A multi-method examination of contrast avoidance and opioid misuse in patients with chronic pain

慢性疼痛患者对比剂回避和阿片类药物滥用的多方法检查

• 批准号: 10202453
• 负责人: Katherine McDermott
• 金额: $ 3.78万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10202453
• 关键词: Absence of pain sensation; Affect; Affective; Attention; Behavioral; Brain; Clinical; Drug Screening; Emotional; Emotional Stability; Emotions; Event; Fellowship; Individual; Lead; Link; Literature; Measures; Methodology; Methods; Modeling; Moods; Opioid; Outcome; Overdose; Pain; Pain Research; Pain intensity; Participant; Patient Self-Report; Patients; Population; Populations at Risk; Prevention; Psychophysiology; Regulation; Relaxation; Research; Research Training; Risk; Role; Scientist; Shock; Stimulus; Substance Use Disorder; Techniques; Testing; Training; Urine; anxious individuals; base; career; chronic pain; chronic pain patient; chronic painful condition; coping; craving; experience; in vivo; indexing; negative affect; neurophysiology; novel; opioid epidemic; opioid misuse; opioid use; opioid use disorder; positive emotional state; prescription opioid; relating to nervous system; response; risk minimization

Project Summary. Chronic pain is a highly prevalent and disabling condition that is associated with heightened risk for opioid use disorder and overdose.1-4 Given the current opioid epidemic,5 it is essential to identify factors that could be associated with heightened opioid misuse in patients with chronic pain and could be potential novel treatment targets to reduce the risk of misuse and overdose in this at-risk population. Of note, chronic pain conditions are characterized by affective variability, resulting in frequent, sudden shifts from positive to negative affective states, often as the result of pain worsening.14,15 While previous research has examined the association between negative affective states and opioid outcomes,16, 17 affective variability has been overlooked. This is a crucial gap in the literature, given that reactivity to emotional shifts may lead to the prolonged negative affective states that put patients at risk for worse opioid outcomes. To fill this gap, the present proposal will be a novel examination of the emotional processing construct contrast avoidance (CA) in patients with chronic pain. CA is defined as 1) discomfort with shifts from positive to negative emotion (i.e., contrasts) and 2) engagement in strategies to reduce or avoid contrasts (e.g., avoiding engagement with positive emotion).9 Research on CA has shown that contrasts are aversive and disabling in anxious individuals, leading to greater emotional reactivity toward unpleasant events that follow a contrasting state (e.g., relaxation).10,11 Similarly, pain experienced following a contrasting – i.e., pleasant – state, could be experienced as more aversive and salient than pain following a neutral state. Heightened reactivity to post-contrast pain could lead to greater opioid craving and misuse to cope with the contrast, rather than for analgesia alone. Opioid misuse could also reflect a desire to create a stable emotional state and preemptively avoid contrasts. That is, individuals with chronic pain who engage in contrast-reducing strategies (e.g., blunting their engagement with pleasant states) under threat of pain may be those who are more likely to use opioids to artificially stabilize their affect. The present study will be the first to test the association between CA and opioid misuse in patients with chronic pain. Specifically, this study will: a) Investigate the association between self- reported CA and opioid misuse in chronic pain patients receiving prescription opioids b) Determine whether greater reactivity to pain following a contrasting (i.e., pleasant state) is higher in opioid misusers than non- misusers c) Determine whether opioid misusers are more likely to engage in a contrast-reducing strategy, mainly blunting of engagement with pleasant stimuli under threat of pain. In examining CA, we will utilize neurophysiological measures that allow for the indexing of emotional reactivity and attentional salience that cannot be captured by self-report alone. This fellowship will provide invaluable training in psychophysiological methodology and chronic pain research that will prepare the applicant for a career as an independent clinical scientist examining the association between chronic pain and substance use disorders.

项目摘要。 鉴于当前的阿片类药物表育症，阿片类药物使用障碍和过量服用障碍的风险增加，5至关重要 确定与慢性疼痛患者相关的因素滥用阿片类药物滥用的因素，并且可能无法计算的因素。 成为潜在的新型治疗目标，以减少这种高危人群中滥用和过量的风险。 注意，慢性疼痛状况的特征是情感变异，导致频繁，突然的转移 通常由于疼痛恶化的结果，正对负面情感状态。14,15虽然先前的研究已有 检查了负面情感状态与阿片类药物结果之间的关联，16，17情感变异性已有 被忽略了。 长时间的负面情感状态表明，患者有较差的阿片类药物结局。 目前的建议将是对避免情感处理构建体（CA）的新颖检查 慢性疼痛的患者被定义为1）从积极情绪转向的不适感（即 对比）和2）在减少或避免对比的策略中英语（例如，避免参与 积极情绪）.9对CA的研究表明，对比是厌恶的，并且在焦虑的个体中残疾， 导致对遵循对比状态的不愉快事件的情绪反应性更大（例如 放松）.10，11同样，在形成对比之后经历了疼痛 - 即宜人的状态，可以进行实验 与中性状态相比，对对比后疼痛的反应性更大，而痛苦更为厌恶和显着性。 可能会导致更大的阿片类药物渴望和滥用以应对对比，而不是仅仅用于镇痛。 阿片类药物的滥用也可能反映出建立稳定的情绪状态并先发出对比的愿望。 也就是说，患有慢性疼痛的人在对比度减少策略方面英语（例如，他们 在痛苦的威胁下与宜人的状态互动可能是那些更多地使用阿片类药物的人 人为地稳定其影响。 特别是慢性疼痛的患者。 报告了接受处方阿片类药物的慢性油漆中的CA和阿片类药物滥用 对比度（即宜人的状态）在阿片类药物误用者中对疼痛的反应性更大，而不是非 - 误用者c）确定阿片类药物误用者是否更多地参与降低对比策略， 在检查CA时，主要是在痛苦的刺激下接触。 神经生理学的措施表明，情绪反应性和同意萨拉克的索引是 不能仅由自我报告捕获。 方法和慢性疼痛研究将使申请人成为独立临床的职业生涯 科学家检查了慢性疼痛与药物使用障碍之间的关联。