Mind-body approaches targeting the psychological aspects of opioid use problems in patients with chronic pain: evidence and opportunities

Martel, Marc O.; Bruneau, Alice; Edwards, Robert R.

doi:10.1016/j.trsl.2021.02.013

Cited by 10 publications

(10 citation statements)

References 191 publications

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“…Patient demographics predictive of COU were psychological in nature and included depression and substance abuse disorders. Multiple studies have observed increased risk of COU in patients with depression, anxiety, and substance abuse disorders 5,27–33. Better treatment pathways including appropriate psychological optimization may help reduce COU 34…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have observed increased risk of COU in patients with depression, anxiety, and substance abuse disorders. 5,[27][28][29][30][31][32][33] Better treatment pathways including appropriate psychological optimization may help reduce COU. 34 Four cohorts of surgical diagnoses were evaluated: spondylolisthesis, stenosis, disk herniation, and DDD.…”

Section: Discussionmentioning

confidence: 99%

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Opioid Use Patterns in a Statewide Adult Medicaid Population Undergoing Elective Lumbar Spine Surgery

Reitman

Ward

Taber

et al. 2022

Spine

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Study Design. Retrospective administrative database review.Objective. Analyze patterns of opioid use in patients undergoing lumbar surgery and determine associated risk factors in a Medicaid population. Summary of Background Data. Opioid use in patients undergoing surgery for degenerative lumbar spine conditions is prevalent and impacts outcomes. There is limited information defining the scope of this problem in Medicaid patients. Materials and Methods. Longitudinal cohort study of adult South Carolina (SC) Medicaid patients undergoing lumbar surgery from 2014 to 2017. All patients had continuous SC Medicaid coverage for 15 consecutive months, including six months before and nine months following surgery. The primary outcome was a longitudinal assessment of postoperative opioid use to determine trajectories and group-based membership using latent modeling. Univariate and multivariable modeling was conducted to assess risk factors for group-based trajectory modeling and chronic opioid use (COU). Results. A total of 1455 surgeries met inclusion criteria. Groupbased trajectory model demonstrated patients fit into five groups; very low use (23.4%), rapid wean following surgery (18.8%), increasing use following surgery (12.9%), slow wean following surgery (12.6%) and sustained high use (32.2%). Variables predicting membership in high opioid use included preoperative opioid use, younger age, longer length of stay, concomitant medications, and readmissions. More than three quarter of patients were deemed COUs (76.4%). On bivariate analysis, patients with degenerative disk disease were more likely to be COUs (24.8% vs. 18.6%; P = 0.0168), more likely to take opioids before surgery (88.5% vs. 61.9%; P < 0.001) and received higher amounts of opioids during the 30 days following surgery (mean morphine milligram equivalents 59.6 vs. 25.1; P < 0.001). Conclusions. Most SC Medicaid patients undergoing lumbar elective lumbar spine surgery were using opioids preoperatively and continued long-term use postoperatively at a higher rate than previously reported databases. Preoperative and perioperative intake, degenerative disk disease, multiple prescribers, depression, and concomitant medications were significant risk factors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Opioid Use Patterns in a Statewide Adult Medicaid Population Undergoing Elective Lumbar Spine Surgery

Reitman

Ward

Taber

et al. 2022

Spine

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“…It is also possible that distress or other psychological factors indirectly affect autonomic function, via mechanisms that the current analyses did not capture. For instance, previous studies have identified significant associations between opioid craving and psychological factors such as positive and negative affect 49,50 and depressed mood, 51 suggesting a link between psychological variables and OUD-related processes that should be further investigated in future studies.…”

Section: Discussionmentioning

confidence: 99%

Association between opioid use disorder and blunted heart rate variability among opioid‐treated chronic pain patients

Roberts

Garland

2022

Addiction Biology

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Given the severity of the ongoing opioid epidemic, it is essential to understand the mechanisms of risk for development and maintenance of opioid use disorder (OUD). The aim of the current large‐scale psychophysiological investigation was to test whether patients with OUD had lower resting‐state high‐frequency heart rate variability (HF‐HRV) than those without OUD, controlling for sociodemographic and clinical confounds. Additionally, we tested whether HF‐HRV was associated with opioid craving in this population. Participants in this cross‐sectional study were 490 chronic pain patients (50.4% female) treated with long‐term opioid therapy. OUD diagnosis was determined by psychiatric interview. HF‐HRV was measured at resting baseline. We computed the association between OUD and resting‐state HF‐HRV, controlling for age, gender, race, pain severity, emotional distress and opioid dose. Opioid craving was measured with visual analogue scales to assess whether HF‐HRV was associated with craving. Results showed that resting HF‐HRV was significantly lower for patients with OUD than for those without OUD (p < 0.001, d = 0.36), indicating deficits in autonomic flexibility. OUD diagnosis (p = 0.002) and OUD severity (p = 0.03) were associated with lower HF‐HRV in regression models accounting for a range of confounders. Additionally, lower HF‐HRV was significantly (but weakly) correlated with heightened opioid craving (r = −0.166, p < 0.001). Overall, findings suggest that resting‐state HF‐HRV may serve as a valid biomarker of addiction among people on long‐term opioid therapy.

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“…Opioid misuse behaviors could be monitored and addressed clinically without necessarily discontinuing opioid therapy. 10,13,16 If opioid tapering (ie, opioid dose reduction) or opioid discontinuation is deemed clinically indicated, patients must be willing to engage in this avenue. Importantly, they deserve a supportive, patient-centered discussion about potential opioid tapering plans.…”

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confidence: 99%

Implications of hedonic effects of opioids in clinical practice

Blatt

2022

Pain

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exposure to prescription opioids. 1 This study compared a group on long-term opioid therapy at a pain center with a group whose initial exposure to opioids was for chronic pain but who were currently receiving treatment of opioid addiction. The Addiction Center Research Inventory 7,8 was completed by both groups. The Addiction Center Research Inventory scores were much higher, indicating more euphoric effects from opioids, in those who later became addicted to opioids. Yet the group that was not addicted also reported frequently experiencing hedonic effects of opioids. 30% recalled "I was full of energy," 25% noted "things around me seemed more pleasing than usual," 35% "felt more clear headed than dreamy," and 25% recalled "feeling more excited than dreamy."The Kaiser Family Foundation performed a phone survey of recipients of chronic opioid prescriptions. This was self-published on the website of the Kaiser Family Foundation in December of 2016. 2 20% of survey respondents reported that a major reason for using prescribed opioids was "for fun or to get high," 14% "to deal with day to day stress," and 10% "to relax or relieve tension." An additional 14%, 8%, and 3%, respectively, reported that it was a minor reason to use prescribed opioids for these purposes.In a phone survey of retired National Football League players, 4 participants were asked if they used opioid medications for any of the following purposes: to function; to change mood, be happy, or get high; to relax, calm down or relieve stress; to sleep; or for pain. Roughly 25% exposed to prescribed pain medications during their playing career were currently prescribed opioids. Of those, 45% disclosed current misuse of opioids. 35% of those currently misusing opioids reported that during their playing careers they used opioids to relax or relieve stress, whereas 22% reported opioid use to improve mood.These articles seem to have substantial agreement with Frimerman et al., in that all show a very high rate of hedonic effects of prescribed opioids. However, patients in the 2 phone surveys reported a wider variety of hedonic effects than were evaluated in this study and a higher rate of opioid misuse.The authors suggest 2 important clinical implications of these data: to routinely discuss the possibility of hedonic effects with patients and cognitive behavioral or mindfulness interventions for those patients who seek the pleasurable or calming effects of opioids. These seem to be very reasonable responses to their findings and the impact of misuse on clinical outcomes.I propose another clinical implication: The information that is discussed here, and in the extensive body of research cited in their references, is not already widely shared in the locations where it would seem most likely to be seen by the medical community: in opioid management guidelines, standardized informed consent documents, and medication management agreements. 3,5,9 By contrast, the risk of addiction is already covered in these documents. Similarly, ordinary risks common to opioids...

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Mind-body approaches targeting the psychological aspects of opioid use problems in patients with chronic pain: evidence and opportunities

Cited by 10 publications

References 191 publications

Opioid Use Patterns in a Statewide Adult Medicaid Population Undergoing Elective Lumbar Spine Surgery

Opioid Use Patterns in a Statewide Adult Medicaid Population Undergoing Elective Lumbar Spine Surgery

Association between opioid use disorder and blunted heart rate variability among opioid‐treated chronic pain patients

Implications of hedonic effects of opioids in clinical practice

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