Day-to-day Hedonic and Calming Effects of Opioids, Opioid Craving, and Opioid Misuse Among Patients With Chronic Pain Prescribed Long-term Opioid Therapy

Leah Frimerman; Maria Verner; Amanda Sirois; Katherine Scott; Alice Bruneau; Jordi Perez; Yoram Shir; Marc O. Martel

Disclosures

Pain. 2021;162(8):2214-2224. 

In This Article

Abstract and Introduction

Abstract

Concerns have been raised regarding the misuse of opioids among patients with chronic pain. Although a number of factors may contribute to opioid misuse, research has yet to examine if the hedonic and calming effects that can potentially accompany the use of opioids contribute to opioid misuse. The first objective of this study was to examine the degree to which the hedonic and calming effects of opioids contribute to opioid misuse in patients with chronic pain. We also examined whether the hedonic and calming effects of opioids contribute to patients' daily levels of opioid craving, and whether these associations were moderated by patients' daily levels of pain intensity, catastrophizing, negative affect, or positive affect. In this longitudinal diary study, patients (n = 103) prescribed opioid therapy completed daily diaries for 14 consecutive days. Diaries assessed a host of pain, psychological, and opioid-related variables. The hedonic and calming effects of opioids were not significantly associated with any type of opioid misuse behavior. However, greater hedonic and calming effects were associated with heightened reports of opioid craving (both P's < 0.005). Analyses revealed that these associations were moderated by patients' daily levels of pain intensity, catastrophizing, and negative affect (all P's < 0.001). Results from this study provide valuable new insights into our understanding of factors that may contribute to opioid craving among patients with chronic pain who are prescribed long-term opioid therapy. The implications of our findings for the management of patients with chronic pain are discussed.

Introduction

Concerns have been raised regarding the misuse of opioids among patients with chronic noncancer pain.[2,14,80] The prevalence of opioid misuse (ie, the use of opioids differently from how they were prescribed) ranges between 21% and 29% in primary and tertiary care settings, respectively.[80] Opioid misuse may cause health problems[9,14] and may create challenges for the management of patients with chronic pain.[5,6,74]

In previous studies conducted among patients with chronic pain prescribed long-term opioid therapy, psychological factors such as negative affect (NA) and catastrophizing have been associated with opioid misuse.[35,36,53,55] Opioid craving (ie, the subjective desire to consume opioids) has also been associated with opioid misuse.[51,53] To date, however, a number of factors that could potentially contribute to opioid misuse in patients with chronic pain have remained unexplored. For instance, research has yet to examine if the potentially hedonic (eg, pleasurable) or calming effects of opioids contribute to prescription opioid misuse. These opioid effects are known to be experienced, to varying degrees, when using prescription opioids.[15,16,85] To date, however, these opioid effects have been primarily examined in the context of opioid abuse liability studies among illicit opioid users[16,78,86] or pain-free healthy volunteers[87,88] under laboratory conditions. Although informative, these studies do not fully represent everyday long-term opioid use by patients with chronic pain. Studies have examined the hedonic effects of opioids among patients with chronic pain in the context of clinical trials,[42,58,84] but the contribution of hedonic effects to opioid misuse was not explored. The degree to which the calming effects of opioids contribute to opioid misuse has also yet to be explored.

Questions also need to be addressed concerning the degree to which the hedonic and calming effects of opioids contribute to opioid craving. For instance, there is reason to believe that contribution of these effects to opioid craving might vary as a function of patients' day-to-day pain levels and psychological states. Given that the pleasurable and/or calming effects of opioids may contribute to alleviating the unpleasantness of pain as well as psychological distress,[46,61] they might be more strongly linked to opioid craving on days when patients experience elevations in pain intensity, catastrophizing, or negative affect. Similarly, the hedonic or calming effects of opioids might be more strongly linked to opioid craving on days when patients experience decreases in positive affect (PA). To our knowledge, this has yet to be investigated in patients with chronic pain who are prescribed opioid therapy.

The first objective of this study was to examine if the hedonic and calming effects of opioids contribute to opioid misuse in patients with chronic pain who are prescribed long-term opioid therapy. The second objective was to examine whether the hedonic and calming effects of opioids contribute to patients' daily levels of opioid craving. Analyses then examined whether these associations vary as a function of patients' daily levels of pain intensity, catastrophizing, and daily affective states (ie, NA or PA).

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