title: The downward spiral of chronic pain, prescription opioid misuse, and addiction: cognitive, affective, and neuropsychopharmacologic pathways.
abstract: Prescription opioid misuse and addiction among chronic pain patients are emerging public health concerns of considerable significance. Estimates suggest that more than 10% of chronic pain patients misuse opioid analgesics, and the number of fatalities related to nonmedical or inappropriate use of prescription opioids is climbing. Because the prevalence and adverse consequences of this threat are increasing, there is a pressing need for research that identifies the biobehavioral risk chain linking chronic pain, opioid analgesia, and addictive behaviors. To that end, the current manuscript draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to prescription opioid misuse and addiction among chronic pain patients receiving opioid analgesic pharmacotherapy. Addictive use of opioids is described as the outcome of a cycle initiated by chronic pain and negative affect and reinforced by opioidergic-dopamingeric interactions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. Implications for clinical practice are discussed; multimodal, mindfulness-oriented treatment is introduced as a potentially effective approach to disrupting the downward spiral and facilitating recovery from chronic pain and opioid addiction.
authors.affiliation: Supportive Oncology & Survivorship Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States; College of Social Work, University of Utah, Salt Lake City, UT, United States. Electronic address: eric.garland@socwk.utah.edu.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Garland
authors.forename: Brett
authors.initials: B
authors.lastname: Froeliger
authors.forename: Fadel
authors.initials: F
authors.lastname: Zeidan
authors.forename: Kaitlyn
authors.initials: K
authors.lastname: Partin
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Howard
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy*; D003072:Cognition Disorders / Q000139:chemically induced*; D006801:Humans; D019964:Mood Disorders / Q000139:chemically induced*; D009293:Opioid-Related Disorders / Q000209:etiology*; D063487:Prescription Drug Misuse / Q000009:adverse effects*
chemical_list: D000701:Analgesics, Opioid
keywords: Addiction; Allostasis; Attentional bias; Chronic pain; Default mode; Mindfulness; Opioid misuse; Reward