Background & Aims
While opioids offer potential analgesic benefits to chronic non-cancer pain (CNCP) patients, their long-term use may result in misuse and opioid use disorder. Existing evidence suggests that opioid craving (i.e., the desires and/or urges to use opioids) may increase the likelihood of misuse; however, the factors influencing opioid craving among CNCP patients remain unclear and studies assessing daily misuse are lacking. The interplay between opioid-related physical withdrawal symptoms (OWS), psychological states, and opioid-related problems in the daily lives of CNCP patients needs to be further examined. Our aims were 1) To investigate the intra-day relationships between OWS and opioid craving among CNCP patients; 2) Evaluate if psychological factors such as negative affect (NA) and catastrophic thinking contribute to the relationship between OWS and opioid craving; and 3) Examine the relative contribution of OWS, opioid craving, NA, and pain catastrophizing to daily opioid misuse.
Methods
This was a longitudinal observational study of CNCP patients (n = 78) who were prescribed long-term opioid therapy. Patients were prescribed short-acting oral opioids and were using them on a daily or near-daily basis. Participants were recruited from tertiary care and the community. Patients provided momentary reports, when randomly prompted during their daily lives, for 10 consecutive days, using an ecological momentary assessment (EMA) smartphone application (MetricWire). Reports were made based on diary adaptations of the following measures: 1) opioid withdrawal symptoms (presence/absence, intensity), from the Subjective Opiate Withdrawal Scale; 2) opioid craving (0-100), from the Opioid Craving Scale; 3) pain intensity (0-100), from the Brief Pain Inventory; 4) negative affect, from the Positive and Negative Affect Scale; 5) pain catastrophizing, from the Daily Pain Catastrophizing Scale. EMA entries were date- and time-stamped to track compliance with diary reports.
Results
The average age of the sample was 54 years old, and the sample comprised 47 women and 31 men. Participants had a variety of chronic non-cancer pain diagnoses. A multilevel regression analysis revealed a significant intra-day (i.e., within-person) relationship between opioid withdrawal symptoms and opioid craving (p < 0.001). Intra-day elevations in NA and pain catastrophizing were associated with greater withdrawal symptoms and opioid craving (all p's < .05). The association between opioid withdrawal symptoms and craving was mediated by concurrent elevations in catastrophic thinking and negative affect (all p's < .05). Finally, a multivariable regression examined the relative contribution of opioid withdrawal symptoms, opioid craving, negative affect and pain catastrophizing to daily opioid misuse behaviors. Results revealed that daily craving was the only significant predictor of daily opioid misuse (p < .001).
Conclusions
Findings from our study provide new insights into the daily experiences of patients with chronic pain who use opioids. By using EMA-based diary procedures, we explored the dynamic inter-connections that occur between patients’ physical states (e.g., pain, opioid withdrawal symptoms) and psychological states (e.g., negative affect, catastrophic thinking). We also explored how these states contribute to daily opioid-related problems such as opioid craving and opioid misuse. Consistent with our previous research, our study suggests that opioid withdrawal symptoms may exacerbate psychological distress among chronic pain patients, which in turn could lead to heightened opioid craving and misuse. In our study, craving was linked to a greater likelihood of using opioids for reasons other than pain, even when accounting for pain, psychological, and opioid-related variables. Further research will be needed to better understand the psychological and biological determinants of opioid craving.
References
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Presenting Author
Alice Bruneau
Poster Authors
Alice Bruneau
MSc
McGill University
Lead Author
Amanda Sirois
McGill University
Lead Author
Yami-Louise Djoudi
McGill University
Lead Author
Sarah Petkau
McGill University
Lead Author
Alexandra Gavrilescu
McGill University
Lead Author
Juliet Ware
University of British Columbia
Lead Author
Jordi Perez
MD
McGill University
Lead Author
Marc O Martel
PhD
McGill University
Lead Author
Topics
- Treatment/Management: Pharmacology: Opioid