The Effect of Chronic Pain on Delay Discounting in Methadone Patients

慢性疼痛对美沙酮患者延迟折扣的影响

• 批准号: 10020379
• 负责人: David Andrew Tompkins
• 金额: $ 21.14万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10020379
• 关键词: AIDS/HIV problem; Abstinence; Acute; Affect; Attention; Buprenorphine; Characteristics; Chronic; Clinical Trials; Decision Making; Development; Double-Blind Method; Dropout; Drug usage; Emotional; Epidemic; Evidence based treatment; Future; Height; Impulsivity; Individual; Injections; Intervention; Intramuscular; Investigation; Measures; Methadone; Modeling; Naloxone; Normal saline; Overdose; Pain; Pain management; Patients; Persons; Play; Population; Primary Prevention; Procedures; Public Health; Relapse; Research Project Grants; Rewards; Role; Secondary Prevention; Severities; Sleep Deprivation; Substance Use Disorder; Surrogate Endpoint; Testing; Time; Treatment Efficacy; Treatment outcome; United States; Withdrawal; chronic musculoskeletal pain; chronic pain; chronic pain patient; clinical practice; cognitive process; coping; discount; discounting; drug relapse; experience; experimental study; follow-up; improved; insight; medication-assisted treatment; methadone patient; methadone treatment; opioid epidemic; opioid mortality; opioid use; opioid use disorder; opioid withdrawal; pain catastrophizing; pain relief; pain sensation; primary outcome; recruit; standard of care; stressor; trait

PROJECT SUMMARY / ABSTRACT This R21 resubmission proposes to systematically study the association between chronic musculoskeletal pain, delay discounting, opioid withdrawal and pain catastrophizing in patients on methadone maintenance for opioid use disorder (OUD). The epidemic of opioid overdose deaths continues to rise, killing more persons in 2017 then at the height of the HIV/AIDS epidemic. Medication assisted treatment, utilizing methadone or buprenorphine, is the standard of care for the treatment of OUD. However, co-occurring chronic pain can reduce treatment efficacy and is associated with relapse and poor retention in treatment. Mechanisms by which chronic pain may influence the impulsive decision-making (e.g., drug relapse) in persons with OUD have not been well characterized. Two factors that can influence decisions to use drugs are impulsivity and acute opioid withdrawal. Delay discounting is a model of impulsive decision-making and refers to the observation that delaying a consequence reduces its subjective value. Though delay discounting was originally thought to be trait-like, situational stressors have recently been shown to increase discounting, including acute opioid withdrawal. It is not known if a chronic stressor (i.e., chronic pain) has a similar effect on discounting or whether there are greater changes to discounting in the presence of both an acute and chronic stressor than either stressor alone. Trait pain catastrophizing is thought to increase attention and focus on pain and influence the choice of coping strategies used to respond to pain. It could play an important role in the impulsive decision to use drugs for immediate pain relief at the expense of abstinence, especially as a function of chronic pain. This proposal will test how chronic pain is associated with increases in impulsive decision-making in OUD, whether impulsive decision-making is greater when undergoing opioid withdrawal for OUD patients with and without chronic pain, and how catastrophizing may modify the association between chronic pain and impulsive decision- making. The proposed study will recruit two groups of patients maintained on methadone for OUD – individuals with (PAIN) and without (NO PAIN) chronic musculoskeletal pain, matched on characteristics that can influence delay discounting. Each group will have two double-blind experimental sessions in counterbalanced order: 1) control condition [intramuscular (IM) injection of normal saline] during peak methadone effects and 2) IM naloxone-precipitated opioid withdrawal. The same delay discounting tasks will be measured during each session. The specific aims are to: (1) Determine the effect of aversive stressors on delay discounting in persons in methadone maintenance; and (2) Investigate the degree to which trait pain catastrophizing modifies the association between opioid withdrawal and delay discounting. If withdrawal and catastrophizing were found to affect impulsive decision-making, future research could extend the study of these variables to determine if they play an explicitly causal role in decisions to use opioids or to relapse, and to develop interventions to remediate impulsivity leading to relapse, thereby improving treatment outcomes.

项目概要/摘要 此 R21 重新提交建议系统地研究慢性病之间的关联 美沙酮患者的肌肉骨骼疼痛、延迟折扣、阿片类药物戒断和疼痛灾难 阿片类药物使用障碍 (OUD) 的维持治疗 阿片类药物过量死亡的流行持续上升，导致死亡。 2017 年，利用药物辅助治疗的人数比艾滋病毒/艾滋病流行高峰期的人数还要多。 美沙酮或丁丙诺啡是治疗 OUD 的标准疗法，但同时存在慢性疾病。 疼痛会降低治疗效果，并与复发和治疗效果不佳有关。 慢性疼痛可能影响 OUD 患者的冲动决策（例如药物复发） 冲动性和敏锐性是影响药物使用决定的两个因素。 阿片类药物戒断是一种冲动决策模型，指的是这样的观察： 延迟结果会降低其主观价值，尽管延迟折扣最初被认为是。 最近显示，类似特质的情境压力源会增加折扣，包括急性阿片类药物 目前尚不清楚慢性压力源（即慢性疼痛）是否对折扣有类似的影响。 在存在急性和慢性压力源的情况下，折扣的变化比任何一种都更大 单独的压力源被认为会增加对疼痛的注意力并影响疼痛。 用于应对疼痛的应对策略的选择可能在冲动决定中发挥重要作用。 使用药物来立即缓解疼痛，但要牺牲禁欲，尤其是作为慢性疼痛的功能。 该提案将测试慢性疼痛与 OUD 冲动决策增加之间的关系，是否 对于有或没有症状的 OUD 患者，在接受阿片类药物戒断时，冲动决策会更严重 慢性疼痛，以及灾难化如何改变慢性疼痛和冲动决策之间的关联—— 拟议的研究将招募两组持续服用美沙酮进行 OUD 的患者——个体。 有（疼痛）和无（无疼痛）慢性肌肉骨骼疼痛，匹配可影响的特征 每组将进行两次双盲实验，顺序为平衡顺序：1） 美沙酮效应峰值期间的控制条件[肌内 (IM) 注射生理盐水] 和 2) IM 纳洛酮促阿片类药物戒断期间将测量相同的延迟贴现任务。 会议的具体目标是：（1）确定厌恶性压力源对人的延迟贴现的影响。 在美沙酮维持治疗中；以及 (2) 研究特征性疼痛灾难性改变的程度 如果发现阿片类药物戒断和延迟折扣之间存在关联。 影响冲动决策，未来的研究可以扩展对这些变量的研究，以确定它们是否 在使用阿片类药物或复发的决定中发挥明确的因果作用，并制定干预措施进行补救 冲动导致复发，从而改善治疗效果。