Emotional distress and pain catastrophizing predict cue-elicited opioid craving among chronic pain patients on long-term opioid therapy. (1st April 2022)

• Record Type: Journal Article
• Authors: Parisi, Anna; Landicho, Hannah Louise; Hudak, Justin; Leknes, Siri; Froeliger, Brett; Garland, Eric L.
• Is Part Of: Drug and alcohol dependence. Volume 233(2022)
• Publication Date: 2022-04-01
• Subjects: Chronic pain -- Opioids -- Cue-elicited craving -- Emotional distress -- Pain catastrophizing; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2022.109361
• Languages: English
• ISSNs: 0376-8716

Abstract

Abstract: Background: Individuals who use illicit substances exhibit cue-elicited craving and autonomic cue-reactivity when exposed to cues associated with past drug use. However, little is known about this phenomenon among chronic pain patients on long-term opioid therapy (LTOT). Negative cognitive-emotional reactivity in general (e.g., distress) and cognitive-emotional reactivity specific to pain (e.g., pain catastrophizing) might drive cue-reactivity independent of pain severity. Here we examined emotional distress and pain catastrophizing as predictors of cue-reactivity among a sample of chronic pain patients receiving LTOT. We also tested whether associations between distress, catastrophizing, and cue-reactivity differed as a function of opioid misuse status. Materials and methods: Patients receiving LTOT (N = 243) were classified as exhibiting aberrant behavior consistent with opioid misuse (MISUSE+, n = 145) or as using opioids as prescribed (MISUSE-, n = 97). Participants completed assessments of pain catastrophizing and emotional distress and then participated in an opioid cue-reactivity task one week later. Cue-elicited opioid craving and autonomic cue-reactivity were measured with craving ratings and high-frequency heart rate variability (HRV), respectively. Results: Distress and catastrophizing predicted cue-elicited craving and HRV, whereas pain severity did not. Misuser status moderated the relationship between emotional distress and self-reported craving, such that higher levels of distress predicted craving among the MISUSE+ group, but not among the MISUSE- group. No moderating effects were found for catastrophizing. Conclusions: Findings suggest that although opioids are prescribed for analgesia, the exacerbating influence of negative cognitive-emotional reactivity, both in general and specific to pain, on cue-elicited opioid craving extends beyond the effects of pain severity alone. Highlights: People with chronic pain prescribed opioids are at heightened risk for opioid misuse. Distress and catastrophizing predicted cue reactivity among chronic pain patients. Misuser status moderated the relationship between distress and craving. No moderating effects were found for catastrophizing. Physical pain was not found to predict distress or catastrophizing.