title: Day-to-day pain symptoms are only weakly associated with opioid craving among patients with chronic pain prescribed opioid therapy.
abstract: BACKGROUND
  Over the past decade, there has been a substantial rise in the use of opioids for the treatment of chronic noncancer pain. Despite the potential benefits of opioid therapy, the rise in the use of opioids has been accompanied by escalating rates of prescription opioid misuse and addiction. There is now a growing body of evidence indicating that opioid craving (i.e., the subjective desire to consume opioids) is one of the strongest determinants of opioid misuse among patients with chronic pain prescribed opioids. Although research has elucidated some of the factors associated with opioid craving, the contribution of patients' levels of pain to opioid craving remains unclear.
  
  
  OBJECTIVE
  The main objective of this study was to examine the day-to-day association between pain and opioid craving.
  
  
  METHODS
  In this longitudinal cohort study, patients with chronic pain prescribed opioid therapy completed baseline measures and were then asked to provide daily reports of pain intensity and opioid craving for a period of 14 days.
  
  
  RESULTS
  Multilevel analyses indicated that day-to-day elevations in patients' levels of pain were associated with heightened opioid craving. That is, on more painful days, patients reported higher levels of craving. Within-person changes in pain intensity, however, explained less than 5% of the variance in patients' reports of craving.
  
  
  CONCLUSIONS
  Findings from this study suggest that patients with chronic pain do not crave their opioid medications simply because they experience high levels of pain. The theoretical and clinical implications of our findings are discussed.
authors.affiliation: Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA. Electronic address: momartel.bwh.harvard@outlook.com.
authors.forename: Marc O
authors.initials: MO
authors.lastname: Martel
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Finan
authors.affiliation: Division of Alcohol and Drug Abuse, Harvard Medical School, McLean Hospital, Belmont, MA, USA.
authors.forename: R Kathryn
authors.initials: RK
authors.lastname: McHugh
authors.affiliation: Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Issa
authors.affiliation: Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Edwards
authors.affiliation: Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Jamison
authors.affiliation: Departments of Anesthesiology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Ajay D
authors.initials: AD
authors.lastname: Wasan
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D066249:Craving; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000150:complications / Q000523:psychology*; D010147:Pain Measurement
chemical_list: D000701:Analgesics, Opioid
keywords: Chronic pain; Opioid craving; Opioid therapy