Clinical and psychological factors associated with interdose opioid withdrawal in chronic pain population

Sara Rodríguez-Espinosa,Ainhoa Coloma-Carmona,Ana Pérez-Carbonell,José F Román-Quiles,José L Carballo

doi:10.1016/j.jsat.2021.108386

Abstract

BackgroundThe DSM-5 diagnostic criteria for Prescription Opioid-Use Disorder (POUD) have undergone some significant changes. One of the most controversial changes has been the elimination of the withdrawal symptoms criterion when opioid use is under appropriate medical supervision. For this reason, the goal of this study was to analyze factors associated with opioid withdrawal in patients with chronic non-cancer pain (CNCP). MethodsThis cross-sectional descriptive study involved 404 patients who use prescription opioids for long-term treatment (≥90 days) of CNCP. Measures included sociodemographic and clinical characteristics, POUD, withdrawal symptoms, craving, anxiety-depressive symptoms, and pain intensity and interference. ResultsForty-seven percent (n = 193) of the sample reported moderate-severe withdrawal symptoms, which were associated with lower age, higher daily morphine dose and duration of treatment with opioids, moderate-severe POUD, use of psychotropic drugs, higher anxiety-depressive symptoms, and greater pain intensity and interference (p < .05). Binary logistic regression analysis showed that moderate-severe POUD (OR = 2.82), anxiety (OR = 2.21), depression (OR = 1.81), higher pain interference (OR = 1.05), and longer duration of treatment with opioids were the strongest factors associated with moderate-severe withdrawal symptoms (p < .05). ConclusionPsychological factors seem to play a key role in the severity of withdrawal symptoms. Since greater intensity of these symptoms increases the risk of developing POUD, knowing the factors associated with withdrawal may be useful in developing preventive psychological interventions.

Highlights

The use of opioids for chronic non-cancer pain (CNCP) has increased worldwide (Bedson et al, 2016; Davies, Phillips, Rance, & Sewell, 2019; Larochelle, Zhang, Ross-Degnan, & Wharam, 2015)
The Adjective Rating Scale for Withdrawal (ARSW) demonstrated a unidimensional factor structure and high internal consistency (Cronbach’s alpha = .85) in the validation per formed with patients under long-term opioid therapy for CNCP (ColomaCarmona, Carballo, Rodríguez-Marín, & van-der Hofstadt, 2019)
This study examined the prevalence and clinical and psychological factors associated with interdose opioid withdrawal severity in a sample of chronic pain patients under long-term opioid therapy

Summary

Introduction

The use of opioids for chronic non-cancer pain (CNCP) has increased worldwide (Bedson et al, 2016; Davies, Phillips, Rance, & Sewell, 2019; Larochelle, Zhang, Ross-Degnan, & Wharam, 2015). Several studies suggest that both are common physiologic adaptations that are expected to occur as a result of chronic opioid therapy (Boscarino et al, 2011; Degenhardt et al, 2015) For this reason, the fifth edition of the DSM (APA, 2013) expressly excludes both criteria for Prescription Opioid-Use Disorder (POUD) diagnosis when the patient takes opioids under appropriate medical supervision (Boscarino et al, 2011; Martel et al, 2018). One of the most controversial changes has been the elimination of the withdrawal symptoms criterion when opioid use is under appropriate medical supervision For this reason, the goal of this study was to analyze factors associated with opioid withdrawal in patients with chronic non-cancer pain (CNCP). Since greater intensity of these symptoms increases the risk of developing POUD, knowing the factors associated with with drawal may be useful in developing preventive psychological interventions

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