title: Dependency-like behaviors and pain coping styles in subjects with chronic migraine and medication overuse: results from a 1-year follow-up study.
abstract: BACKGROUND
  Even after successful detoxification, 20-40% of subjects presenting chronic migraine with symptomatic medication overuse (CMwMO) relapse into medication overuse within one year. In this restrospective analysis on subjects referred to our center for detoxification, we investigated whether personality traits, dependency-like behaviors and pain coping styles predicted those who relapsed into medication overuse within the 12 months following the detoxification and those who did not.
  
  
  METHODS
  63 patients with CMwMO were assessed for personality traits, mood and anxiety, pain coping styles and dependency-like behaviors prior-to and one year after a detoxification program.
  
  
  RESULTS
  Of the 42 subjects who attended 1-year follow-up interviews, 11 relapsed into medication overuse despite a temporary benefit from detoxification and did not show clinical or psychological improvement, instead reporting increased anxiety and unmodified perpetuation of severe dependency-like behaviors. In contrast, subjects who did not relapse into medication overuse had clinical improvements that generalized to untreated domains, including decreased depressive symptoms and dependency-like behaviors, although showing unmodified low internal control over pain.
  
  
  CONCLUSIONS
  Subjects who did not fall into medication overuse throughout the 12 months following the detoxification showed improved clinical, affective and dependence-related outcomes, but not pain coping strategies. Conversely, subjects who relapsed within one year into CMwMO continued to experience significant disability, pain intensity, and dependency-like behaviors. We believe that the persistence of maladaptive pain coping strategies and residual symptomatology increase the risk for recurrent relapses, against which pharmacological interventions are only partially effective. Further studies investigating predictors of relapse are needed to inform multi-disciplinary interventions for CMwMO.
authors.affiliation: San Francisco Department of Veterans Affairs Medical Center, Building 16, 4150 Clement Street, San Francisco 94121, CA, USA. bruno.biagianti@ucsf.edu.
authors.forename: Bruno
authors.initials: B
authors.lastname: Biagianti
authors.forename: Licia
authors.initials: L
authors.lastname: Grazzi
authors.forename: Susanna
authors.initials: S
authors.lastname: Usai
authors.forename: Orsola
authors.initials: O
authors.lastname: Gambini
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000523:psychology*; D012008:Recurrence; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000523:psychology*
chemical_list: D000700:Analgesics