The downward spiral of chronic pain, prescription opioid misuse, and addiction: Cognitive, affective, and neuropsychopharmacologic pathways

NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS

卷:37

Review

Garland, Eric L.^1,6  Froeliger, Brett²  Zeidan, Fadel³  Partin, Kaitlyn⁴  Howard, Matthew O.⁵ 

[1] Univ Utah, Huntsman Canc Inst, Support Oncol & Survivorship Program, Salt Lake City, UT USA

[2] Med Univ S Carolina, Dept Neurosci, Charleston, SC USA

[3] Wake Forest Univ, Dept Neurobiol & Anat, Winston Salem, NC 27109 USA

[4] Ft Walton Beach Med Ctr, Ft Walton Beach, FL USA

[5] Univ N Carolina, Sch Social Work, Chapel Hill, NC 27515 USA

[6] Univ Utah, Coll Social Work, Salt Lake City, UT USA

关键词: Chronic pain;    Opioid misuse;    Addiction;    Allostasis;    Reward;    Attentional bias;    Default mode;    Mindfulness;   

DOI  :  10.1016/j.neubiorev.2013.08.006

来源: Elsevier

【 摘 要 】

Prescription opioid misuse and addiction among chronic pain patients are emerging public health concerns of considerable significance. Estimates suggest that more than 10% of chronic pain patients misuse opioid analgesics, and the number of fatalities related to nonmedical or inappropriate use of prescription opioids is climbing. Because the prevalence and adverse consequences of this threat are increasing, there is a pressing need for research that identifies the biobehavioral risk chain linking chronic pain, opioid analgesia, and addictive behaviors. To that end, the current manuscript draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to prescription opioid misuse and addiction among chronic pain patients receiving opioid analgesic pharmacotherapy. Addictive use of opioids is described as the outcome of a cycle initiated by chronic pain and negative affect and reinforced by opioidergic-dopamingeric interactions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. Implications for clinical practice are discussed: multimodal, mindfulness-oriented treatment is introduced as a potentially effective approach to disrupting the downward spiral and facilitating recovery from chronic pain and opioid addiction. (C) 2013 Elsevier Ltd. All rights reserved.

【 授权许可】

Free