Other: Changes in facial expressions during cold pressor pain stimulation

Abstract

Chronic pain appears to be substantially more prevalent among patients with active addiction than in the general population (Rosenblum et al., 2003). Preliminary research suggests that individuals vulnerable to developing addictions may be more sensitive to pain (Stewart et al., 1995). Additionally, the presence of active addiction may facilitate tolerance to analgesics thereby rendering standard treatments less effective in this population (Compton et al., 2000). However, our understanding of the etiology of comorbid addiction and chronic pain is incomplete and this population continues to be underserved. The purpose of this presentation is to present a motivational theory of vulnerability to substance-related disorders and chronic pain. A theoretical rationale for the model based on the opiate system, which has important roles in controlling pain, addiction, reward and response to punishment (Sharifi et al., 2001), will be presented. Because opiates can both alleviate pain and suppress the inhibitory effects of punishment on previously rewarded behavior (Gray, 1987), pain can be considered a potentially powerful motivating factor for drug use. The convergence of this hypothesis with the Motivational Theory of Drug Abuse Vulnerability (Pihl & Peterson, 1995), which suggests that individual differences exist in the functioning of motivation systems, will be discussed. As well, a systematic review literature supporting the proposed motivational model of chronic pain and addiction will be provided. Given the barriers to treatment encountered by individuals with comorbid chronic pain and substance abuse (Merrill et al., 2002), enhanced understanding the relationship between pain and substance use could facilitate development of etiologically-relevant treatment for dually diagnosed individuals. Implications for the development of a treatment program that would address the particular needs and characteristics of individuals with both substance abuse and chronic pain problems will be discussed.