WASHINGTON — When it comes to battling the opioid epidemic, psychological science offers useful insights on everything from the factors underlying addiction to treating chronic pain effectively without using medication, according to articles published in the American Psychological Association’s flagship journal.
This special issue of the journal American Psychologist®, entitled “Psychology’s Role in Addressing the Dual Crises of Chronic Pain and Opioid-Related Harms,” includes 10 studies focusing on patterns of opioid use, misuse and abuse and ways to treat those living with chronic pain and opioid abuse.
“The studies look at how pain and opioid abuse affect a number of demographics,” said Robert D. Kerns, PhD, a psychology professor at Yale University, who co-edited the issue with Tonya M. Palermo, PhD, a professor of anesthesiology and pain medicine from the University of Washington and Seattle Children’s Research Institute. “We know the risk factors can begin in adolescence and present unique concerns with treatment for older adults. We also know that this epidemic has disproportionately affected low-income communities and ethnic minorities.”
The editors of the issue said they hope the findings will encourage other researchers to conduct additional research that could help reduce opioid misuse, educate providers on best practices for prescribing pain medication and address co-occurring chronic pain and opioid use disorder in vulnerable populations.
“This research is an important step in expanding our understanding of the underlying issues at play with comorbid pain and substance abuse and how psychologists and other health care workers can continue to address these issues in an increasingly effective way,” said Palermo. “We look forward to seeing other researchers build on these findings and hope they will reach the professionals who are working with populations at risk.”
What started as a problem with doctors overprescribing medication to treat pain in the 1990s quickly morphed into a nationwide epidemic of opioid addiction that has ravaged communities and led to the deaths of 450,000 people between 1999 and 2018, according to the U.S. Centers for Disease Control and Preventionopens in new window (CDC). Health care professionals and other frontline workers have scrambled over the years to help the country cope with these issues.
Researchers inside and outside the federal government have worked to better understand the issues surrounding pain management and addiction issues. For example, the National Institutes of Health launched Helping to End Addiction Long-Termopens in new window to provide scientific solutions to the opioid crisis, and other agencies, such as the U.S. Department of Health and Human Services and CDC have dedicated significant resources to combating the problem.
Among the articles in the special issue:
- The Relative Contribution of Pain and Psychological Factors to Opioid Misuse: A 6-Month Observational Study by Marc O. Martel, PhD, McGill University; Robert R. Edwards, PhD, Harvard Medical School; and Robert N. Jamison, PhD, Brigham and Women’s Hospital.
Despite the potential benefits of opioid therapy, the use of opioids may lead to problems such as opioid misuse and addiction. One of the key findings of this six-month study of patients taking prescription opioids for chronic pain was that the association between pain intensity and opioid misuse was no longer significant when controlling either for negative affect or catastrophizing. This finding is important, according to the researchers, as it suggests that patients do not misuse opioids simply because they experience high levels of pain. Psychological interventions that help reduce catastrophizing and negative emotions, such as cognitive-behavioral therapy, may be effective in reducing opioid misuse. Findings also reveal that opioid misuse behaviors fluctuate over time, and that certain types of opioid misuse behaviors occur more frequently than others.
Contact: Marc O. Martel - Patient Race and Opioid Misuse History Influence Provider Risk Perceptions for Future Opioid-Related Problems (PDF, 253KB)opens in new window by Adam T. Hirsh, PhD, Tracy M. Anastas, PhD, and Megan M. Miller, PhD, Indiana University–Purdue University Indianapolis; Patrick D. Quinn, PhD, Indiana University, Bloomington; and Kurt Kroenke, PhD, Indiana University School of Medicine.
Guided by prior research and theory, this study examined how a patient’s race and history of opioid misuse influence provider risk assessments for future opioid-related problems in patients with chronic pain. The findings suggest that efforts to address the dual public health crises of chronic pain and opioid misuse may have unintended negative consequences for certain patient groups.
Contact: Adam T. Hirsh - Comorbid Chronic Pain and Opioid Misuse in Youth: Knowns, Unknowns, and Implications for Behavioral Treatment (PDF, 262KB)opens in new window by Melissa Pielech, PhD, and Sara J. Becker, PhD, Brown University School of Public Health; Claire E. Lunde, PhD, Boston Children’s Hospital and University of Oxford; and Kevin E. Vowles, PhD, Queen’s University Belfast, Christine B. Sieberg, PhD, clinical psychologist in the pain treatment service at Boston Children's Hospital and an assistant professor in psychiatry at Harvard Medical School.
Little is known about the optimal behavioral treatments for youth with comorbid chronic pain and opioid misuse, despite the high likelihood of short- and long-term adverse consequences associated with both conditions. To address this gap, this review article draws from the evidence base and best practices for the psychosocial treatment of pediatric pain, opioid misuse and adolescent substance use to propose a comprehensive agenda to prevent and treat chronic pain and opioid misuse in youth.
Contact: Melissa Pielech - Pain Rehabilitation’s Dual Power: Treatment for Chronic Pain and Prevention of Opioid-related Risks (PDF, 260KB)opens in new window by Taylor B. Crouch, PhD, Sharlene Wedin, PhD, Rebecca L. Kilpatrick, PhD, Lillian Christon, PhD, Wendy Balliet, PhD, Jeffrey Borckardt, PhD, and Kelly Barth, PhD, Medical University of South Carolina.
This study provides a data-driven exploration of interdisciplinary pain rehabilitation, including psychological, physical and behavioral interventions, to address chronic pain and related suffering while also reducing opioid use. The authors present multidimensional outcomes of an intensive pain rehabilitation program, including objective functional performance and opioid misuse risk and highlight the key role of health psychologists on pain rehabilitation teams.
Contact: Taylor B. Crouch
“As we work to eliminate COVID-19, it is important to remember that we have been battling another deadly health care issue for years,” said Palermo. “It is important that we continue to dedicate all necessary resources to better understanding the problems of chronic pain and addiction and how to mitigate them.”