Abstract
Little is known about whether patients with chronic pain treated with opioids experience
craving for their medications, whether contextual cues may influence craving, or if
there is a relationship between craving and medication compliance. We hypothesized
that craving for prescription opioids would be significantly correlated with the urge
for more medication, preoccupation with the next dose, and current mood symptoms.
We studied craving in 62 patients with chronic pain who were at low or high risk for
opioid misuse, while they were enrolled in an RCT to improve prescription opioid medication
compliance. Using electronic diaries, patients completed ratings of craving at monthly
clinic visits and daily during a 14-day take-home period. Both groups consistently
endorsed craving, whose levels were highly correlated (P < .001) with urge, preoccupation, and mood. The intervention to improve opioid compliance
in the high-risk group was significantly associated with a rate of decrease in craving
over time in comparison to a high-risk control group (P < .05). These findings indicate that craving is a potentially important psychological
construct in pain patients prescribed opioids, regardless of their level of risk to
misuse opioids. Targeting craving may be an important intervention to decrease misuse
and improve prescription opioid compliance.
Perspective
Patients with noncancer pain can crave their prescription opioids, regardless of their
risk for opioid misuse. We found craving to be highly correlated with the urge to
take more medication, fluctuations in mood, and preoccupation with the next dose,
and to diminish with a behavioral intervention to improve opioid compliance.
Key words
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Article info
Publication history
Published online: January 16, 2012
Accepted:
October 25,
2011
Received in revised form:
August 12,
2011
Received:
April 20,
2011
Footnotes
Supported by the National Institute of Drug Abuse (NIDA) of the National Institutes of Health (K23 DA020682, Wasan, PI) and the Arthritis Foundation (Investigator Award; Wasan, PI). It was also funded in part by an investigator-initiated grant from Endo Pharmaceuticals, Chadds Ford, PA, and NIDA grant (R21 DA024298, Jamison, PI) as well as K24 DA019855 (Greenfield PI) and K24 DA022288 (Weiss PI) from NIDA.
All of the authors significantly contributed to the design, patient enrollment, data collection, data analysis, and manuscript preparation. The authors have no conflicts of interest to declare.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
