Comorbid chronic pain and opioid misuse in youth: Knowns, unknowns, and implications for behavioral treatment.

Abstract

Chronic pain and opioid misuse are both common in pediatric populations and associated with a range of negative adverse outcomes that may persist into adulthood. While the association between chronic pain, opioid prescribing, and opioid-related adverse consequences is reasonably well established in adults, the relation in pediatric patients is not well understood. The present review draws from the available literature on chronic and acute pediatric pain prevalence and treatment, opioid misuse, and adolescent substance use to address knowns and unknowns of comorbid pediatric chronic pain and opioid misuse. Gaps in knowledge regarding the prevalence and etiology of co-occurring chronic pain and opioid misuse are identified. Hypothesized, modifiable risk factors associated with both pediatric pain and opioid misuse are considered. Due to a lack of empirically supported integrated treatments for co-morbid chronic pain and opioid misuse in youth, this review examines the evidence base and best practices from both the chronic pain and opioid treatment literature to guide treatment recommendations for these co-morbid conditions in youth. Recommendations are then provided to promote screening and mitigate risk of chronic pain and opioid misuse across a range of medical settings. Lastly, a comprehensive agenda to prevent and treat chronic pain and opioid misuse in adolescents and young adults is discussed.

Nonmedical Prescription Opioid Use among a Sample of College Students: Prevalence and Predictors

“…Factors associated with an increased likelihood of NMPO, in general, include physical pain, anxiety, depression, executive functioning deficits, and other comorbid substance misuse [ 23 , 24 , 25 , 26 , 27 ]. A primary motivation for use of prescription opioids among the general adult population is both physical and emotional pain relief [ 24 ].…”

“…A primary motivation for use of prescription opioids among the general adult population is both physical and emotional pain relief [ 24 ]. Individuals with chronic pain appear to be at greater risk for NMPO, because of greater access to opioids for medical use and due to illegal means that may be taken when medical treatment is perceived as inadequate for pain relief [ 26 ]. Research supports a high rate of prescriptions in medical contexts for pain management [ 28 , 29 ] and, concomitantly, a strong relationship between prescribing patterns for prescription opioids and overdose mortality rates [ 30 , 31 , 32 ].…”

Longitudinal Analysis of Substance Use Disorder Symptom Severity at Age 18 Years and Substance Use Disorder in Adulthood

“… 32 , 33 , 34 , 35 Severe SUD symptoms may be initiated by or exaggerated by comorbid psychiatric disorders as well as family history of SUD. 36 , 37 , 38 , 39 The contributing mechanisms are likely not mutually exclusive and together may amplify disease status. Because of the higher rates of psychiatric comorbidity among those with multiple DSM-5 SUDs and the more persistent course of multiple SUDs, a greater emphasis toward identifying SUD severity and comorbid psychiatric disorders is warranted.…”

Preventing pediatric chronic postsurgical pain: Time for increased rigor

“…However, the opioid crisis is attributed, in large part, to a dearth of research on how and why existing nonopioid pain therapies (e.g., behavioral interventions, anticonvulsants) work for certain patients and not others. 84 A meta-analysis exploring the use of gabapentin for postsurgical pain in individuals 18 years or older concluded that though it improved the efficacy of opioids as well as reduced the need for analgesic consumption and opioid-related adverse effects, it is associated with side effects including sedation and dizziness, which is not ideal for an adolescent patient who has to focus at school. 85 Additionally, it remains unclear whether gabapentin reduces mechanical hyperalgesia in and around the wound, and studies on dose–response efficacy are lacking.…”