Highlights
- •At present, there is no sound method of identifying optimal opioid candidates.
- •Endogenous opioid function × anger-out interactions identified individuals with different response patterns.
- •Low endogenous opioid function plus low anger-out showed largest morphine analgesic responses.
- •High anger-out plus low endogenous opioid function showed weaker morphine analgesic responses.
- •High anger-out plus low endogenous opioid function showed highest side effects.
Abstract
Long-term use of opioid analgesics may be ineffective or associated with significant
negative side effects for some people. At present, there is no sound method of identifying
optimal opioid candidates. Individuals with chronic low back pain (n = 89) and healthy
control individuals (n = 102) underwent ischemic pain induction with placebo, opioid
blockade (naloxone), and morphine in counterbalanced order. They completed the Spielberger
Anger-Out subscale. Endogenous opioid function × Anger-out × Pain status (chronic
pain, healthy control) interactions were tested for morphine responses to ischemic
threshold, tolerance, and pain intensity (McGill Sensory and Affective subscales)
and side effects. For individuals with chronic pain and healthy control participants,
those with low endogenous opioid function and low anger-out scores exhibited the largest
morphine analgesic responses, whereas those with high anger-out and low endogenous
opioid function showed relatively weaker morphine analgesic responses. Further, individuals
with chronic pain with low endogenous opioid function and low anger-out scores also
reported the fewest negative effects to morphine, whereas those with low endogenous
opioid function and high anger-out reported the most. Findings point toward individuals
with chronic pain who may strike a favorable balance of good analgesia with few side
effects, as well as those who have an unfavorable balance of poor analgesia and many
side effects.
Perspective
We sought to identify optimal candidates for opioid pain management. Low back pain
patients who express anger and also have deficient endogenous opioid function may
be poor candidates for opioid therapy. In contrast, low back patients who tend not
to express anger and who also have deficient endogenous opioid function may make optimal
candidates for opioid therapy.
Key words
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Article info
Publication history
Published online: March 29, 2017
Accepted:
February 26,
2017
Received in revised form:
February 11,
2017
Received:
February 18,
2016
Footnotes
This study was supported by grant R01 DA031726 from the National Institute of Drug Abuse/National Institutes of Health.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2017 by the American Pain Society
