title: Opioid attentional bias and cue-elicited craving predict future risk of prescription opioid misuse among chronic pain patients.
abstract: BACKGROUND
  Some chronic pain patients receiving long-term opioid analgesic pharmacotherapy are at risk for misusing opioids. Like other addictive behaviors, risk of opioid misuse may be signaled by an attentional bias (AB) towards drug-related cues. The purpose of this study was to examine opioid AB as a potential predictor of opioid misuse among chronic pain patients following behavioral treatment.
  
  
  METHODS
  Chronic pain patients taking long-term opioid analgesics (n=47) completed a dot probe task designed to assess opioid AB, as well as self-report measures of opioid misuse and pain severity, and then participated in behavioral treatment. Regression analyses examined opioid AB and cue-elicited craving as predictors of opioid misuse at 3-month posttreatment follow-up.
  
  
  RESULTS
  Patients who scored high on a measure of opioid misuse risk following treatment exhibited significantly greater opioid AB scores than patients at low risk for opioid misuse. Opioid AB for 200 ms cues and cue-elicited craving significantly predicted opioid misuse risk 20 weeks later, even after controlling for pre-treatment opioid dependence diagnosis, opioid misuse, and pain severity (Model R(2)=.50).
  
  
  CONCLUSIONS
  Biased initial attentional orienting to prescription opioid cues and cue-elicited craving may reliably signal future opioid misuse risk following treatment. These measures may therefore provide potential prognostic indicators of treatment outcome.
authors.affiliation: Integrative Medicine, Huntsman Cancer Institute, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States; College of Social Work & Huntsman Cancer Institute, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Garland
authors.affiliation: University of North Carolina, Chapel Hill, Tate Turner Kuralt Bldg. 325 Pittsboro St. no. 3550, Chapel Hill, NC 27599, United States.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Howard
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D001288:Attention; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D066249:Craving; D003463:Cues; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy; D011237:Predictive Value of Tests; D063487:Prescription Drug Misuse / Q000523:psychology*; D012307:Risk Factors; D057566:Self Report
chemical_list: D000701:Analgesics, Opioid
keywords: Attentional bias; Chronic pain; Cue-reactivity; Dot probe; Implicit cognition; Opioid misuse