Emotion dysregulation as a transdiagnostic mechanism of opioid misuse and suicidality among chronic pain patients

Abstract

BackgroundChronic pain is a prevalent condition that causes functional impairment and emotional suffering. To allay pain-induced suffering, opioids are often prescribed for chronic pain management. Yet, chronic pain patients on opioid therapy are at heightened risk for opioid misuse—behaviors that can lead to addiction and overdose. Relatedly, chronic pain patients are at elevated risk for suicidal ideation and suicidal behaviors.Main bodyOpioid misuse and suicidality are maladaptive processes aimed at alleviating the negative emotional hyperreactivity, hedonic hyporeactivity, and emotion dysregulation experienced by chronic pain patients on opioid therapy. In this review, we explore the role of emotion dysregulation in chronic pain. We then describe why emotionally dysregulated chronic pain patients are vulnerable to opioid misuse and suicidality in response to these negative affective states.ConclusionEmotion dysregulation is an important and malleable treatment target with the potential to reduce or prevent opioid misuse and suicidality among opioid-treated chronic pain patients.

Role of affective instability on suicidal risk in complex regional pain syndrome: a diary approach (preliminary report)

“…Many patients with CRPS face numerous challenges because of pain and its consequences [ 32 , 34 ]. Repeated exposure to such challenges over a long period of time may increasingly stimulate the development of catastrophic thoughts, which may interfere with patients’ ability to regulate negative emotions [ 35 ]. Difficulties encountered in the regulation of negative emotions are associated with the development and maintenance of suicidal ideations and behaviors [ 35 ].…”

“…Repeated exposure to such challenges over a long period of time may increasingly stimulate the development of catastrophic thoughts, which may interfere with patients’ ability to regulate negative emotions [ 35 ]. Difficulties encountered in the regulation of negative emotions are associated with the development and maintenance of suicidal ideations and behaviors [ 35 ]. Specifically, repeated failure in emotional regulation may result in patients developing more elaborate suicidogenic cognitive structures as means of escaping from their pain and emotional distress.…”

“…This may be achieved by emotional regulation strategies [ 16 , 44 ]. Cognitive reappraisal is one of the most widely used adaptive strategies, particularly for intense or persistent negative emotions [ 35 ]. CRPS often does not respond well to treatments [ 34 ].…”

“…Thus, catastrophic thoughts, such as believing the condition will never get better, may increasingly develop over time. Such negative appraisals are likely to lead to suicidal ideation or suicide attempts as a final resort to escape pain and emotional distress [ 35 ]. Thus, health professionals should consider assisting patients to interpret pain sensations, and situations or events, in more adaptive ways including cognitive reappraisals to decrease their negative emotions.…”

“…First, the sample size was relatively small (N = 23) and the majority of the sample were male (78.26%). CRPS-I occurs more frequently in female than male [ 35 ]. Also, participants were patients registered at the CRPS Association in Korea, but we did not attempt to obtain further information from them regarding their diagnosis.…”