title: Psychosocial factors predict opioid analgesia through endogenous opioid function.
abstract: Use of opioid analgesics for management of chronic nonmalignant pain has become common, yet there are presently no well-validated predictors of optimal opioid analgesic efficacy. We examined whether psychosocial factors (eg, depressive symptoms) predicted changes in spontaneous low back pain after administration of opioid analgesics, and whether endogenous opioid (EO) function mediated these relationships. Participants with chronic low back pain but who were not chronic opioid users (N = 89) underwent assessment of low back pain intensity pre- and post-drug in 3 (counterbalanced) conditions: (1) placebo, (2) intravenous naloxone, and (3) intravenous morphine. Comparison of placebo condition changes in back pain intensity to those under naloxone and morphine provided indexes of EO function and opioid analgesic responses, respectively. Results showed that (1) most psychosocial variables were related significantly and positively to morphine analgesic responses for low back pain, (2) depressive symptoms, trait anxiety, pain catastrophizing, and pain disability were related negatively to EO function, and (3) EO function was related negatively to morphine analgesic responses for low back pain. Bootstrapped mediation analyses showed that links between morphine analgesic responses and depressive symptoms, trait anxiety, pain catastrophizing, and perceived disability were partially mediated by EO function. Results suggest that psychosocial factors predict elevated analgesic responses to opioid-based medications, and may serve as markers to identify individuals who benefit most from opioid therapy. Results also suggest that people with greater depressive symptoms, trait anxiety, pain catastrophizing, and perceived disability may have deficits in EO function, which may predict enhanced response to opioid analgesics.
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Burns
authors.affiliation: Department of Anesthesiology, Vanderbilt University School of Medicine, Vanderbilt, TN, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bruehl
authors.affiliation: Department of Psychology, Ohio University, Athens, OH, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: France
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Schuster
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL USA.
authors.forename: Daria
authors.initials: D
authors.lastname: Orlowska
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL USA.
authors.forename: Asokumar
authors.initials: A
authors.lastname: Buvanendran
authors.affiliation: Department of Anesthesiology, Vanderbilt University School of Medicine, Vanderbilt, TN, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Chont
authors.affiliation: Department of Anesthesiology, Vanderbilt University School of Medicine, Vanderbilt, TN, USA.
authors.forename: Rajnish K
authors.initials: RK
authors.lastname: Gupta
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D058443:Catastrophization / Q000139:chemically induced* / Q000523:psychology; D059350:Chronic Pain / Q000188:drug therapy / Q000523:psychology; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000139:chemically induced*; D009020:Morphine / Q000008:administration & dosage*; D009270:Naloxone / Q000008:administration & dosage; D009292:Narcotic Antagonists / Q000008:administration & dosage; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects / Q000502:physiology; D011569:Psychiatric Status Rating Scales; D057566:Self Report
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D009020:Morphine