored program for individuals with co-occurring pain. Regional location of the facility, ownership status, and availability of tailored gender programs, nonhospital residential services, and outpatient services served as independent variables in the analysis. RESULTS A slight majority of the sample had a program for both adult men and adult women ( n = 2010, 51.0%). Most facilities had outpatient services ( n = 3289, 83.4%) and did not have a tailored program for addressing co-occurring pain ( n = 2756, 69.9%). Binary logistic regression analysis showed that among opioid withdrawal facilities, programs with nonhospital residential services, government or private nonprofit funding, or tailored gender programming had higher odds of reporting having a tailored program for pain and substance use disorder. Facilities in the Western United States were most likely to have tailored programs for pain and substance use disorder. CONCLUSIONS Future research should investigate what support patients may receive and how to better scale access to pain management during opioid withdrawal treatment.
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Affiliation(s)
- Orrin D Ware
- From the School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC (ODW); Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (ASH, JDE, HEB, KED); Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ (CJM)
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2
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Roussin A, Cissé Z, Rousseau V, Roche G, Lestrade C, Cauchie A, Delage N, Donnet A, Van Obberghen E, Wood C, Lapeyre-Mestre M, Cantagrel N. Discordance between pain specialists and patients on the perception of dependence on pain medication: A multi-centre cross-sectional study. Therapie 2024:S0040-5957(24)00043-X. [PMID: 38653623 DOI: 10.1016/j.therap.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/10/2023] [Accepted: 01/11/2024] [Indexed: 04/25/2024]
Abstract
AIM Patients with chronic non-cancer pain are referred to pain centres to improve their pain treatment. The discontinuation of pain medications in case of poor efficacy can be difficult to accept for patients, particularly opioid analgesics. Previous research has described that from the patients' perspective, the psychological relief of a negative effect of chronic pain and withdrawal symptoms of prescription opioids represent drivers of persistent use and first stage of opioid use disorder, despite insufficient pain relief. There is no validated tool to investigate this psychological dependence. This study aimed to assess discordance between patients and pain specialists in their perception of dependence on pain medication and investigate associations with characteristics of patients, type of pain and iatrogenic pharmacodependence. METHODS Self-administered questionnaires (patients and physicians) were administered in six pain centres in France. A question on perceived dependence on pain medications was addressed to the patient and the physician in a matched pair. Discordance between them was evaluated by the Cohen kappa coefficient. Demographics, pain, anxiety and depression, pain medication withdrawal symptoms, diverted use, and craving represented variables studied in a multivariate model as potentially associated with patient-physician discordance. RESULTS According to the 212 pairs of completed questionnaires, a perceived dependence was reported by the majority of patients (65.6%) and physicians (68.4%). However, the concordance was fair (kappa=0.38; CI [95%]: 0.25-0.51). Almost all patients (89.3%) were treated with an opioid analgesic. A higher likelihood of discordance was observed when patients suffered from nociplastic pain (odds ratio [OR]: 2.72, 95% [CI]: 1.29-5.84). CONCLUSION Medical shared-decision for changing pain treatment could be improved by taking into account the perception of patient dependence on medications for pain relief and or psychoactive effects, particularly in nociplastic pain for which the treatment is challenging.
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Affiliation(s)
- Anne Roussin
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France; Département de pharmacologie clinique et médicale, centre d'addictovigilance, Toulouse University Hospital, 31000 Toulouse, France.
| | - Zénab Cissé
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France
| | - Vanessa Rousseau
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France
| | - Guillaume Roche
- Département de pharmacologie clinique et médicale, centre d'addictovigilance, Toulouse University Hospital, 31000 Toulouse, France
| | - Cécile Lestrade
- Centre d'évaluation et de traitement de la douleur, Toulouse University Hospital, 31059 Toulouse, France
| | - Alexandre Cauchie
- Centre d'évaluation et de traitement de la douleur, pôle neurosciences cliniques, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Noémie Delage
- Centre d'évaluation et de traitement de la douleur, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France
| | - Anne Donnet
- Centre d'évaluation et de traitement de la douleur, Timone Hospital, 13005 Marseille, France
| | - Elise Van Obberghen
- Pain Department, CHU de Nice, France - FHU InovPain, université Côte d'Azur, 06000 Nice, France; Department of Pharmacology and Toxicology, PharmacoVigilance Centre, University of Nice Medical Centre, 06000 Nice, France
| | - Chantal Wood
- Centre d'évaluation et de traitement de la douleur, Limoges University Hospital, 87042 Limoges, France
| | - Maryse Lapeyre-Mestre
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France; Département de pharmacologie clinique et médicale, centre d'addictovigilance, Toulouse University Hospital, 31000 Toulouse, France
| | - Nathalie Cantagrel
- Centre d'évaluation et de traitement de la douleur, Toulouse University Hospital, 31059 Toulouse, France
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Kaye AD, Dufrene K, Cooley J, Walker M, Shah S, Hollander A, Shekoohi S, Robinson CL. Neuropsychiatric Effects Associated with Opioid-Based Management for Palliative Care Patients. Curr Pain Headache Rep 2024:10.1007/s11916-024-01248-0. [PMID: 38564124 DOI: 10.1007/s11916-024-01248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW The abundance of opioids administered in the palliative care setting that was once considered a standard of care is at present necessitating that providers evaluate patients for unintentional and deleterious symptomology related to aberrant opioid use and addiction. Polypharmacy with opioids is dynamic in affecting patients neurologically, and increased amounts of prescriptions have had inimical effects, not only for the individual, but also for their families and healthcare providers. The purpose of this review is to widen the perspective of opioid consequences and bring awareness to the numerous neuropsychiatric effects associated with the most commonly prescribed opioids for patients receiving palliative care. RECENT FINDINGS Numerous clinical and research studies have found evidence in support for increased incidence of opioid usage and abuse as well as undesirable neurological outcomes. The most common and concerning effects of opioid usage in this setting are delirium and problematic drug-related behavioral changes such as deceitful behavior towards family and physicians, anger outbursts, overtaking of medications, and early prescription refill requests. Other neuropsychiatric effects detailed by recent studies include drug-seeking behavior, tolerance, dependence, addictive disorder, anxiety, substance use disorder, emotional distress, continuation of opioids to avoid opioid withdrawal syndrome, depression, and suicidal ideation. Opioid usage has detrimental and confounding effects that have been overlooked for many years by palliative care providers and patients receiving palliative care. It is necessary, even lifesaving, to be cognizant of potential neuropsychiatric effects that opioids can have on an individual, especially for those under palliative care. By having an increased understanding and awareness of potential opioid neuropsychiatric effects, patient quality of life can be improved, healthcare system costs can be decreased, and patient outcomes can be met and exceeded.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
- Department of Pharmacology, Louisiana State University Health Sciences Center at Shreveport, Toxicology, and Neurosciences, Shreveport, LA, 71103, USA
| | - Kylie Dufrene
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Jada Cooley
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Madeline Walker
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Shivam Shah
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Alex Hollander
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
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Archambault L, Bertrand K, Martel MO, Bérubé M, Belhouari S, Perreault M. The current state of knowledge on care for co-occurring chronic pain and opioid use disorder: A scoping review. J Clin Nurs 2024. [PMID: 38532646 DOI: 10.1111/jocn.17139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND AIMS Opioid use disorder often co-occurs with chronic pain but assessment and treatment of these co-occurring disorders is complex. This review aims to identify current treatments and delivery models for co-occurring chronic pain and opioid use disorder (OUD) documented in the scientific literature. DESIGN Scoping review. METHODS The review was conducted in six databases in June 2022 (no time limit): CINAHL, PsycINFO, Web of Science, Cochrane, PubMed and Embase. The PRISMA-ScR checklist was used to guide reporting. RESULTS Forty-seven publications addressing the issue of co-occurring chronic pain and OUD management were included. Randomized controlled trials provide evidence for the effectiveness of opioid agonist treatments (OAT) such as methadone or buprenorphine/naloxone, as well as for combining OAT with Mindfulness-Oriented Recovery Enhancement or cognitive behavioural therapy. A number of other pharmacological treatments (opioid and nonopioid), nonpharmacological treatments (e.g. physiotherapy) and service delivery models (e.g. simultaneous treatment of comorbidities, interdisciplinary and interprofessional collaboration) are also underlined. In most cases, authors recommend a combination of strategies to meet patient needs. CONCLUSIONS The scoping review reveals gaps in evidence-based knowledge to effectively care for co-occurring chronic pain and OUD, but several experts recommend the uptake of known 'best' practices such as integrated treatment of the multiple biopsychosocial dimensions of the co-occurring disorders as well as collaborative interdisciplinary work. CLINICAL RELEVANCE Improving services is dependent on alleviating barriers such as working in silos, the costs associated with nonpharmacological treatments, and the double stigma associated with pain in people with a substance use disorder.
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Affiliation(s)
- Léonie Archambault
- Université de Sherbrooke and Douglas Research Center, Montréal, Quebec, Canada
- Institut universitaire sur les dépendances, Direction de l'enseignement universitaire et de la recherche, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Karine Bertrand
- Institut Universitaire Sur les dépendances and Community Health Science Dept., Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Marc O Martel
- Faculty of Dentistry & Department of Anesthesiology, McGill University, Montréal, Quebec, Canada
| | - Mélanie Bérubé
- Faculté Des Sciences infimières, Université Laval, Quebec City, Quebec, Canada
| | | | - Michel Perreault
- Douglas Research Center and Dept. of Psychiatry, McGill University, Montréal, Quebec, Canada
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Rausch J, Entrup P, Deaner M, King J, Hall OT. Pain and its Perceived Relatedness to the Onset, Maintenance, and Relapse of Opioid use Disorder: A Descriptive Study of Non-Treatment-Seeking Individuals. Can J Pain 2024; 8:2332198. [PMID: 38778924 PMCID: PMC11110686 DOI: 10.1080/24740527.2024.2332198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/15/2024] [Indexed: 05/25/2024]
Abstract
Background Previous research has found chronic pain to be prevalent among individuals with opioid use disorder (OUD). The perception that pain is related to OUD onset, maintenance, relapse, and treatment delay has been noted in this population. However, prior works primarily involved treatment-engaged populations. Scant research describes such perceptions among non-treatment-seeking individuals. Aims This study describes pain burden and perceptions regarding the role of pain in OUD onset, maintenance, relapse, and addiction treatment delay in a sample of individuals with untreated OUD. Methods This cross-sectional study surveyed syringe exchange participants (n = 141). Participants responded to a survey including Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition OUD criteria, pain survey scales, demographic characteristics, and questions regarding pain and its perceived relatedness to aspects of OUD. Results Most participants reported pain within the past 4 weeks (127, 91.4%). Data displayed a skew toward more intense pain ratings, with 120 reporting their pain as greater than mild (86.3%). A majority of participants agreed that pain was responsible for their OUD onset (79, 56.4%), maintenance (76, 54.3%), past relapse experience (82, 57.9%), and treatment delay (81, 57.9%). Correlative analyses revealed that pain severity and interference measures displayed moderate and statistically significant associations with extent of perceived relatedness of pain to these aspects of OUD. Conclusions Among this sample of individuals with untreated OUD, pain and pain interference were prevalent. Pain was perceived to be related to OUD onset, maintenance, relapse, and treatment delay by a majority of the sample. These findings are in accordance with and expand upon prior works. Abbreviations OUD: opioid use disorder; DSM-5: Diagnostic and Statistical Manual 5; BPI: Brief Pain Inventory; NIDA: National Institute on Drug Abuse; IASP: International Association for the Study of Pain; MOUD: Medications for Opioid Use Disorder; IQR: Interquartile Range.
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Affiliation(s)
- Johnathan Rausch
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center Talbot Hall, Columbus, OH, USA
| | - Parker Entrup
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Megan Deaner
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center Talbot Hall, Columbus, OH, USA
| | - Jasmine King
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - O. Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center Talbot Hall, Columbus, OH, USA
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MacLean RR, Spinola S, Pittman B, Meyerovich J, Szollosy SK, Wolkowicz NR, Minnix S, Sofuoglu M. The relationship of pain intensity and opioid craving with delayed methadone dose: A preliminary study of individuals with opioid use disorder. Br J Clin Pharmacol 2024. [PMID: 38439592 DOI: 10.1111/bcp.16027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/26/2023] [Accepted: 01/06/2024] [Indexed: 03/06/2024] Open
Abstract
AIMS Despite a strong theoretical link between opioid craving and pain, little is known about the temporal relationship between pain and craving and the acute experience of pain in the context of methadone treatment. Using a cross-over design, the current study evaluated the time course of pain and craving and objective experience of pain as a function of the last methadone dose. METHODS Participants (n = 20) presented for the study in the morning and either received methadone dose as scheduled or delayed dose until the afternoon. During the 4-h study visit, participants completed a series of tasks, including repeated assessment of pain and craving at 0, +40, +70, +130, +160 and +240 min and a cold pressor test (CPT) at +15 and +220 min. RESULTS Separate mixed model results demonstrated no effect of dosing condition on craving; however, there was a significant dosing condition by time interaction (F(5,209) = 3.38, P = .006) such that pain increased over time in the delayed methadone condition but decreased in time in the scheduled methadone condition. A mixed model predicting self-reported pain revealed a three-way interaction between dosing condition, craving and time (F(5,197) = 2.39, P = .039) explained by a positive association between craving and pain at each time point (except 240 min) in delayed condition (P-range = .004-.0001). A separate mixed model on CPT data indicated a significant condition by time interaction such that pain threshold decreased in the delayed, but not scheduled, condition (F(1,57) = 4.01, P = .050). CONCLUSIONS These preliminary findings highlight the potential for increased risks after even a short delay in receiving a methadone dose.
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Affiliation(s)
- R Ross MacLean
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Suzanne Spinola
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brian Pittman
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Sara K Szollosy
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Noah R Wolkowicz
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stacy Minnix
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
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Evans VD, Arenas A, Shinozuka K, Tabaac BJ, Beutler BD, Cherian K, Fasano C, Muir OS. Psychedelic Therapy: A Primer for Primary Care Clinicians-Ketamine. Am J Ther 2024; 31:e155-e177. [PMID: 38518272 DOI: 10.1097/mjt.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Ketamine, an arylcyclohexylamine dissociative anesthetic agent, has evolved into a versatile therapeutic. It has a rapid-onset, well-understood cardiovascular effects and a favorable safety profile in clinical use. Its enantiomeric compound, esketamine, was approved by the Food and Drug Administration in 2019 for both treatment-resistant depression and major depressive disorder with suicidal ideation. AREAS OF UNCERTAINTY Research indicates dose-dependent impacts on cognition, particularly affecting episodic and working memory following both acute administration and chronic use, albeit temporarily for the former and potentially persistent for the latter. Alongside acute risks to cardiovascular stability, ketamine use poses potential liver toxicity concerns, especially with prolonged or repeated exposure within short time frames. The drug's association with "ketamine cystitis," characterized by bladder inflammation, adds to its profile of physiological risks. THERAPEUTIC ADVANCES Data demonstrate a single intravenous infusion of ketamine exhibits antidepressant effects within hours (weighted effect size averages of depression scores (N = 518) following a single 0.5 mg/kg infusion of ketamine is d = 0.96 at 24 hours). Ketamine is also effective at reducing posttraumatic stress disorder (PTSD) symptom severity following repeated infusions (Clinician-Administered PTSD Scale scores: -11.88 points compared with midazolam control). Ketamine also decreased suicidal ideation in emergency settings (Scale for Suicidal Ideation scores: -4.96 compared with midazolam control). Through its opioid-sparing effect, ketamine has revolutionized postoperative pain management by reducing analgesic consumption and enhancing recovery. LIMITATIONS Many studies indicate that ketamine's therapeutic effects may subside within weeks. Repeated administrations, given multiple times per week, are often required to sustain decreases in suicidality and depressive symptoms. CONCLUSIONS Ketamine's comprehensive clinical profile, combined with its robust effects on depression, suicidal ideation, PTSD, chronic pain, and other psychiatric conditions, positions it as a substantial contender for transformative therapeutic application.
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Affiliation(s)
- Viviana D Evans
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alejandro Arenas
- Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA
| | - Kenneth Shinozuka
- Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Burton J Tabaac
- University of Nevada, Reno School of Medicine, Reno, NV
- Department of Neurology, Carson Tahoe Health, Carson City, NV
| | - Bryce D Beutler
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Kirsten Cherian
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | | | - Owen S Muir
- Fermata Health, Brooklyn, NY; and
- Acacia Clinics, Sunnyvale, CA
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Rattanavong M, Kwan D, Jorgenson D, Landry E, Marwah R, Halpape K. Low-dose Initiation of Buprenorphine/naloxone for the Management of Chronic Non-cancer Pain in Patients on Long-term Opioid Therapy: A Case Series. Can J Pain 2024; 8:2310811. [PMID: 38571889 PMCID: PMC10989697 DOI: 10.1080/24740527.2024.2310811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/23/2024] [Indexed: 04/05/2024]
Abstract
Background Buprenorphine may provide superior analgesia to full opioid agonist therapy and reverse the effects of opioid-induced hyperalgesia, while having a favorable safety profile and fewer adverse effects, in chronic non-cancer pain treatment. Low-dose initiation of buprenorphine is a useful strategy for patients on long-term opioid therapy because it avoids the need for moderate opioid withdrawal required for traditional buprenorphine initiations. However, there are few published reports of low-dose initiation regimens in the setting of chronic pain. Aims The aim of the study was to describe a case series of individuals living with chronic pain who were transitioned from long-term full opioid agonist therapy onto sublingual buprenorphine/naloxone using low-dose initiation regimens. Methods This study is a retrospective case series that included all patients who received care at an outpatient chronic pain clinic and were scheduled for low-dose initiation of buprenorphine/naloxone between March 2020 and December 2022. Data were collected through a retrospective review of electronic medical records and results were analyzed using descriptive statistics. Results Eighteen patients underwent transitions from their baseline opioids onto buprenorphine/naloxone using a low-dose initiation regimen. Of those patients, 17 successfully completed the initiation (94.44%), 12 experienced adverse effects during the initiation (66.67%), with only one patient requiring treatment discontinuation, and all adverse effects resolved once maintenance doses of buprenorphine/naloxone were established. The mean Clinical Global Impression-Improvement score after initiation was 2 (1-5). Conclusion Low-dose initiation is an effective approach to transition patients with chronic non-cancer pain from long-term opioid therapy to buprenorphine/naloxone without major complications or worsening pain.
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Affiliation(s)
- Maya Rattanavong
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Donica Kwan
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Derek Jorgenson
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Eric Landry
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Radhika Marwah
- Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Katelyn Halpape
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Norton LS, Dibb B. "I'm Not the Same Person Anymore": Thematic Analysis Exploring Experiences of Dependence to Prescribed Analgesics in Patients with Chronic Pain in the UK. Pain Ther 2023; 12:1427-1438. [PMID: 37751058 PMCID: PMC10616007 DOI: 10.1007/s40122-023-00553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/29/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION The rising issue of dependence to prescribed pain medication for patients with chronic pain has been highlighted in the literature; however, there is a dearth of research exploring the patient perspective of this dependence in the United Kingdom (UK). This exploratory qualitative study aimed to investigate experiences of prescribed analgesic dependence in patients with chronic pain in the UK. METHODS Semi-structured interviews were conducted with nine UK-based participants (eight females, one male) with a mean age of 44, who experienced chronic pain and identified as dependent to their prescribed pain medication. The interviews were recorded and transcribed verbatim and the data analysed using thematic analysis. RESULTS Three main themes emerged, including perceptions of dependence, interactions with others, and interactions with medical professionals. The findings revealed how the experiences focused on the participants' own perception of their dependence, such as its perceived impact on their life and how the dependence began, and the relation of the dependence to their social environment, for example, doctor-patient relations. CONCLUSIONS These findings suggest practical implications for the management of dependence such as, raising awareness of the risks of dependence with these medications in the UK, and stricter observation of those taking the medications to identify dependence issues early.
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Affiliation(s)
- Louise S Norton
- University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom.
| | - Bridget Dibb
- University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom.
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10
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Rogers AH, Heggeness LF, Smit T, Zvolensky MJ. Opioid coping motives and pain intensity among adults with chronic low back pain: associations with mood, pain reactivity, and opioid misuse. J Behav Med 2023; 46:860-870. [PMID: 37148396 DOI: 10.1007/s10865-023-00416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/21/2023] [Indexed: 05/08/2023]
Abstract
Chronic low back pain (CLBP) is a significant public health problem that is associated with opioid misuse and use disorder. Despite limited evidence for the efficacy of opioids in the management of chronic pain, they continue to be prescribed and people with CLBP are at increased risk for misuse. Identifying individual difference factors involved in opioid misuse, such as pain intensity as well as reasons for using opioids (also known as motives), may provide pertinent clinical information to reduce opioid misuse among this vulnerable population. Therefore, the aims of the current study were to examine the relationships between opioid motives-to cope with pain-related distress and pain intensity, in terms of anxiety, depression, pain catastrophizing, pain-related anxiety, and opioid misuse among 300 (Mage= 45.69, SD = 11.17, 69% female) adults with CLBP currently using opioids. Results from the current study suggest that both pain intensity and motives to cope with pain-related distress with opioids were associated with all criterion variables, but the magnitude of variance explained by coping motives was larger than pain intensity in terms of opioid misuse. The present findings provide initial empirical evidence for the importance of motives to cope with pain-related distress with opioids and pain intensity in efforts to better understand opioid misuse and related clinical correlates among adults with CLBP.
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Affiliation(s)
- Andrew H Rogers
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA.
| | - Luke F Heggeness
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, USA
- Health Institute, University of Houston, Houston, USA
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Hall OT, Teater J, Entrup P, Deaner M, Bryan C, Harte SE, Kaplan CM, Phan KL, Clauw DJ. Fibromyalgia predicts increased odds of pain-related addiction exacerbation among individuals with pain and opioid use disorder. Pain 2023; 164:1801-1809. [PMID: 36921216 PMCID: PMC10348630 DOI: 10.1097/j.pain.0000000000002878] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 03/16/2023]
Abstract
ABSTRACT Fibromyalgia and opioid use disorder (OUD) are highly impactful chronic illnesses with substantially overlapping psychosocial, biological, and clinical features. Little previous research has examined interactions between fibromyalgia and OUD. Limiting such research has been the previous requirement of a clinical examination to diagnose fibromyalgia. The 2011 American College of Rheumatology Fibromyalgia Survey (ACR-FMS) is a validated self-report instrument with high sensitivity and specificity for fibromyalgia intended to enable fibromyalgia research in settings where a clinical examination is impractical. The present observational study uses the ACR-FMS to determine whether fibromyalgia affects odds of acknowledging pain-related OUD exacerbations among a sample of participants with pain and OUD. Participants with pain and OUD (n = 125) were recruited from an academic substance use treatment facility. The ACR-FMS, along with an original scale measuring pain-related OUD exacerbation-the Pain-related OUD Exacerbation Scale-was administered through an electronic survey. The factor structure, internal consistency, and construct validity of Pain-related OUD Exacerbation Scale were tested. In addition, descriptive analyses, multiple hierarchical linear regression, ordinal logistic regression, and multinomial logistic regression analyses were performed. Although all participants had pain, those with fibromyalgia demonstrated significantly greater odds of acknowledging pain-related OUD exacerbations. Pain-related OUD Exacerbation Scale was found to have a single-factor solution, strong internal consistency, and construct validity. This study provides first evidence of fibromyalgia as a risk factor for pain-related exacerbation of OUD and introduces a new scale with promising psychometric properties to measure pain-related OUD exacerbation.
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Affiliation(s)
- Orman Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Julie Teater
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Parker Entrup
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Megan Deaner
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Craig Bryan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Chelsea M. Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Kihn Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Daniel J. Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
- Departments of Anesthesiology, Internal Medicine (Rheumatology) and Psychiatry, University of Michigan, Ann Arbor, MI, United States
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12
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Monroe SC, Radke AK. Opioid withdrawal: role in addiction and neural mechanisms. Psychopharmacology (Berl) 2023; 240:1417-1433. [PMID: 37162529 DOI: 10.1007/s00213-023-06370-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
Withdrawal from opioids involves a negative affective state that promotes maintenance of drug-seeking behavior and relapse. As such, understanding the neurobiological mechanisms underlying withdrawal from opioid drugs is critical as scientists and clinicians seek to develop new treatments and therapies. In this review, we focus on the neural systems known to mediate the affective and somatic signs and symptoms of opioid withdrawal, including the mesolimbic dopaminergic system, basolateral amygdala, extended amygdala, and brain and hormonal stress systems. Evidence from preclinical studies suggests that these systems are altered following opioid exposure and that these changes mediate behavioral signs of negative affect such as aversion and anxiety during withdrawal. Adaptations in these systems also parallel the behavioral and psychological features of opioid use disorder (OUD), highlighting the important role of withdrawal in the development of addictive behavior. Implications for relapse and treatment are discussed as well as promising avenues for future research, with the hope of promoting continued progress toward characterizing neural contributors to opioid withdrawal and compulsive opioid use.
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Affiliation(s)
- Sean C Monroe
- Department of Psychology and Center for Neuroscience and Behavior, Miami University, 90 N Patterson Ave, Oxford, OH, USA
| | - Anna K Radke
- Department of Psychology and Center for Neuroscience and Behavior, Miami University, 90 N Patterson Ave, Oxford, OH, USA.
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13
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Tsai PF, Oliveto AH, Landes RD, Mancino MJ. Characteristics of patients undergoing medication-assisted -treatment for opioid use disorder and their interest in Tai Chi practice. J Opioid Manag 2023; 19:329-341. [PMID: 37644791 PMCID: PMC10913153 DOI: 10.5055/jom.2023.0790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVES (1) To explore the characteristics of patients with opioid use disorder (OUD) maintained on either methadone or buprenorphine and (2) to determine the relative acceptability of integrating Tai Chi (TC) practice into an ongoing medication-assisted treatment for opioid use disorder (MOUD) program. DESIGN Survey study. SETTING The University of Arkansas for Medical Sciences Center for Addiction Services and Treatment Program. PATIENTS 97 patients receiving MOUD treatment. MAIN OUTCOMES Drug use history, treatment status, physical limitation, mental health, pain, and whether participants were interested in using TC to improve health outcomes. RESULTS At least 30.9 percent of the sample reported moderate or higher level of limitation in performing rigorous physical activities, pain intensity, and pain interference. Between 37.1 and 61.5 percent of the sample reported various psychiatric symptoms. Methadone patients reported higher levels of physical limitations, especially in rigorous activities (p = .012), climbing several flights of stairs (p = .001), and walking more than a mile (p = .011), but similar levels of pain (ps = .664-.689) and psychiatric symptoms (ps = .262-.879) relative to buprenorphine patients. At least 40.2 percent of participants expressed moderate or higher level of interest in TC for improving health outcomes, with methadone patients more interested in participating to ease mental and sleep problems (p = .005) and improve physical fitness (p = .015) compared to buprenorphine patients. CONCLUSIONS High prevalence of physical limitation, pain, and psychiatric comorbidities were found in OUD patients. Since patients were interested in TC to improve their health outcomes, this low-cost intervention, if proven effective, can be integrated into ongoing MOUD programs to improve health in this population.
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Affiliation(s)
- Pao-Feng Tsai
- Professor and Associate Dean for Research, College of Nursing, Auburn University, Auburn, Alabama. ORCID: https://orcid.org/0000-0003-2574-4930
| | - Alison H Oliveto
- Professor and Vice Chair for Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Reid D Landes
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Michael J Mancino
- Professor and Director, Department of Psychiatry, Center for Addiction Services and Treatment, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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14
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Li T, Zeng YW, Zhang F, Zhou X, Ren Y. Acupuncture for protracted opioid abstinence syndrome: study protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e071864. [PMID: 37336541 DOI: 10.1136/bmjopen-2023-071864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Protracted opioid abstinence syndrome (POAS) refers to a series of physical discomforts and neuropsychiatric symptoms after discontinuation of opioid-type substances for a certain amount of time and is one of the main causes of relapse. Studies have shown that acupuncture is effective in the treatment of POAS. We plan to conduct this systematic review and meta-analysis to assess the efficacy and safety of acupuncture for POAS. METHODS AND ANALYSIS A comprehensive search of studies will be carried out in the following databases from inception to 31 January 2023: Web of Science, Embase, PubMed, Chinese Biology Medicine, China National Knowledge Infrastructure, Wan Fang Database and Chinese Scientific Journal Database (VIP). WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and Chinese Clinical Trial Registry will also be searched for ongoing relevant trials, and 'grey literatures' will be identified from GreyNet International, OpenGrey and Google Scholar. Randomised controlled trials regarding acupuncture therapy for treatment of POAS will be included. The primary outcome is the severity of protracted withdrawal symptoms. Two reviewers will screen studies using the inclusion criteria, extract data and assess the risk of bias, respectively. The quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation. Data synthesis will be performed using RevMan V.5.4.1. ETHICS AND DISSEMINATION This study will not invade patients' personal privacy, and so ethical review is not required. The results will be disseminated in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022382978.
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Affiliation(s)
- Tao Li
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi Wei Zeng
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Feng Zhang
- Department of Ophthalmology, Third Military Medical University Southwest Hospital, Chongqing, China
| | - Xin Zhou
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yulan Ren
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
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15
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McCarter SJ, Labott JR, Mazumder MK, Gebhard J, Cunningham JL, Loukianova LL, Gilliam WP, Lipford MC. Emergence of restless legs syndrome during opioid discontinuation. J Clin Sleep Med 2023; 19:741-748. [PMID: 36692170 PMCID: PMC10071383 DOI: 10.5664/jcsm.10436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES The development of restless legs syndrome (RLS) has been rarely reported during and following opioid withdrawal. We aimed to determine the presence and severity of RLS symptoms during and after supervised opioid tapering. METHODS Ninety-seven adults enrolled in the Mayo Clinic Pain Rehabilitation Center who underwent supervised prescription opioid tapering were prospectively recruited. RLS presence and severity was assessed with the Cambridge-Hopkins Questionnaire 13 and International Restless Legs Syndrome Study Group Rating Severity Scale at admission, midpoint, and dismissal from the program as well as 2 weeks, 4 weeks, and 3 months after completion. Frequency and severity of RLS symptoms were compared between admission and each time point. RESULTS Average age of the cohort was 52.6 ± 13.3 years with a morphine milligram equivalent dose for the cohort of 45.6 ± 48.3 mg. Frequency of RLS symptoms increased from 28% at admission to peak frequency of 41% at 2 weeks following discharge from the Mayo Pain Rehabilitation Clinic (P = .01), returning to near baseline frequency 3 months after opioid discontinuation. International Restless Legs Syndrome Study Group Rating Severity Scale increased from baseline and then remained relatively stable at each time point following admission. Thirty-five (36.1%) participants developed de novo symptoms of RLS during their opioid taper, with those being exposed to higher morphine milligram equivalent doses having higher risk of developing RLS. CONCLUSIONS Moderately severe symptoms of RLS, as assessed by survey, occur commonly in individuals undergoing opioid tapering, particularly if exposed to higher doses. In many cases, symptoms appear to be self-limited, although a minority develop persistent symptoms. Our results may have implications for successful opioid tapering, but future confirmatory studies with structured clinician interview are needed to establish that these symptoms truly represent restless legs syndrome given the potential for RLS-mimicking symptoms in individuals with chronic pain syndromes. CITATION McCarter SJ, Labott JR, Mazumder MK, et al. Emergence of restless legs syndrome during opioid discontinuation. J Clin Sleep Med. 2023;19(4):741-748.
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Affiliation(s)
- Stuart J. McCarter
- Center for Sleep Medicine, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Joshua R. Labott
- Department of Orthopedics, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Mridul K. Mazumder
- Department of Geriatric Psychiatry Florida State University, Tallahassee, Florida
| | - Judy Gebhard
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Julie L. Cunningham
- Department of Pharmacy and Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Larissa L. Loukianova
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Wesley P. Gilliam
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Melissa C. Lipford
- Center for Sleep Medicine, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota
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16
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Wilson M, Fritz R, Finlay M, Cook DJ. Piloting Smart Home Sensors to Detect Overnight Respiratory and Withdrawal Symptoms in Adults Prescribed Opioids. Pain Manag Nurs 2023; 24:4-11. [PMID: 36175277 PMCID: PMC9925396 DOI: 10.1016/j.pmn.2022.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/09/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Novel strategies are needed to curb the opioid overdose epidemic. Smart home sensors have been successfully deployed as digital biomarkers to monitor health conditions, yet they have not been used to assess symptoms important to opioid use and overdose risks. AIM This study piloted smart home sensors and investigated their ability to accurately detect clinically pertinent symptoms indicative of opioid withdrawal or respiratory depression in adults prescribed methadone. METHODS Participants (n = 4; 3 completed) were adults with opioid use disorder exhibiting moderate levels of pain intensity, withdrawal symptoms, and sleep disturbance. Participants were invited to two 8-hour nighttime sleep opportunities to be recorded in a sleep research laboratory, using observed polysomnography and ambient smart home sensors attached to lab bedroom walls. Measures of feasibility included completeness of data captured. Accuracy was determined by comparing polysomnographic data of sleep/wake and respiratory status assessments with time and event sensor data. RESULTS Smart home sensors captured overnight data on 48 out of 64 hours (75% completeness). Sensors detected sleep/wake patterns in alignment with observed sleep episodes captured by polysomnography 89.4% of the time. Apnea events (n = 118) were only detected with smart home sensors in two episodes where oxygen desaturations were less severe (>80%). CONCLUSIONS Smart home technology could serve as a less invasive substitute for biologic monitoring for adults with pain, sleep disturbances, and opioid withdrawal symptoms. Supplemental sensors should be added to detect apnea events. Such innovations could provide a step forward in assessing overnight symptoms important to populations taking opioids.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington; Sleep and Performance Research Center, Washington State University, Spokane, Washington.
| | - Roschelle Fritz
- College of Nursing, Washington State University, Vancouver, Washington
| | - Myles Finlay
- Sleep and Performance Research Center, Washington State University, Spokane, Washington
| | - Diane J Cook
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, Washington
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17
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Omranian S, Zolnoori M, Huang M, Campos-Castillo C, McRoy S. Predicting Patient Satisfaction With Medications for Treating Opioid Use Disorder: Case Study Applying Natural Language Processing to Reviews of Methadone and Buprenorphine/Naloxone on Health-Related Social Media. JMIR INFODEMIOLOGY 2023; 3:e37207. [PMID: 37113381 PMCID: PMC9987197 DOI: 10.2196/37207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/06/2022] [Accepted: 12/30/2022] [Indexed: 04/29/2023]
Abstract
Background Medication-assisted treatment (MAT) is an effective method for treating opioid use disorder (OUD), which combines behavioral therapies with one of three Food and Drug Administration-approved medications: methadone, buprenorphine, and naloxone. While MAT has been shown to be effective initially, there is a need for more information from the patient perspective about the satisfaction with medications. Existing research focuses on patient satisfaction with the entirety of the treatment, making it difficult to determine the unique role of medication and overlooking the views of those who may lack access to treatment due to being uninsured or concerns over stigma. Studies focusing on patients' perspectives are also limited by the lack of scales that can efficiently collect self-reports across domains of concerns. Objective A broad survey of patients' viewpoints can be obtained through social media and drug review forums, which are then assessed using automated methods to discover factors associated with medication satisfaction. Because the text is unstructured, it may contain a mix of formal and informal language. The primary aim of this study was to use natural language processing methods on text posted on health-related social media to detect patients' satisfaction with two well-studied OUD medications: methadone and buprenorphine/naloxone. Methods We collected 4353 patient reviews of methadone and buprenorphine/naloxone from 2008 to 2021 posted on WebMD and Drugs.com. To build our predictive models for detecting patient satisfaction, we first employed different analyses to build four input feature sets using the vectorized text, topic models, duration of treatment, and biomedical concepts by applying MetaMap. We then developed six prediction models: logistic regression, Elastic Net, least absolute shrinkage and selection operator, random forest classifier, Ridge classifier, and extreme gradient boosting to predict patients' satisfaction. Lastly, we compared the prediction models' performance over different feature sets. Results Topics discovered included oral sensation, side effects, insurance, and doctor visits. Biomedical concepts included symptoms, drugs, and illnesses. The F-score of the predictive models across all methods ranged from 89.9% to 90.8%. The Ridge classifier model, a regression-based method, outperformed the other models. Conclusions Assessment of patients' satisfaction with opioid dependency treatment medication can be predicted using automated text analysis. Adding biomedical concepts such as symptoms, drug name, and illness, along with the duration of treatment and topic models, had the most benefits for improving the prediction performance of the Elastic Net model compared to other models. Some of the factors associated with patient satisfaction overlap with domains covered in medication satisfaction scales (eg, side effects) and qualitative patient reports (eg, doctors' visits), while others (insurance) are overlooked, thereby underscoring the value added from processing text on online health forums to better understand patient adherence.
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Affiliation(s)
- Samaneh Omranian
- Department of Electrical Engineering and Computer Science College of Engineering & Applied Science University of Wisconsin-Milwaukee Milwaukee, WI United States
| | - Maryam Zolnoori
- School of Nursing Columbia University New York, NY United States
| | - Ming Huang
- Department of Artificial Intelligence and Informatics Mayo Clinic Rochester, MN United States
| | - Celeste Campos-Castillo
- Department of Media and Information Michigan State University East Lansing, MI United States
| | - Susan McRoy
- Department of Electrical Engineering and Computer Science College of Engineering & Applied Science University of Wisconsin-Milwaukee Milwaukee, WI United States
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18
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Truitt B, Venigalla G, Singh P, Singh S, Tao J, Chupikova I, Roy S. The gut microbiome contributes to somatic morphine withdrawal behavior and implicates a TLR2 mediated mechanism. Gut Microbes 2023; 15:2242610. [PMID: 37589387 PMCID: PMC10438851 DOI: 10.1080/19490976.2023.2242610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/10/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023] Open
Abstract
The ongoing opioid epidemic has left millions of people suffering from opioid use disorder due to the over-prescription of highly addictive substances. Chronic opioid exposure leads to dependence, where the absence of the drug results in negative symptoms of withdrawal, often driving patients to continue drug use; however, few therapeutic strategies are currently available to combat the cycle of addiction and the severity of morphine withdrawal. This study investigates the microbiome as a potential therapeutic target for morphine withdrawal, as gut dysbiosis caused by morphine use has been proven to contribute to other aspects of opioid use disorders, such as tolerance. Results show that although the microbiome during morphine withdrawal trends toward recovery from morphine-induced dysbiosis, there continues to be a disruption in the alpha and beta diversity as well as the abundance of gram-positive bacteria that may still contribute to the severity of morphine withdrawal symptoms. Germ-free mice lacking the microbiome did not develop somatic withdrawal symptoms, indicating that the microbiome is necessary for the development of somatic withdrawal behavior. Notably, only TLR2 but not TLR4 whole-body knockout models display less withdrawal severity, implicating that the microbiome, through a gram-positive, TLR2 mediated mechanism, drives opioid-induced somatic withdrawal behavior.
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Affiliation(s)
- Bridget Truitt
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
- Neuroscience Graduate Program, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Greeshma Venigalla
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Praveen Singh
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Salma Singh
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Junyi Tao
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Irina Chupikova
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Sabita Roy
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
- Neuroscience Graduate Program, Miller School of Medicine, University of Miami, Miami, FL, USA
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19
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Ware OD, Ellis JD, Dunn KE, Hobelmann JG, Finan P, Huhn AS. The association of chronic pain and opioid withdrawal in men and women with opioid use disorder. Drug Alcohol Depend 2022; 240:109631. [PMID: 36126611 DOI: 10.1016/j.drugalcdep.2022.109631] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Approximately 2.7 million individuals in the United States had an opioid use disorder (OUD) in 2020. Chronic pain may exacerbate opioid withdrawal severity, yet most research on opioid withdrawal has not collected data on chronic pain status. Moreover, there is limited evidence that women tend to experience greater opioid withdrawal severity than men, but large, confirmatory studies on this topic have not been published. The goal of this study was to examine the roles of chronic pain and gender on opioid withdrawal severity using a large, multi-site database. METHODS Data were collected from N = 1252 individuals with OUD entering eight residential addiction treatment facilities. Demographic, drug use behaviors, and chronic pain status were collected at treatment intake, and self-reported opioid withdrawal and craving were measured at intake and 1-3 days, 4-6 days, and 7-9 days after intake. Regression analyses were used to predict withdrawal and craving severity at intake and across the four timepoints. RESULTS At intake, withdrawal was higher in persons who were older, had greater SUD severity, women, had chronic pain, and used > 1 substance (p-values ≤.007) and craving was higher in persons with greater SUD severity (p < .001) and women (p = .033). Withdrawal remained higher in women and persons with chronic pain across timepoints but decreased at a similar rate relative to comparators. CONCLUSIONS Women and persons with chronic pain would benefit from earlier engagement in treatment and may require a more intensive strategy to mitigate opioid withdrawal in early treatment.
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Affiliation(s)
- Orrin D Ware
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - J Gregory Hobelmann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Ashley Addiction Treatment, Havre de Grace, MD, United States
| | - Patrick Finan
- Department of Anesthesiology, University of Virginia School of Medicine, United States
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Ashley Addiction Treatment, Havre de Grace, MD, United States.
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20
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Loya JM, Tangney JP, Stuewig JB. Are Borderline Personality Disorder Features Differentially Related to Pre-Incarceration Alcohol, Cannabis, Cocaine, and Opioid Dependence Among People Recently Incarcerated in Jail? J Pers Disord 2022; 36:623-640. [PMID: 36181491 DOI: 10.1521/pedi.2022.36.5.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) and substance use disorders (SUDs) commonly co-occur across various settings. However, little research has examined how BPD features relate to specific types of SUDs. This study examined whether BPD features assessed shortly after incarceration were differentially related to symptoms of dependence on alcohol, cannabis, cocaine, and opioids experienced in the 12 months prior to incarceration among 510 people recently incarcerated in jail. Follow-up multigroup analyses evaluated whether gender or race moderated the relation of BPD features to the four SUDs. Using structural equational modeling, the relationships of BPD features were compared to each of the four preincarceration dependence symptoms. BPD features were significantly related to dependence on each of the four substances, but the link between BPD features and cocaine dependence was stronger than BPD's association with alcohol, cannabis, or opioid dependence. These findings generalized across men and women and across White and Black people.
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Affiliation(s)
- Jennifer M Loya
- Yale School of Medicine, New Haven, Connecticut.,George Mason University, Fairfax, Virginia
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21
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Hasin DS, Shmulewitz D, Stohl M, Greenstein E, Aharonovich E, Petronis KR, Von Korff M, Datta S, Sonty N, Ross S, Inturrisi C, Weinberger ML, Scodes J, Wall MM. Diagnosing Prescription Opioid Use Disorder in Patients Using Prescribed Opioids for Chronic Pain. Am J Psychiatry 2022; 179:715-725. [PMID: 35702830 DOI: 10.1176/appi.ajp.21070721] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The diagnostic criteria for opioid use disorder, originally developed for heroin, did not anticipate the surge in prescription opioid use and the resulting complexities in diagnosing prescription opioid use disorder (POUD), including differentiation of pain relief (therapeutic intent) from more common drug use motives, such as to get high or to cope with negative affect. The authors examined the validity of the Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 opioid version, an instrument designed to make this differentiation. METHODS Patients (N=606) from pain clinics and inpatient substance treatment who ever received a ≥30-day opioid prescription for chronic pain were evaluated for DSM-5 POUD (i.e., withdrawal and tolerance were not considered positive if patients used opioids only as prescribed, per DSM-5 guidelines) and pain-adjusted POUD (behavioral/subjective criteria were not considered positive if pain relief [therapeutic intent] was the sole motive). Bivariate correlated-outcome regression models indicated associations of 10 validators with DSM-5 and pain-adjusted POUD measures, using mean ratios for dimensional measures and odds ratios for binary measures. RESULTS The prevalences of DSM-5 and pain-adjusted POUD, respectively, were 44.4% and 30.4% at the ≥2-criteria threshold and 29.5% and 25.3% at the ≥4-criteria threshold. Pain adjustment had little effect on prevalence among substance treatment patients but resulted in substantially lower prevalence among pain treatment patients. All validators had significantly stronger associations with pain-adjusted than with DSM-5 dimensional POUD measures (ratios of mean ratios, 1.22-2.31). For most validators, pain-adjusted binary POUD had larger odds ratios than DSM-5 measures. CONCLUSIONS Adapting POUD measures for pain relief (therapeutic intent) improved validity. Studies should investigate the clinical utility of differentiating between therapeutic and nontherapeutic intent in evaluating POUD diagnostic criteria.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Malka Stohl
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Eliana Greenstein
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Kenneth R Petronis
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Michael Von Korff
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Samyadev Datta
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Nomita Sonty
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Stephen Ross
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Charles Inturrisi
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Michael L Weinberger
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Jennifer Scodes
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
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22
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Kudrich C, Hurd YL, Salsitz E, Wang AL. Adjunctive Management of Opioid Withdrawal with the Nonopioid Medication Cannabidiol. Cannabis Cannabinoid Res 2022; 7:569-581. [PMID: 34678050 PMCID: PMC9587789 DOI: 10.1089/can.2021.0089] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: Opioid use disorder (OUD) is a major public health crisis worldwide. Patients with OUD inevitably experience withdrawal symptoms when they attempt to taper down on their current opioid use, abstain completely from opioids, or attempt to transition to certain medications for opioid use disorder. Acute opioid withdrawal can be debilitating and include a range of symptoms such as anxiety, pain, insomnia, and gastrointestinal symptoms. Whereas acute opioid withdrawal only lasts for 1-2 weeks, protracted withdrawal symptoms can persist for months after the cessation of opioids. Insufficient management of opioid withdrawal often leads to devastating results including treatment failure, relapse, and overdose. Thus, there is a critical need for cost-effective, nonopioid medications, with minimal side effects to help in the medical management of opioid withdrawal syndrome. We discuss the potential consideration of cannabidiol (CBD), a nonintoxicating component of the cannabis plant, as an adjunctive treatment in managing the opioid withdrawal syndrome. Materials and Methods: A review of the literature was performed using keywords related to CBD and opioid withdrawal syndrome in PubMed and Google Scholar. A total of 144 abstracts were identified, and 41 articles were selected where CBD had been evaluated in clinical studies relevant to opioid withdrawal. Results: CBD has been reported to have several therapeutic properties including anxiolytic, antidepressant, anti-inflammatory, anti-emetic, analgesic, as well as reduction of cue-induced craving for opioids, all of which are highly relevant to opioid withdrawal syndrome. In addition, CBD has been shown in several clinical trials to be a well-tolerated with no significant adverse effects, even when co-administered with a potent opioid agonist. Conclusions: Growing evidence suggests that CBD could potentially be added to the standard opioid detoxification regimen to mitigate acute or protracted opioid withdrawal-related symptoms. However, most existing findings are either based on preclinical studies and/or small clinical trials. Well-designed, prospective, randomized-controlled studies evaluating the effect of CBD on managing opioid withdrawal symptoms are warranted.
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Affiliation(s)
- Christopher Kudrich
- Department of Psychiatry, Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mount Sinai Beth Israel Hospital, New York, New York, USA
| | - Yasmin L. Hurd
- Department of Psychiatry, Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Edwin Salsitz
- Department of Psychiatry, Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mount Sinai Beth Israel Hospital, New York, New York, USA
| | - An-Li Wang
- Department of Psychiatry, Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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23
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Lim G, Nowakowski E, LaSorda KR, Altamirano V, Morgan M, Makeen M, Beck S, Krans E, Chelly JE. NSS-Bridge Device for Post-Cesarean Delivery Analgesia: A Randomized Controlled Trial. OBSTETRICS AND GYNECOLOGY RESEARCH 2022; 5:210-218. [PMID: 36276260 PMCID: PMC9581440 DOI: 10.26502/ogr094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Percutaneous auricular nerve stimulation has been used for the treatment of symptoms associated with opioid withdrawal, including abdominal pain, nausea, and general discomfort. However, its potential utility for pain management and opioid minimization after surgery has not been investigated. The purpose of this study was to test the feasibility and acceptability of a trial protocol designed to assess the effectiveness of the NSS2-Bridge device as a non-pharmacologic alternative to opioids after cesarean delivery. Methods In a randomized control design, healthy women receiving cesarean delivery were randomized to receive the active device, placebo device, or no device. Devices were placed on the ear following cesarean delivery and left in place for 5 days. Feasibility and acceptability of the device was assessed by patient reports of device tolerability (rated on a 100mm visual analog scale where 0 is not tolerable at all and 100 is the most tolerable) as well as qualitative reporting. Additional outcomes assessed included proportion of patients not using opioids in hospital, as well as pain at rest, pain with movement, and total opioid consumption in the hospital and for the first 5 days after surgery. Results There were 60 patients included in the final analysis. Device tolerability was rated highly, with an average daily score of >75 mm on the visual analog scale. The trial retention rate was 89.7% with most exclusions (42.9%) occurring due to unanticipated development of care complexity (e.g., hemorrhage and additional surgical procedures), with only 1 exclusion (14.3%) due to device discomfort. The active device group achieved the highest proportion of opioid-free hospitalizations (40%) compared to placebo (20%) and no device groups (30%). Pain at rest and with movement was similar between treatment groups. Conclusions This trial protocol designed to test the efficacy of NSS2-Bridge device for post-cesarean pain management is feasible and acceptable. Larger proportions of patients not using opioids in the active device group justifies additional investigation on device effectiveness in pregnant and postpartum people at highest risk for pain.
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Affiliation(s)
- Grace Lim
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Center for Innovation in Pain Medicine, Center for Complementary and Alternative Pain Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Emma Nowakowski
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kelsea R LaSorda
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Valeria Altamirano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Madison Morgan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mutasim Makeen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stacy Beck
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Krans
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jacques E Chelly
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Center for Innovation in Pain Medicine, Center for Complementary and Alternative Pain Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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24
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Zhang J, Song C, Dai J, Li L, Yang X, Chen Z. Mechanism of opioid addiction and its intervention therapy: Focusing on the reward circuitry and mu‐opioid receptor. MedComm (Beijing) 2022; 3:e148. [PMID: 35774845 PMCID: PMC9218544 DOI: 10.1002/mco2.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jia‐Jia Zhang
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| | - Chang‐Geng Song
- Department of Neurology Xijing Hospital The Fourth Military Medical University Xi'an China
| | - Ji‐Min Dai
- Department of Hepatobiliary Surgery Xijing Hospital The Fourth Military Medical University Xi'an China
| | - Ling Li
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| | - Xiang‐Min Yang
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| | - Zhi‐Nan Chen
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
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25
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Bruneau A, Poirier C, Bérubé M, Boulanger A, Gélinas C, Guénette L, Lacasse A, Lussier D, Tousignant-Laflamme Y, Pagé MG, Martel MO. French-Canadian Translation and Cultural Adaptation of the Clinical Opiate Withdrawal Scale: The COWS-FC. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:701-711. [PMID: 35290134 PMCID: PMC9449138 DOI: 10.1177/07067437221087066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The main objective of the present study was to develop a French-Canadian translation and adaptation of the COWS (i.e., the COWS-FC) for the assessment of opioid withdrawal symptoms in clinical and research settings. METHODS The French-Canadian translation and cultural adaptation of the COWS was performed following guidelines for the translation and cross-cultural adaptation of self-report measures. The steps consisted of (1) initial translation from English to French, (2) synthesis of the translation, (3) back-translation from French to English, (4) expert committee meeting, (5) test of the prefinal version among healthcare professionals and (6) review of final version by the expert committee. The expert committee considered four major areas where the French-Canadian version should achieve equivalence with the original English-version of the COWS. These areas were (1) semantic equivalence; (2) idiomatic equivalence; (3) experiential equivalence and (4) conceptual equivalence. RESULTS Rigorous steps based on the guidelines for the translation and cultural adaptation of assessment tools were followed, which led to a semantically equivalent version of the COWS. After a pretest among healthcare professionals, members from the expert committee agreed upon slight modifications to the French-Canadian version of the COWS to yield a final COWS-FC version. CONCLUSIONS A French-Canadian translation and adaptation of the COWS (i.e., the COWS-FC) was developed. The COWS-FC could be used for the assessment of opioid withdrawal symptoms in clinical and research settings.
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Affiliation(s)
- Alice Bruneau
- Faculty of Medicine, 5620McGill University, Montreal, Quebec, Canada
| | - Clarice Poirier
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Mélanie Bérubé
- Faculty of Nursing, Université Laval, Québec City, Quebec, Canada.,177460Centre de recherche du Centre hospitalier universitaire de Québec, Population Health and Optimal Health Practices Research Unit, Québec City, Quebec, Canada
| | - Aline Boulanger
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Pain Clinic, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Céline Gélinas
- Ingram School of Nursing, 5620McGill University, Montreal, Quebec, Canada
| | - Line Guénette
- 177460Centre de recherche du Centre hospitalier universitaire de Québec, Population Health and Optimal Health Practices Research Unit, Québec City, Quebec, Canada.,Faculty of Pharmacy, 4440Laval University, Quebec City, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, 7001Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - David Lussier
- Centre de recherche, l'Institut universitaire de gériatrie de Montréal du CIUSSS du Centre-Sud-de-l'Ile-de Montréal, Montreal, Quebec, Canada.,Département de médecine, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, 7321Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - M Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre de recherche, Centre hospitalier de l'5622Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Marc O Martel
- Faculty of Dentistry & Department of Anesthesiology, 5620McGill University, Montreal, Quebec, Canada
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26
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Gripshover J, Kosten T. Managing Opioid Withdrawal in an Outpatient Setting With Lofexidine or Clonidine. Cureus 2022; 14:e27639. [PMID: 36072176 PMCID: PMC9437420 DOI: 10.7759/cureus.27639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background There is a need for improved strategies for managing abrupt opioid withdrawal when transitioning patients with opioid use disorder to comprehensive longitudinal care strategies such as naltrexone maintenance treatment. In addition, alpha-2 adrenergic agonists are used to ameliorate withdrawal symptoms, but current data characterizing real-world treatment are lacking. Methods A retrospective chart review was conducted in outpatients undergoing abrupt opioid withdrawal managed with lofexidine (0.18 mg, 1-4 tablets 4x daily for 7 days, pro re nata [PRN or as needed]) or clonidine (0.2 mg, 1 tablet 3x daily for 10 days, PRN). Withdrawal outcomes were characterized at 30 days of follow-up. Binomial logistic regression was used to assess a potential association of the two treatments with different likelihoods of opioid cessation success in this real-world outpatient practice. Results In cases treated with lofexidine (n=166) and clonidine (n=432), respectively, 40% and 10% were opioid-free, 6% and 2% continued long-term buprenorphine or methadone, 17% and 36% relapsed, and 37% and 52% were lost to follow-up at 30 days post-withdrawal. Among patients returning for follow-up care, 63% of patients treated with lofexidine and 21% treated with clonidine were opioid-free. Lofexidine was associated with a higher likelihood of opioid cessation success relative to clonidine (OR=6.47; Wald Chi-square=53.79, p<0.001). Conclusion Among outpatients returning for follow-up care, nearly two-thirds of those managed with lofexidine reached opioid-free status at 30 days post-withdrawal, which was a higher likelihood than those managed with clonidine, thus allowing their transition to comprehensive care, including naltrexone.
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27
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Rodríguez-Espinosa S, Coloma-Carmona A, Pérez-Carbonell A, Román-Quiles JF, Carballo JL. Differential Experience of Interdose Withdrawal During Long-Term Opioid Therapy and its Association With Patient and Treatment Characteristics: A Latent Class Analysis in Chronic Pain Population. THE JOURNAL OF PAIN 2022; 23:1427-1436. [PMID: 35429674 DOI: 10.1016/j.jpain.2022.03.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/20/2022] [Accepted: 03/12/2022] [Indexed: 06/14/2023]
Abstract
Opioid withdrawal is characterized by a set of physical and psychological symptoms that depend on both opioid and patient specific characteristics. The present study aims to identify different latent classes of chronic pain patients according to the type of opioid withdrawal symptoms experienced, and to analyze the relationships between the classes and demographic, opioid therapy, psychological and substance use variables. This cross-sectional descriptive study included 391 chronic pain patients on long-term opioid therapy. A Latent Class Analysis (LCA) identified 3 classes (BIC = 7051.89, entropy = .87, LRTs P < .01). The mild withdrawal class showed low probabilities of presenting physical and psychological symptoms, the moderate withdrawal class was characterized by experiencing psychological symptoms, and the severe withdrawal class stood out for high probabilities of presenting both types of symptoms. The classes differed from each other, with higher rates of moderate-severe POUD, opioid misuse, anxiety, depression, and greater pain intensity and interference in more severe withdrawal classes (P < .05). The multinomial logistic regression showed that moderate-severe POUD and anxiety were the strongest variables related to moderate (ORPOUD = 3.34, ORAnxiety = 2.58) and severe withdrawal classes (ORPOUD = 4.26, ORAnxiety = 5.15). Considering that POUD and anxiety were strongly related to a more severe withdrawal syndrome, the inclusion of psychological interventions in pain management seems critical in this population. PERSPECTIVE: Although interdose opioid withdrawal is common in chronic pain patients, this study shows 3 different patterns in its experience (mild, moderate, and severe withdrawal). A more severe withdrawal may result in reduced effectiveness of opioids in relieving pain and increased negative consequences, such as higher risk of POUD. Findings that could help improve chronic pain management.
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Affiliation(s)
- Sara Rodríguez-Espinosa
- Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, Elche, Spain
| | - Ainhoa Coloma-Carmona
- Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, Elche, Spain
| | | | | | - José L Carballo
- Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, Elche, Spain.
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28
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A neuroeconomic signature of opioid craving: How fluctuations in craving bias drug-related and nondrug-related value. Neuropsychopharmacology 2022; 47:1440-1448. [PMID: 34916590 PMCID: PMC9205977 DOI: 10.1038/s41386-021-01248-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/24/2021] [Indexed: 12/24/2022]
Abstract
How does craving bias decisions to pursue drugs over other valuable, and healthier, alternatives in addiction? To address this question, we measured the in-the-moment economic decisions of people with opioid use disorder as they experienced craving, shortly after receiving their scheduled opioid maintenance medication and ~24 h later. We found that higher cravers had higher drug-related valuation, and that moments of higher craving within-person also led to higher drug-related valuation. When experiencing increased opioid craving, participants were willing to pay more for personalized consumer items and foods more closely related to their drug use, but not for alternative "nondrug-related" but equally desirable options. This selective increase in value with craving was greater when the drug-related options were offered in higher quantities and was separable from the effects of other fluctuating psychological states like negative mood. These findings suggest that craving narrows and focuses economic motivation toward the object of craving by selectively and multiplicatively amplifying perceived value along a "drug relatedness" dimension.
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29
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Central sensitization in opioid use disorder: a novel application of the American College of Rheumatology Fibromyalgia Survey Criteria. Pain Rep 2022; 7:e1016. [PMID: 35812839 PMCID: PMC9263499 DOI: 10.1097/pr9.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022] Open
Abstract
Central sensitization may be an underlying mechanism linking chronic pain and opioid use disorder associated with opioid use disorder onset, maintenance, escalation, treatment delay, and relapse. Introduction: Central sensitization (CS) involves dysfunctional central nervous system pain modulation resulting in heightened pain perception. Central sensitization is not commonly assessed among patients with opioid use disorder (OUD), despite the fact that pain has been implicated in the development, maintenance, and relapse of OUD and chronic opioid use may produce opioid-induced hyperalgesia. Central sensitization is a plausibly important mechanism underlying the complex relationship between OUD and chronic pain. However, this premise is largely untested. Methods: Participants with OUD (n = 141) were recruited from an academic addiction treatment center in Columbus, Ohio. An established surrogate measure of CS, the American College of Rheumatology 2011 Fibromyalgia Survey Criteria, was administered using electronic survey. Participants also responded to questions about pain interference (Brief Pain Inventory), quality of life (RAND-36), and items regarding pain beliefs and expectations of pain and addiction treatment. Descriptive analyses, Spearman rho correlations, and Mann–Whitney U tests were performed. Results: Hypothesized relationships were confirmed between degree of CS, pain interference, and health-related quality of life. Degree of CS was also positively correlated with greater endorsement of pain as a reason for the onset, maintenance, and escalation of OUD; treatment delay; and OUD relapse. Participants with the American College of Rheumatology 2011 Fibromyalgia Survey Criteria ≥13 had significantly greater endorsement of pain as a reason for delaying OUD treatment, continuing and increasing opioid use, and precipitating OUD relapse. Conclusions: This study provides early evidence CS may underlie previously observed connections between clinically salient features of chronic pain and OUD, potentially informing future mechanistic research and precision treatment.
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Vowles KE, Schmidt ZS, Ford CG. Opioid and Alcohol Misuse in Veterans with Chronic Pain: A Risk Screening Study. THE JOURNAL OF PAIN 2022; 23:1790-1798. [PMID: 35753662 DOI: 10.1016/j.jpain.2022.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 10/17/2022]
Abstract
In United States military veterans, chronic pain represents a risk factor for opioid and alcohol misuse, yet few studies have examined interactions among chronic pain, opioid prescription, and opioid and alcohol misuse. Previous work found substantial risk of co-morbid alcohol and opioid misuse in a community sample of opioid-prescribed individuals with chronic pain, a finding expanded upon here. Specifically, 211 veterans assessed within a chronic pain treatment service for opioid-prescribed individuals completed self-report measures of opioid misuse, alcohol misuse, pain intensity, depression, pain catastrophizing, and post-traumatic stress symptoms (PTS). Based on the substance misuse measures, 32% (n = 68) were misusing neither opioids nor alcohol, 23% (n = 48) were misusing both opioids and alcohol, 40% (n = 84) were misusing opioids alone, and 5% (n = 11) were misusing alcohol alone. Group comparisons indicated that individuals not misusing either substance were less distressed in comparison to those who were misusing opioids alone or both substances. The latter groups differed in PTS. Overall, misuse frequencies mirrored previous work, with approximately 1 of 3 misusing opioids and approximately 1 of 5 misusing both substances. There is a need for increased focus on both polysubstance misuse and the development of integrated treatment.
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Affiliation(s)
- Kevin E Vowles
- School of Psychology, Queen's University Belfast & Belfast Centre for Chronic Pain Rehabilitation, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom.
| | - Zachary S Schmidt
- Raymond G. Murphy Veterans Affairs Medical Center, New Mexico VA Healthcare System, Albuquerque, New Mexico, United States of America
| | - C Graham Ford
- Durham Veterans Affairs Medical Center, Durham, North Carolina, United States of America
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Xavier J, Greer A, Pauly B, Loyal J, Mamdani Z, Ackermann E, Barbic S, Buxton JA. "There are solutions and I think we're still working in the problem": The limitations of decriminalization under the good Samaritan drug overdose act and lessons from an evaluation in British Columbia, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103714. [PMID: 35561485 DOI: 10.1016/j.drugpo.2022.103714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/20/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Drug prohibition has been associated with increased risk of overdose. However, drug prohibition remains the dominant drug policy, including in Canada with the Controlled Drugs and Substances Act. In 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted, to encourage people to contact emergency medical services by providing bystanders at the scene of an overdose with legal protection for simple possession and conditions related to simple possession. METHODS We conducted an evaluation of the GSDOA in British Columbia, Canada that included one-on-one interviews with people who use illicit drugs (PWUD), to determine peoples' experiences and perceptions surrounding this form of decriminalization. We present findings from a thematic analysis of 37 interviews. RESULTS We identified limitations of the GSDOA at overdose events; key themes and concerns causing PWUD to hesitate to or avoid contacting emergency medical services included drug confiscation, the thin line between simple possession and drug trafficking, and enforcement of other charges and court ordered conditions that are not legally protected by the GSDOA. Moreover, participants discussed the GSDOA as inequitable; benefiting some while excluding PWUD with intersecting marginalized identities. CONCLUSION Our findings are pertinent in light of many jurisdictions across the world considering dejure decriminalization, including BC and Vancouver. The GSDOA and associated limitations that emerged in our evaluation can serve to guide jurisdictions implementing or amending dejure decriminalization policies.
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Affiliation(s)
- Jessica Xavier
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University,8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Bernadette Pauly
- School of Nursing, University of Victoria, 3800 Finnerty Road, HSD Building, Victoria, BC V8P 5C2, Canada
| | - Jackson Loyal
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Zahra Mamdani
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Emma Ackermann
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Skye Barbic
- Occupational Science & Occupational Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z8, Canada; British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada.
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32
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Nelson EUE, Alichie BO. Chronic Pain and Prescription Opioid Use Among Socially Marginalized Nigerian Women: Exploring Supply Channels and Pathways to Misuse. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221083655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explores pathways to prescription opioid misuse and supply channels based on in-depth interviews with 16 socially marginalized Nigerian women suffering chronic pain. The pathways identified were medical pain treatment, prior substance use and opioid use for recreation and coping with psychological distress. Facing barriers to prescription opioids due to prescribing restrictions and provider stigma, many resorted to unlicensed chemist stores and street drug dealers for opioid analgesics, including fake and potentially harmful products. Patterns of prescription opioid misuse were woven into multiple and overlapping dynamics of marginalization shaping the lives of these women, including homelessness, sex work, substance use and intimate partner violence. Findings show a need to improve access to prescription opioids and other evidence-based approaches, framed within a trauma-informed approach to pain management. Further, integrating substance abuse treatment and pain management could make services responsive to the inter-related problems of chronic pain and prescription opioid misuse.
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Affiliation(s)
- Ediomo-Ubong E. Nelson
- Global Drug Policy Observatory, Swansea University, Singleton Park, UK
- Centre for Research and Information on Substance Abuse, Uyo, Nigeria
| | - Bridget O. Alichie
- Department of Sociology, University of Alberta, Canada
- Department of Sociology and Anthropology, Nnamdi Azikiwe University, Awka, Nigeria
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Koob GF. Anhedonia, Hyperkatifeia, and Negative Reinforcement in Substance Use Disorders. Curr Top Behav Neurosci 2022; 58:147-165. [PMID: 35112332 DOI: 10.1007/7854_2021_288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Drug addiction has been defined as a chronically relapsing disorder that is characterized by a compulsion to seek and take a drug or stimulus, the loss of control in limiting intake, and the emergence of a negative emotional state when access to the drug or stimulus is prevented, a component of which is anhedonia. The present review explores a heuristic framework for understanding the role of anhedonia in addiction, in which anhedonia is a key component of hyperkatifeia (conceptualized as the potentiated intensity of negative emotional/motivational symptoms during drug withdrawal) and negative reinforcement in addiction. The neural substrates that mediate such anhedonia and crosstalk between elements of hyperkatifeia that contribute to anhedonia are then explored, including crosstalk between physical pain and emotional pain systems. The present review explores current knowledge of neurochemical neurocircuitry changes that are associated with conditioned hyperkatifeia/anhedonia. The overall hypothesis is that the shift in motivation toward negative reinforcement in addiction reflects the allostatic misregulation of hedonic tone, such that drug taking makes anhedonia worse during the process of seeking temporary relief by compulsive drug taking, thereby perpetuating the addiction cycle and hedonic comorbidities that are associated with addiction.
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Affiliation(s)
- George F Koob
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD, USA. .,National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
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McHugh RK, Chase A, Trinh CD, Weiss RD. Are Pain and Negative Affect Coping Distinct Motives for Opioid Misuse? Subst Use Misuse 2022; 57:848-852. [PMID: 35258408 PMCID: PMC9069863 DOI: 10.1080/10826084.2022.2046094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Coping with pain is a commonly reported motive for opioid misuse. Opioids also provide relief of stress and negative affect and thus are often misused to cope with these emotional states. Although several studies have investigated coping motives in people who misuse opioids, it remains unclear whether pain coping and negative affect coping are distinct or overlapping motives for misuse. Objectives: In this study, we examined opioid use motives (enhancement, social, negative affect coping, and pain coping) in a sample of 52 adults seeking treatment for opioid use disorder. We used an adaptation of the Drug Use Motives Questionnaire that included an additional 5 items to assess pain coping motives for use. Results: Results indicated that pain coping was not significantly associated with other motives for use, including negative affect coping. Pain coping motives were strongly correlated with both pain severity (r = .51) and pain interference (r = .39), but not anxiety severity. Conversely, negative affect coping motives were strongly correlated with anxiety severity (r = .45), but not pain severity or interference. Conclusions: These results suggest that pain coping motives may be distinct from negative affect coping motives and should be assessed separately.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Chase
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA
| | - Catherine D Trinh
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA
| | - Roger D Weiss
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Felix RB, Rao A, Khalid M, Wang Y, Colloca L, Murthi SB, Morris NA. Adjunctive virtual reality pain relief following traumatic injury: protocol for a randomised within-subjects clinical trial. BMJ Open 2021; 11:e056030. [PMID: 34848527 PMCID: PMC8634353 DOI: 10.1136/bmjopen-2021-056030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The annual mortality and national expense of the opioid crisis continue to rise in the USA (130 deaths/day, $50 billion/year). Opioid use disorder usually starts with the prescription of opioids for a medical condition. Its risk is associated with greater pain intensity and coping strategies characterised by pain catastrophising. Non-pharmacological analgesics in the hospital setting are critical to abate the opioid epidemic. One promising intervention is virtual reality (VR) therapy. It has performed well as a distraction tool and pain modifier during medical procedures; however, little is known about VR in the acute pain setting following traumatic injury. Furthermore, no studies have investigated VR in the setting of traumatic brain injury (TBI). This study aims to establish the safety and effect of VR therapy in the inpatient setting for acute traumatic injuries, including TBI. METHODS AND ANALYSIS In this randomised within-subjects clinical study, immersive VR therapy will be compared with two controls in patients with traumatic injury, including TBI. Affective measures including pain catastrophising, trait anxiety and depression will be captured prior to beginning sessions. Before and after each session, we will capture pain intensity and unpleasantness, additional affective measures and physiological measures associated with pain response, such as heart rate and variability, pupillometry and respiratory rate. The primary outcome is the change in pain intensity of the VR session compared with controls. ETHICS AND DISSEMINATION Dissemination of this protocol will allow researchers and funding bodies to stay abreast in their fields through exposure to research not otherwise widely publicised. Study protocols are compliant with federal regulation and University of Maryland Baltimore's Human Research Protections and Institutional Review Board (protocol number HP-00090603). Study results will be published on completion of enrolment and analysis, and deidentified data can be shared by request to the corresponding author. TRIAL REGISTRATION NUMBER NCT04356963; Pre-results.
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Affiliation(s)
- Ryan B Felix
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Aniruddha Rao
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Mazhar Khalid
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yang Wang
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Sarah B Murthi
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nicholas A Morris
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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The Effect of Adding Memantine to Clonidine in Reducing Withdrawal Symptoms in Opioid-Dependent Patients: A Double-Blind Randomized Controlled Trial. J Clin Psychopharmacol 2021; 41:644-649. [PMID: 34559090 DOI: 10.1097/jcp.0000000000001466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Addiction is a complex condition and a brain disease manifested by compulsive substance use despite its harmful consequence. Addicted individuals have an intense focus on using substances. This study aimed to investigate the effect of adding memantine to clonidine and buprenorphine in reducing withdrawal symptoms, compared with placebo, in drug-dependent patients (opium and heroin). MATERIALS AND METHODS In this double-blind, randomized clinical trial study, 60 patients using opium or heroin were assigned to the intervention (n = 30) and control (n = 30) groups. Both groups were treated with buprenorphine and clonidine at the same dose in the detoxification process. The intervention group received memantine 10 mg daily for 10 days and then 20 mg daily for 21 days, and the control group received a placebo prepared in the same shape and size as memantine tablets. The severity of withdrawal symptoms was measured using the Short Opioid Withdrawal Scale over 3 weeks. Data analysis was performed using SPSS and descriptive and inferential tests. RESULTS The results showed that despite memantine's superiority in controlling some withdrawal symptoms such as feeling sick, stomach pain, muscle spasm, and feeling cold, no significant difference was found between the 2 groups. There was also no statistically significant difference between the 2 groups in the total score of symptoms. CONCLUSIONS No specific advantage of memantine was found for reducing the symptoms of withdrawal syndrome in the present study. However, this drug was well tolerated without any evidence of serious or significant adverse effects.
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Le AB, Rosen JD. It Is Time to Implement Primary Prevention in the Workplace to Ameliorate the Ongoing U.S. Opioid Epidemic. New Solut 2021; 31:210-218. [PMID: 34431383 PMCID: PMC8505780 DOI: 10.1177/10482911211039880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The United States' opioid public health crisis continues having disastrous consequences on communities, including workers and employers. From May 2019 to May 2020, the largest number of drug overdose deaths was recorded over a twelve-month period. The "twindemics" of COVID-19 and opioids underscore the urgent need to address workers' physical and mental health. Although much has been written about the negative impacts of the opioid epidemic on the workplace, few initiatives have focused on primary prevention, addressing work-related root causes of opioid use disorders (e.g., injury, stress) that may lead to prescription or illicit opioid use. We suggest primary prevention efforts to address the connection between workplace hazards and opioid misuse, dependence, and addiction such as examining patterns of work injury and stress with records of opioid prescription. Government funding should be expanded to support primary prevention and research efforts to strengthen the evidence-base to support workplace primary prevention endeavors.
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Affiliation(s)
- Aurora B. Le
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jonathan D. Rosen
- National Clearinghouse for Worker Safety and Health Training, Schenectady, NY, USA
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Association of Lifetime History of Traumatic Brain Injury With Prescription Opioid Use and Misuse Among Adults. J Head Trauma Rehabil 2021; 36:328-337. [PMID: 34489383 DOI: 10.1097/htr.0000000000000729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate associations of lifetime history of traumatic brain injury (TBI) with prescription opioid use and misuse among noninstitutionalized adults. PARTICIPANTS Ohio Behavioral Risk Factor Surveillance System (BRFSS) participants in the 2018 cohort who completed the prescription opioid and lifetime history of TBI modules (n = 3448). DESIGN Secondary analyses of a statewide population-based cross-sectional survey. MAIN MEASURES Self-report of a lifetime history of TBI using an adaptation of the Ohio State University TBI-Identification Method. Self-report of past year: (1) prescription pain medication use (ie, prescription opioid use); and (2) prescription opioid misuse, defined as using opioids more frequently or in higher doses than prescribed and/or using a prescription opioid not prescribed to the respondent. RESULTS In total, 22.8% of adults in the sample screened positive for a lifetime history of TBI. A quarter (25.5%) reported past year prescription opioid use, and 3.1% met criteria for prescription opioid misuse. A lifetime history of TBI was associated with increased odds of both past year prescription opioid use (adjusted odds ratio [AOR] = 1.52; 95% CI, 1.27-1.83; P < .01) and prescription opioid misuse (AOR = 1.65; 95% CI, 1.08-2.52; P < .05), controlling for sex, age, race/ethnicity, and marital status. CONCLUSION Results from this study support the "perfect storm" hypothesis-that persons with a history of TBI are at an increased risk for exposure to prescription opioids and advancing to prescription opioid misuse compared with those without a history of TBI. Routine screening for a lifetime history of TBI may help target efforts to prevent opioid misuse among adults.
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Powers MB, Carl E, Levihn-Coon A, Van Veldhuizen M, Caven A, Pogue J, Fresnedo M, Turner ED, Adams M, Leonard K, Conroy H, Lantrip C, Caven T, Isbell C, Regner J, Garmon E, Foreman M, Miller W, Fares LA, Carlbring P, Otto MW, Weiss DN, Hughes J, Bernhardt JM, Roy R, Oh J, Copt R, MacClements J, Warren AM, Rosenfield B, Rosenfield D, Minns S, Telch MJ, Smits JAJ. Nonpharmacologic Pain Management Among Hospitalized Inpatients: A Randomized Waitlist-Controlled Trial of Standard Virtual Reality (CGI VR) Versus Video Capture VR (360 degrees 3D/Stereoscopic Video Capture VR). Clin J Pain 2021; 37:678-687. [PMID: 34265789 DOI: 10.1097/ajp.0000000000000958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Nonpharmacologic pain management strategies are needed because of the growing opioid epidemic. While studies have examined the efficacy of virtual reality (VR) for pain reduction, there is little research in adult inpatient settings, and no studies comparing the relative efficacy of standard animated computer-generated imagery (CGI) VR to Video Capture VR (360 degrees 3D/stereoscopic Video Capture VR). Here, we report on a randomized controlled trial of the relative efficacy of standard CGI VR versus Video Capture VR (matched for content) and also compared the overall efficacy of VR to a waitlist control group. MATERIALS AND METHODS Participants (N=103 hospitalized inpatients reporting pain) were randomized to 1 of 3 conditions: (1) waitlist control, (2) CGI VR, or (3) Video Capture VR. The VR and waitlist conditions were 10 minutes in length. Outcomes were assessed pretreatment, post-treatment, and after a brief follow-up. RESULTS Consistent with hypotheses, both VR conditions reduced pain significantly more relative to the waitlist control condition (d=1.60, P<0.001) and pain reductions were largely maintained at the brief follow-up assessment. Both VR conditions reduced pain by ∼50% and led to improvements in mood, anxiety, and relaxation. Contrary to prediction, the Video Capture VR condition was not significantly more effective at reducing pain relative to the CGI VR condition (d=0.25, P=0.216). However, as expected, patients randomized to the Video Capture VR rated their experience as more positive and realistic (d=0.78, P=0.002). DISCUSSION Video Capture VR was as effective as CGI VR for pain reduction and was rated as more realistic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Crystal Lantrip
- Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans at Central Texas Veterans Health Care System
| | - Thomas Caven
- The University of Texas at Austin Dell Medical School
- Department of Psychology and Neuroscience, Baylor University, Waco
| | - Claire Isbell
- Baylor Scott and White Medical Center Temple, Temple, TX
| | - Justin Regner
- Baylor Scott and White Medical Center Temple, Temple, TX
| | - Emily Garmon
- Baylor Scott and White Medical Center Temple, Temple, TX
| | | | | | - Lorie A Fares
- Baylor Scott and White Medical Center Temple, Temple, TX
| | | | | | | | | | | | - Rob Roy
- Boston University, Boston, MA
| | | | - Ryan Copt
- Bongiovi Medical, Port Saint Lucie, FL
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Starosta AJ, Adams RS, Marwitz JH, Kreutzer J, Monden KR, Dams O'Connor K, Hoffman J. Scoping Review of Opioid Use After Traumatic Brain Injury. J Head Trauma Rehabil 2021; 36:310-327. [PMID: 34489382 PMCID: PMC8428300 DOI: 10.1097/htr.0000000000000721] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To summarize the current literature to identify what research has been conducted, examine the approaches used, and determine what is presently known about prescription and nonprescription opioid receipts and use among individuals with traumatic brain injury (TBI). DATA SOURCES The search strategy included the following: opioid; opiate; analgesics, opioid; opiate alkaloids; or opioid-related disorders; AND brain injury; brain injuries; brain injuries, traumatic; head injury; head injuries; head injuries, closed; head injuries, penetrating; brain concussion; diffuse axonal injury; diffuse axonal injuries; brain trauma/s; head trauma/s; concussion; craniocerebral trauma/s; or TBI. Filters included English and Adults (19+ years). Study Selection: Inclusion: English language, adults with stable TBI, and prescription opioid receipt or use after TBI. Exclusion: Animal models, populations with other acquired brain injury, acute TBI management, and non-peer-reviewed articles, theses, or conference abstracts. Multiple reviewers screened abstracts and full-text articles for eligibility. In total, 771 abstracts were screened, 183 full texts were reviewed, and 21 met eligibility criteria. Data Extraction: Relevant content was independently extracted by multiple observers, including authors, design, sample identification and data source/s, TBI severity, TBI assessment, opioid assessment, study population (demographics, N), military affiliation, comparison groups, date of data collection, and summary of findings. RESULTS Studies were published between 1987 and 2019; most data were collected prior to 2015. The majority utilized administrative and electronic medical record data from the Department of Veterans Affairs and retrospective cohort designs, and most focused on prescription opioids. There were no studies evaluating interventions to reduce use of opioids in TBI populations. Preliminary findings suggest that prescription opioid receipt is strongly related to psychological symptoms, including comorbid depression, anxiety, and posttraumatic stress disorder. CONCLUSIONS Despite increased awareness of opioid receipt and use following TBI, there is limited investigation on the examination of this issue. Future studies should include more varied patient populations as well as evaluate interventions to reduce opioid use following TBI.
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Affiliation(s)
- Amy J Starosta
- Division of Rehabilitation Psychology, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle (Drs Starosta and Hoffman); Institute for Behavioral Health at the Heller School for Social Policy & Management, Brandeis University, Waltham, Massachusetts (Dr Adams); Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Health Administration, Aurora, Colorado (Dr Adams); Division of Rehabilitation Psychology and Neuropsychology (Dr Kreutzer), Department of Physical Medicine and Rehabilitation (Ms Marwitz), Department of Rehabilitation Medicine, University of Minnesota, Minneapolis (Dr Monden); Brain Injury Research Center of Mount Sinai, Departments of Rehabilitation Medicine and Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York (Dr Dams O'Connor)
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Kumar RG, Ornstein KA, Corrigan JD, Sayko Adams R, Dams-O'Connor K. Association between Lifetime History of Traumatic Brain Injury, Prescription Opioid Use, and Persistent Pain: A Nationally Representative Study. J Neurotrauma 2021; 38:2284-2290. [PMID: 33567980 PMCID: PMC8672103 DOI: 10.1089/neu.2020.7496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pain is common among adults with traumatic brain injury (TBI), yet little data exist regarding prevalence of opioid use in this population. The objective of this retrospective cohort study was to evaluate the association between lifetime TBI exposure, opioid use, and pain in a nationally representative sample of 1022 adults aged 50+ who participated in the Health and Retirement Study (HRS). Our primary exposure was lifetime TBI history measured via the Ohio State University TBI Identification Method. We evaluated three alternate TBI exposures (years since most recent TBI, age at first TBI, and number of lifetime TBIs) in sensitivity analyses. We evaluated two outcomes: recent opioid medication use, and moderate-to-severe pain measured over two HRS waves. We classified three pain groups (persistent, intermittent, and no pain). Prevalences of opioid use among individuals with and without TBI were 19.7% and 13.6%, respectively. After adjustment for age, sex, and race, individuals with TBI had a 52% increased risk for opioid use compared with individuals without TBI (relative risk = 1.52, 95% confidence interval: 1.11, 2.04). Individuals with recent TBI (1-10 years ago), first TBI after age 40+, and 2+ lifetime TBIs had greatest risk for opioid use. Compared with individuals without TBI, individuals with TBI had 4.9-times increased odds for persistent versus no pain, and 1.9-times increased odds of intermittent versus no pain. Persistent pain among adults with lifetime TBI is elevated compared with the general population, which may contribute to increased opioid use among persons with TBI, particularly those with recent injuries or multiple lifetime TBIs.
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Affiliation(s)
- Raj G. Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katherine A. Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, Division of General Internal Medicine, and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John D. Corrigan
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio, USA
| | - Rachel Sayko Adams
- Heller School, Institute for Behavioral Health, Brandeis University, Waltham, Massachusetts, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Health Administration, Aurora, Colorado, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Day-to-day opioid withdrawal symptoms, psychological distress, and opioid craving in patients with chronic pain prescribed opioid therapy. Drug Alcohol Depend 2021; 225:108787. [PMID: 34091157 DOI: 10.1016/j.drugalcdep.2021.108787] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/27/2021] [Accepted: 03/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Research has shown that opioid craving is one of the strongest determinants of opioid misuse in patients with chronic pain. To date, however, little is known on the factors that contribute to opioid craving in these patients. It is possible that patients' physical dependence to opioids, manifested by opioid withdrawal symptoms in between daily opioid doses, contribute to opioid craving. Physical dependence symptoms might also lead to psychological distress, which in turn might contribute to opioid craving. The first objective of this study was to examine the day-to-day association between opioid withdrawal symptoms and opioid craving among patients with chronic pain. We also examined whether negative affect and catastrophic thinking mediated this association. METHODS In this longitudinal study, chronic pain patients (n = 79) prescribed short-acting opioids completed daily diaries for 14 consecutive days. Diaries assessed a host of pain, psychological, and opioid-related variables. RESULTS Day-to-day elevations in opioid withdrawal symptoms were associated with heightened opioid craving (p < .001). Results of a multilevel mediation analysis revealed that this association was mediated by patients' daily levels of negative affect and catastrophizing (p < .001). CONCLUSIONS Our study provides valuable new insights into our understanding of factors that may contribute to prescription opioid craving among patients with chronic pain.
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Lack of effect of different pain-related manipulations on opioid self-administration, reinstatement of opioid seeking, and opioid choice in rats. Psychopharmacology (Berl) 2021; 238:1885-1897. [PMID: 33765177 PMCID: PMC10041878 DOI: 10.1007/s00213-021-05816-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 01/26/2023]
Abstract
RATIONALE AND OBJECTIVE Pain-related factors increase the risk for opioid addiction, and pain may function as a negative reinforcer to increase opioid taking and seeking. However, experimental pain-related manipulations generally do not increase opioid self-administration in rodents. This discrepancy may reflect insufficient learning of pain-relief contingencies or confounding effects of pain-related behavioral impairments. Here, we determined if pairing noxious stimuli with opioid self-administration would promote pain-related reinstatement of opioid seeking or increase opioid choice over food. METHODS In Experiment 1, rats self-administered fentanyl in the presence or absence of repeated intraplantar capsaicin injections in distinct contexts to model context-specific exposure to cutaneous nociception. After capsaicin-free extinction in both contexts, we tested if capsaicin would reinstate fentanyl seeking. In Experiment 2, rats self-administered heroin after intraperitoneal (i.p.) lactic acid injections to model acute visceral inflammatory pain. After lactic acid-free extinction, we tested if lactic acid would reinstate heroin seeking. In Experiment 3, we tested if repeated i.p. lactic acid or intraplantar Complete Freund's Adjuvant (CFA; to model sustained inflammatory pain) would increase fentanyl choice over food. RESULTS In Experiments 1-2, neither capsaicin nor lactic acid reinstated opioid seeking after extinction, and lactic acid did not increase heroin-induced reinstatement. In Experiment 3, lactic acid and CFA decreased reinforcement rate without affecting fentanyl choice. CONCLUSIONS Results extend the range of conditions across which pain-related manipulations fail to increase opioid seeking in rats and suggest that enhanced opioid-addiction risk in humans with chronic pain involves factors other than enhanced opioid reinforcement and relapse.
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Jaffa MN, Jha RM, Elmer J, Kardon A, Podell JE, Zusman BE, Smith MC, Simard JM, Parikh GY, Armahizer MJ, Badjatia N, Morris NA. Pain Trajectories Following Subarachnoid Hemorrhage are Associated with Continued Opioid Use at Outpatient Follow-up. Neurocrit Care 2021; 35:806-814. [PMID: 34109554 PMCID: PMC8189709 DOI: 10.1007/s12028-021-01282-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/20/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) is characterized by the worst headache of life and associated with long-term opioid use. Discrete pain trajectories predict chronic opioid use following other etiologies of acute pain, but it is unknown whether they exist following SAH. If discrete pain trajectories following SAH exist, it is uncertain whether they predict long-term opioid use. We sought to characterize pain trajectories after SAH and determine whether they are associated with persistent opioid use. METHODS We reviewed pain scores from patients admitted to a single tertiary care center for SAH from November 2015 to September 2019. Group-based trajectory modeling identified discrete pain trajectories during hospitalization. We compared outcomes across trajectory groups using χ2 and Kruskal-Wallis tests. Multivariable regression determined whether trajectory group membership was an independent predictor of long-term opioid use, defined as continued use at outpatient follow-up. RESULTS We identified five discrete pain trajectories among 305 patients. Group 1 remained pain free. Group 2 reported low scores with intermittent spikes and slight increase over time. Group 3 noted increasing pain severity through day 7 with mild improvement until day 14. Group 4 experienced maximum pain with steady decrement over time. Group 5 reported moderate pain with subtle improvement. In multivariable analysis, trajectory groups 3 (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.5-8.3) and 5 (OR 8.0; 95% CI 3.1-21.1), history of depression (OR 3.6; 95% CI 1.3-10.0) and racial/ethnic minority (OR 2.3; 95% CI 1.3-4.1) were associated with continued opioid use at follow-up (median 62 days following admission, interquartile range 48-96). CONCLUSIONS Discrete pain trajectories following SAH exist. Recognition of pain trajectories may help identify those at risk for long-term opioid use.
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Affiliation(s)
- Matthew N Jaffa
- Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.,Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Ruchira M Jha
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Neurosurgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Safar Center for Resuscitation Research, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Clinical and Translational Science Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Elmer
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam Kardon
- Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Jamie E Podell
- Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.,Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Benjamin E Zusman
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Madeleine C Smith
- Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - J Marc Simard
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, MD, USA.,Department of Pathology, School of Medicine, University of Maryland, Baltimore, MD, USA.,Department of Physiology, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Gunjan Y Parikh
- Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.,Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Michael J Armahizer
- Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, MD, USA
| | - Neeraj Badjatia
- Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.,Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Nicholas A Morris
- Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA. .,Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.
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Rodríguez-Espinosa S, Coloma-Carmona A, Pérez-Carbonell A, Román-Quiles JF, Carballo JL. Clinical and psychological factors associated with interdose opioid withdrawal in chronic pain population. J Subst Abuse Treat 2021; 129:108386. [PMID: 34080554 DOI: 10.1016/j.jsat.2021.108386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The DSM-5 diagnostic criteria for Prescription Opioid-Use Disorder (POUD) have undergone some significant changes. One of the most controversial changes has been the elimination of the withdrawal symptoms criterion when opioid use is under appropriate medical supervision. For this reason, the goal of this study was to analyze factors associated with opioid withdrawal in patients with chronic non-cancer pain (CNCP). METHODS This cross-sectional descriptive study involved 404 patients who use prescription opioids for long-term treatment (≥90 days) of CNCP. Measures included sociodemographic and clinical characteristics, POUD, withdrawal symptoms, craving, anxiety-depressive symptoms, and pain intensity and interference. RESULTS Forty-seven percent (n = 193) of the sample reported moderate-severe withdrawal symptoms, which were associated with lower age, higher daily morphine dose and duration of treatment with opioids, moderate-severe POUD, use of psychotropic drugs, higher anxiety-depressive symptoms, and greater pain intensity and interference (p < .05). Binary logistic regression analysis showed that moderate-severe POUD (OR = 2.82), anxiety (OR = 2.21), depression (OR = 1.81), higher pain interference (OR = 1.05), and longer duration of treatment with opioids were the strongest factors associated with moderate-severe withdrawal symptoms (p < .05). CONCLUSION Psychological factors seem to play a key role in the severity of withdrawal symptoms. Since greater intensity of these symptoms increases the risk of developing POUD, knowing the factors associated with withdrawal may be useful in developing preventive psychological interventions.
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Affiliation(s)
- Sara Rodríguez-Espinosa
- Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, 03202 Elche, Spain
| | - Ainhoa Coloma-Carmona
- Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, 03202 Elche, Spain
| | - Ana Pérez-Carbonell
- University General Hospital of Elche, Camino de la Almazara, 11, 03203 Elche, Spain
| | - José F Román-Quiles
- University General Hospital of Elche, Camino de la Almazara, 11, 03203 Elche, Spain
| | - José L Carballo
- Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, 03202 Elche, Spain.
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Pantazis CB, Gonzalez LA, Tunstall BJ, Carmack SA, Koob GF, Vendruscolo LF. Cues conditioned to withdrawal and negative reinforcement: Neglected but key motivational elements driving opioid addiction. SCIENCE ADVANCES 2021; 7:7/15/eabf0364. [PMID: 33827822 PMCID: PMC8026136 DOI: 10.1126/sciadv.abf0364] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/19/2021] [Indexed: 05/07/2023]
Abstract
Opioid use disorder (OUD) is a debilitating disorder that affects millions of people. Neutral cues can acquire motivational properties when paired with the positive emotional effects of drug intoxication to stimulate relapse. However, much less research has been devoted to cues that become conditioned to the aversive effects of opioid withdrawal. We argue that environmental stimuli promote motivation for opioids when cues are paired with withdrawal (conditioned withdrawal) and generate opioid consumption to terminate conditioned withdrawal (conditioned negative reinforcement). We review evidence that cues associated with pain drive opioid consumption, as patients with chronic pain may misuse opioids to escape physical and emotional pain. We highlight sex differences in withdrawal-induced stress reactivity and withdrawal cue processing and discuss neurocircuitry that may underlie withdrawal cue processing in dependent individuals. These studies highlight the importance of studying cues associated with withdrawal in dependent individuals and point to areas for exploration in OUD research.
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Affiliation(s)
- Caroline B Pantazis
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA.
| | - Luis A Gonzalez
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
- Department of Psychological and Brain Sciences, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Brendan J Tunstall
- Department of Pharmacology, Addiction Science, and Toxicology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephanie A Carmack
- Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, USA
| | - George F Koob
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Leandro F Vendruscolo
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA.
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Johnson ME, Zaidi F. Sex differences in the effects of physical and sexual abuse on the odds of past 30-day opioid misuse among Florida justice-involved children. ADDICTION RESEARCH & THEORY 2021; 29:479-489. [PMID: 35035335 PMCID: PMC8758115 DOI: 10.1080/16066359.2021.1891414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 06/14/2023]
Abstract
AIM Opioid misuse is a severe threat to justice-involved children and adolescents. Identifying risk factors and sex differences is critical to design accurate risk assessments and person-centered interventions. Stress theory and research posit that abuse may be linked to opioid misuse, and the consequences may be harsher for females. The study tests the hypothesis that physical and sexual abuse will individually and cumulatively increase the risk for opioid misuse, and females will have a higher risk than males. METHODS A statewide sample of 79,960 justice-involved children in Florida were examined. Opioid misuse, illicit and non-medical use, was measured by urine analysis or self-disclosure within the past-30 days. Bivariate and multivariate logistic regression analyses were employed. Marginal effects were estimated to investigate the interaction between abuse and sex. RESULTS Over 2000 youth met the criteria for opioid misuse. One-third of female opioid users experienced both physical and sexual abuse. Compared to those with no history of physical or sexual abuse, those who were physically abused had 43% higher odds of opioid misuse, those who were sexually abuse had 78% higher odds, and those who experienced both had twice as high odds of opioid misuse. The individual and combined effects of these abuse types were higher for females. For example, female youth who were sexually abused had 2.7-times higher odds of opioid misuse than males who were sexually abused. CONCLUSION Intervention efforts can be improved by integrating physical and sexual abuse into risk assessments and tailoring assessments by sex.
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Affiliation(s)
- Micah E. Johnson
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
| | - Farwah Zaidi
- The Study of Teen Opioid Misuse and Prevention Laboratory, Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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48
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Yang TC, Kim S, Shoff C. Income inequality and opioid prescribing rates: Exploring rural/urban differences in pathways via residential stability and social isolation. RURAL SOCIOLOGY 2021; 86:26-49. [PMID: 33867589 PMCID: PMC8045985 DOI: 10.1111/ruso.12338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 05/15/2020] [Indexed: 06/12/2023]
Abstract
While opioid prescribing rates have drawn researchers' attention, little is known about the mechanisms through which income inequality affects opioid prescribing rates and even less focuses on whether there is a rural/urban difference in mediating pathways. Applying mediation analysis techniques to a unique ZIP code level dataset from several sources maintained by the Centers for Medicare and Medicaid Services, we explicitly examine two mechanisms through residential stability and social isolation by rural/urban status and find that (1) income inequality is not directly related to opioid prescribing rates, but it exerts its influence on opioid prescribing via poor residential stability and elevated social isolation; (2) social isolation accounts for two-thirds of the mediating effect of income inequality on opioid prescribing rates among urban ZIP codes, but the proportion halves among rural ZIP codes; (3) residential stability plays a larger role in understanding how income inequality matters in rural than in urban ZIP codes; and (4) beneficiary characteristics only matter in urban ZIP codes. These findings offer nuanced insight into how income inequality affects opioid prescribing rates and suggests that the determinants of opioid prescribing rates vary by rural/urban status. Future research may benefit from identifying place-specific factors for opioid prescribing rates.
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Affiliation(s)
- Tse-Chuan Yang
- University at Albany, 1400 Washington Ave., Arts & Sciences 351, Albany, NY 12222
| | - Seulki Kim
- University at Albany, 1400 Washington Ave., Arts & Sciences 356, Albany, NY 12222
| | - Carla Shoff
- Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244
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49
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Kroll SL, Thayer JF, Williams DP, Pfabigan DM, Baumgartner MR, Lamm C, Quednow BB. Chronic non-medical prescription opioid use and empathy for pain: Does pain make the difference? Psychophysiology 2021; 58:e13776. [PMID: 33569774 DOI: 10.1111/psyp.13776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 12/24/2022]
Abstract
Non-medical prescription opioid use (NMPOU) is at the heart of the opioid epidemic in the United States. Although chronic opioid use is commonly accompanied by deficits in social functioning, little is known about the impact of chronic NMPOU on social cognitive functions. Social neuroscience models suggest that empathy activates similar or even equivalent neural structures as those underpinning the first-hand experience in that emotional state (e.g., pain). Therefore, we measured subjective and psychophysiological responses during an empathy-for-pain task in 23 individuals with NMPOU, objectively confirmed by hair and urine testing, and compared them with 29 opioid-naïve healthy controls. NMPOU individuals showed lower other-related and self-related unpleasantness ratings when seeing others in pain than controls. No differences between the control and NMPOU group were found in skin conductance responses and heart rate variability (HRV) assessed by root mean square of successive differences (RMSSD) in response to the task. However, RMSSD-HRV was strongly negatively correlated with self-related unpleasantness and craving in the NMPOU group. A subsequent mediation analysis showed a total effect of RMSSD-HRV on self-related unpleasantness with no mediation of craving. This indicates that stronger emotion regulation indexed by high RMSSD-HRV might have downregulating effects on sharing others' pain in NMPOU individuals but not in healthy controls, which was further accompanied by decreased ratings of personal distress and empathetic concern. These results contribute to a better understanding of social functioning in chronic opioid users, suggesting adequate emotion regulation and empathy trainings as therapeutic targets for future interventions of opioid use disorders and long-term pain treatment with opioids.
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Affiliation(s)
- Sara L Kroll
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Julian F Thayer
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - DeWayne P Williams
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Daniela M Pfabigan
- Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Markus R Baumgartner
- Center for Forensic Hair Analysis, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Claus Lamm
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
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50
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Identifying the Neurodevelopmental Differences of Opioid Withdrawal. Cell Mol Neurobiol 2021; 41:1145-1155. [PMID: 33432504 DOI: 10.1007/s10571-020-01035-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/28/2020] [Indexed: 01/01/2023]
Abstract
Stopping opioid medications can result in a debilitating withdrawal syndrome in chronic users. Opioid withdrawal can occur at all ages, but mechanistic understanding of this condition is predominantly derived from adult studies. Here, we examined whether there are age-dependent differences in the behavioural phenotype and cellular indices of opioid withdrawal. We tested this by assessing the behavioural and cFos response (a surrogate marker for neuronal activation) to morphine withdrawal in C57BL/6J mice across key developmental stages-neonatal, adolescent, and adulthood. Mice in all age groups received escalating doses of morphine (10-50 mg/kg) over 5 days and withdrawal was precipitated by a single injection of the opioid receptor antagonist naloxone (2 mg/kg) two hours after the last morphine dose. In adult and adolescent mice, withdrawal behaviours were robust, with age-related differences in autonomic and somatic signs. In both groups, cFos expression was increased in spinally projecting neurons within the Periaqueductal Grey (PAG), Rostro-ventromedial Medulla (RVM), and Locus Coeruleus. Neonatal animals displayed both a distinct behavioural withdrawal and cFos expression profile. Notably, in young animals cFos expression was increased within the PAG and LC, but decreased in the RVM. In summary, naloxone challenge precipitated robust opioid withdrawal behaviours across all developmental stages with neonatal animals displaying differences in withdrawal behaviours and unique neuronal activation patterns within key brainstem regions.
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