title: Craving of prescription opioids in patients with chronic pain: a longitudinal outcomes trial.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pain Management Center, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA. awasan@partners.org
authors.forename: Ajay D
authors.initials: AD
authors.lastname: Wasan
authors.forename: Edgar L
authors.initials: EL
authors.lastname: Ross
authors.forename: Edward
authors.initials: E
authors.lastname: Michna
authors.forename: Lori
authors.initials: L
authors.lastname: Chibnik
authors.forename: Shelly F
authors.initials: SF
authors.lastname: Greenfield
authors.forename: Roger D
authors.initials: RD
authors.lastname: Weiss
authors.forename: Robert N
authors.initials: RN
authors.lastname: Jamison
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy* / Q000523:psychology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology / Q000523:psychology; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation; D010147:Pain Measurement; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid