Pathways from Chronic Prescription Opioid Use to New Onset Mood Disorder

从长期处方阿片类药物使用到新发情绪障碍的途径

• 批准号: 10553647
• 负责人: Jeffrey F. Scherrer
• 金额: $ 54.78万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10553647
• 关键词: Address; Adult; Alcohols; Anhedonia; Automobile Driving; Chronic; Computerized Medical Record; Data; Development; Diagnosis; Disease; Disease remission; Dose; Dysthymic Disorder; Enrollment; Event; Generalized Anxiety Disorder; Illicit Drugs; Impairment; Intervention; Major Depressive Disorder; Measures; Medical Records; Mental Depression; Mental disorders; Mood Disorders; Moods; Neurobehavioral Manifestations; Opioid; Opioid Analgesics; Pain; Pain management; Pathway interactions; Patients; Pattern; Phenotype; Population; Private Sector; Prospective Studies; Psychopathology; Quality of life; Recording of previous events; Recovery; Recurrence; Research; Risk; Risk Factors; Sampling; Severities; Sleep; Sleep Apnea Syndromes; Social support; Substance Use Disorder; Surveys; Symptoms; Testing; Time; Trauma; United States Department of Veterans Affairs; Veterans Health Administration; Work; adverse outcome; chronic pain; chronic pain patient; comorbid depression; comorbidity; depressive symptoms; drug misuse; exhaustion; follow-up; functional disability; human old age (65+); improved; innovation; middle age; non-cancer chronic pain; opioid abuse; opioid epidemic; opioid misuse; opioid use; opioid use disorder; pain patient; poor sleep; prescription opioid; prospective; recurrent depression; single episode major depressive disorder; sleep quality; sociodemographics; trauma exposure; treatment-resistant depression

Our previous work indicates a new period of opioid analgesic use (OAU) lasting beyond 30 days, is associated with increased risk for new onset depression, depression recurrence and transition to treatment resistant depression compared to 1-30 OAU days. In multiple studies with robust control for confounding, including pain severity, longer OAU predicted new onset depression in middle-aged patients (substantially older than the age of risk for new onset depression in the population) with no recent history of depression, no evidence of opioid misuse and no recent history of OAU. Our research utilized electronic medical record (EMR) data from large samples of Veterans Administration (VA) and private sector patients. Compared to patients who discontinued OAU within 30 days, patients with 31-90 day OAU were 18% (VA) to 33% (private sector) more likely to have new onset depression. In patients with >90 day OAU, the likelihood increased to 35% in VA and 105% in private sector data. In patients with recent depression and in remission, initiation of OAU, compared to no OAU, was associated with depression recurrence in VA (HR=2.2, 95% CI = 2.0-2.3) and private sector data (HR=1.8, 95% CI = 1.4-2.2). We found that patients with depression were 22% more likely to develop treatment resistant depression with OAU of 31-90 days and 49% more likely with OAU of >90 days. The consistency of findings, replication in VA and private sector patients, and rigorous control for pain support the hypothesis that OAU is likely a risk factor for depression, as well as its recurrence and severity. A prospective study is needed to confirm and advance this line of research, in part because medical record data lack lifetime histories of mood disorders and other risk factors such as substance use disorder, trauma exposure, as well as good measures of functional impairment, sleep quality and social support. Also, EMR data do not contain prospective data on the sequence of pain, OAU and depression symptom development. In the proposed research, we hypothesize that events prior to OAU, such as history of depression, will increase risk of post- OAU new onset major depressive episode. Second, we hypothesize that OAU-related adverse outcomes, such as opioid misuse, sleep apnea, occur after long term OAU and subsequently contribute to new onset depression. Third, we hypothesize that OAU leads to worse depression that in turn contributes to higher OAU and still worsening depression, independent of longitudinal pain measures. Fourth, we focus on depression phenotypes (anhedonia, vital exhaustion, dysthymia, comorbid substance use disorder) to elucidate the new onset depression phenotypes most strongly associated with chronic OAU. Fifth, we determine which depression phenotypes are risk factors for incident opioid misuse and abuse.Data is obtained at baseline, 6 month and 12 month follow-up with monthly brief assessments for trajectory analysis. Our innovative research has great potential to advance understanding of depression in OAU and opioid misuse, abuse/use disorder. Results will inform pain management and safe opioid prescribing for patients with chronic non-cancer pain.

我们以前的工作表明，相关 随着新发作抑郁，抑郁症复发和抗治疗过渡的风险增加 抑郁症与1-30个OAU天相比。在多项研究中具有强大控制的混淆，包括疼痛 严重程度更长的OAU预测中年患者的新发作抑郁症（大大大于年龄 人口新发作抑郁的风险）没有最近的抑郁史，没有阿片类药物的证据 滥用，没有OAU的近期历史。我们的研究利用了来自大型的电子病历（EMR）数据 退伍军人管理（VA）和私营部门患者的样本。与停止的患者相比 OAU在30天内，OAU 31-90天的患者为18％（VA）至33％（私营部门） 新发作抑郁症。在OAU> 90天的患者中，VA的可能性增加到35％，在105％中增加 私营部门数据。在最近的抑郁症患者中，启动OAU，而不是 OAU与VA中的抑郁症复发有关（HR = 2.2，95％CI = 2.0-2.3）和私营部门数据 （HR = 1.8，95％CI = 1.4-2.2）。我们发现抑郁症患者的发展可能性高22％ OAU治疗抗抑郁症的抑郁症为31-90天，OAU的可能性高49％。这 调查结果的一致性，VA和私营部门患者的复制以及严格控制疼痛的控制支持 假设OAU可能是抑郁症及其复发和严重性的危险因素。潜在的 需要研究以确认和推进这一研究，部分原因是病历数据缺乏生命周期 情绪障碍的历史和其他危险因素，例如药物使用障碍，创伤暴露以及 功能障碍，睡眠质量和社会支持的良好衡量。另外，EMR数据不包含 有关疼痛，OAU和抑郁症状发育顺序的前瞻性数据。在提议中 研究，我们假设OAU之前的事件（例如抑郁史）将增加后的风险 OAU新发作的重大抑郁发作。其次，我们假设与OAU相关的不良结果， 例如阿片类药物滥用，睡眠呼吸暂停，在长期OAU后发生，随后有助于新发作 沮丧。第三，我们假设OAU导致更严重的抑郁症，进而导致更高的OAU 并且仍然使抑郁症恶化，与纵向疼痛措施无关。 第四，我们专注于抑郁症 表型（ANHEDONIA，重要疲惫，心律失常，合并药物使用障碍）以阐明新的 发作抑郁型表型与慢性OAU最密切相关。第五，我们确定哪个 抑郁型表型是发生阿片类药物滥用和滥用的危险因素。数据在基线时获得6 每月和12个月的随访以及轨迹分析的每月简短评估。我们的创新研究 具有巨大的潜力，可以提高对OAU和阿片类药物滥用，滥用/使用障碍的抑郁症的了解。 结果将为慢性非癌症疼痛患者提供疼痛管理和安全的阿片类药物处方。

项目成果

Factors Associated With Interest in Engaging in Psychological Interventions for Pain Management.

与参与疼痛管理心理干预的兴趣相关的因素。

• DOI: 10.1097/ajp.0000000000001165
• 发表时间: 2024
• 期刊: The Clinical journal of pain
• 作者: Miller-Matero,LisaR;Yaldo,Marissa;Chohan,Sikander;Zabel,Celeste;Patel,Shivali;Chrusciel,Timothy;Salas,Joanne;Wilson,Lauren;Sullivan,MarkD;Ahmedani,BrianK;Lustman,PatrickJ;Scherrer,JeffreyF
• 通讯作者: Scherrer,JeffreyF

Characteristics of patients with non-cancer pain and long-term prescription opioid use who have used medical versus recreational marijuana.

使用医用大麻与娱乐性大麻的非癌症疼痛和长期处方阿片类药物患者的特征。

• DOI: 10.1186/s42238-024-00218-y
• 发表时间: 2024
• 期刊: Journal of cannabis research
• 影响因子: 3.7
• 作者: Davidson,WhitneyM;Mahavni,Anika;Chrusciel,Timothy;Salas,Joanne;Miller-Matero,LisaR;Sullivan,MarkD;Zabel,Celeste;Lustman,PatrickJ;Ahmedani,BrianK;Scherrer,JeffreyF
• 通讯作者: Scherrer,JeffreyF

Characteristics of Patients with Non-Cancer Pain and Perceived Severity of COVID-19 Related Stress.

非癌症疼痛患者的特征和对 COVID-19 相关压力的感知严重程度。

• 发表时间: 2022
• 期刊: Missouri medicine
• 作者: Scherrer,JeffreyF;Miller-Matero,LisaR;Salas,Joanne;Sullivan,MarkD;Secrest,Scott;Autio,Kirsti;Wilson,Lauren;Amick,Matthew;DeBar,Lynn;Lustman,PatrickJ;Gebauer,Sarah;Ahmedani,Brian
• 通讯作者: Ahmedani,Brian

A Preliminary Study of Stress, Mental Health, and Pain Related to the COVID-19 Pandemic and Odds of Persistent Prescription Opioid Use.

• DOI: 10.1007/s11606-022-07940-4
• 发表时间: 2023-03
• 期刊: JOURNAL OF GENERAL INTERNAL MEDICINE
• 影响因子: 5.7
• 作者: Scherrer, Jeffrey F.;Miller-Matero, Lisa R.;Sullivan, Mark D.;Chrusciel, Timothy;Salas, Joanne;Davidson, Whitney;Zabel, Celeste;Wilson, Lauren;Lustman, Patrick;Ahmedani, Brian
• 通讯作者: Ahmedani, Brian

The Prescription Opioids and Depression Pathways Cohort Study.

• DOI: 10.20900/jpbs.20200009
• 发表时间: 2020-01-01
• 期刊: Journal of psychiatry and brain science
• 作者: Scherrer, Jeffrey F;Ahmedani, Brian;Skiold-Hanlin, Sarah
• 通讯作者: Skiold-Hanlin, Sarah