Posttraumatic stress disorder and chronic pain are associated with opioid use disorder: Results from a 2012-2013 American nationally representative survey

Bilevicius, Elena; Sommer, Jordana L.; Asmundson, Gordon J.G.; El‐Gabalawy, Renée

doi:10.1016/j.drugalcdep.2018.04.005

Cited by 47 publications

(51 citation statements)

References 45 publications

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“…The majority of the studies recruited the samples from the veterans' health care system. The remaining studies recruited participants from other health care sources ( i.e ., primary care centres, pain management clinics, gynaecology clinics, trauma surgery inpatient services, emergency departments, urgent care centres)[36-38] and from the noninstitutionalized civilian population[40].…”

Section: Resultsmentioning

confidence: 99%

“…With regard to opioid intake, 7 studies defined opioid prescription as the outcome variable. Three of these studies[40,42,44] converted daily opioid dose into average daily morphine equivalents in milligrams (ME/d) and used established conversion factors to identify opioid overdose. One of these studies[40] assessed opioid abuse or dependence, which were defined according to the DSM-5 criteria for prescription opiate use disorder.…”

Section: Resultsmentioning

confidence: 99%

“…Three of these studies[40,42,44] converted daily opioid dose into average daily morphine equivalents in milligrams (ME/d) and used established conversion factors to identify opioid overdose. One of these studies[40] assessed opioid abuse or dependence, which were defined according to the DSM-5 criteria for prescription opiate use disorder. Liebschutz et al[37] used prescription drug use disorder (PDUD) as the criterion for abuse and also took into account the social, physical, or legal consequences of PDUD.…”

Section: Resultsmentioning

confidence: 99%

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Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review

López‐Martínez¹,

Reyes-Pérez²,

Serrano‐Ibáñez³

et al. 2019

WJCC

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BACKGROUNDThe literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder (PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder (OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.AIMTo perform a systematic review on the association between PTSD, chronic non-cancer pain (CNCP), and opioid intake (i.e., prescription, misuse, and abuse).METHODSWe conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention, Comparator, and Outcomes (PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases: PubMed, MEDLINE, PsycINFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling, confounding variables, and the statistical analysis.RESULTSA total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men (81.6%). The most common chronic pain condition was musculoskeletal pain: back pain (47.14% across studies; range: 16%-60.6%), arthritis and joint pain (31.1%; range: 18%-67.5%), and neck pain (28.7%; range: 3.6%-63%). In total, 42.4% of the participants across studies had a diagnosis of PTSD (range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.CONCLUSIONOpioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review

López‐Martínez¹,

Reyes-Pérez²,

Serrano‐Ibáñez³

et al. 2019

WJCC

View full text Add to dashboard Cite

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“…Problematic opioid use often accompanies other disease states, with mental health diagnoses being among the most prominent. Specifically, problematic use is often seen in conjunction with depressive, anxiety, posttraumatic stress, and panic disorders,6–11 which relationships between mental health and opioids are likely linked insofar that problematic opioid use is a patient’s form of self-medication management for underlying psychiatric care needs 6. In addition to mental health conditions, substance use behaviors also have been closely associated with problematic opioid use, which includes alcohol use disorders, cigarette smoking, other prescription drug misuse, and illicit substance use 7,8,12.…”

Section: Introductionmentioning

confidence: 99%

<p>Screening tools for detecting problematic opioid use and potential application to community pharmacy practice: a review</p>

Lindley¹,

Cox²,

Cochran³

2019

IPRP

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Problematic opioid use, constituted by a myriad of conditions ranging from misuse to use disorders, has continued to receive an increasing amount of attention in recent years resulting from the high use of opioids in the United States coinciding with morbidity and mortality. Deaths from drug overdoses increased by over 11% between 2014 and 2015, which supports the need for identification of problematic opioid use in additional health care settings. One of these settings is community pharmacy. The community pharmacy is a unique health service setting to identify and potentially intervene with patients at risk of or exhibit problematic opioid use. Problematic opioid use can be identified using one of the various screening tools in conjunction with evaluating prescription drug monitoring systems. A total of 12 tools were identified that could be employed in community pharmacy settings for identifying problematic opioid use. This review highlights these tools and strategies for use that can be utilized in the community pharmacy, which should be adapted to individual pharmacy settings and local needs. Future research should assess pharmacy personnel’s knowledge and perceptions of problematic opioid use and associated screening tools and interventions, which tools can be most effectively used in a community pharmacy, workflow needs to implement problematic opioid use screenings, and the impact of pharmacist engagement in problematic opioid use screening on patient clinical outcomes.

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“…Post-traumatic stress disorder (PTSD) is highly comorbid with substance use disorder (SUD), with nearly 40% of individuals with PTSD also having SUD [1][2][3][4][5][6]. Understanding this comorbidity could shed fundamental mechanistic light on disease origins.…”

Section: Introductionmentioning

confidence: 99%

Chronic opioid pretreatment potentiates the sensitization of fear learning by trauma

Pennington

Fanselow

Rajbhandari

et al. 2019

Neuropsychopharmacol.

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Despite the large comorbidity between PTSD and opioid use disorders, as well as the common treatment of physical injuries resulting from trauma with opioids, the ability of opioid treatments to subsequently modify PTSD-related behavior has not been well studied. Using the stress-enhanced fear learning (SEFL) model for PTSD, we characterized the impact of chronic opioid regimens on the sensitization of fear learning seen following traumatic stress in mice. We demonstrate for the first time that chronic opioid pretreatment is able to robustly augment associative fear learning. Highlighting aversive learning as the cognitive process mediating this behavioral outcome, these changes were observed after a considerable period of drug cessation, generalized to learning about multiple aversive stimuli, were not due to changes in stimulus sensitivity or basal anxiety, and correlated with a marker of synaptic plasticity within the basolateral amygdala. Additionally, these changes were not observed when opioids were given after the traumatic event. Moreover, we found that neither reducing the frequency of opioid administration nor bidirectional manipulation of acute withdrawal impacted the subsequent enhancement in fear learning seen. Given the fundamental role of associative fear learning in the generation and progression of PTSD, these findings are of direct translational relevance to the comorbidity between opioid dependence and PTSD, and they are also pertinent to the use of opioids for treating pain resulting from traumas involving physical injuries.

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Posttraumatic stress disorder and chronic pain are associated with opioid use disorder: Results from a 2012-2013 American nationally representative survey

Cited by 47 publications

References 45 publications

Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review

Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review

<p>Screening tools for detecting problematic opioid use and potential application to community pharmacy practice: a review</p>

Chronic opioid pretreatment potentiates the sensitization of fear learning by trauma

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