Additional Material

Pre Test

Which of the follow is an independent risk factor for opioid use disorder (OUD)?

Incorrect
Incorrect
Incorrect
Correct

Important Definitions

  • Addiction - Per American Society of Addiction Medicine: “a primary, chronic disease of brain reward, motivation, memory, and related circuitry”
  • Opioid Use Disorder (OUD) - Per DSM-5: “disorder characterized by loss of control of opioid use, risky opioid use, impaired social functioning, tolerance, and withdrawal”
  • Recovery
    • Return to normal, healthy, productive lifestyle with abstinence as a hallmark feature
    • Use of agonist-based pharmacotherapy does not preclude recovery
  • Relapse - A return to routine or multiple episodes of use following remission
  • Remission - A disappearance of signs and symptoms of OUD in those previously meeting DSM-5 criteria
  • Return to Opioid Use - One or more instances of opioid use without signs or symptoms of OUD
  • Hyperalgesia – An abnormally intense response to a normally noxious stimulus
  • Allodynia – An abnormally intense response to a normally non-noxious stimulus (i.e. light touch causing pain)
  • Opioid induced hyperalgesia – Hyperalgesia that results from the effects of opioids on the central nervous system

Reference

US Department of Health and Human Services (HHS), Office of the Surgeon General. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016. addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf; Substance Abuse and Mental Health Services Administration (SAMHSA). Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63, Full Document. HHS Publication No. (SMA) 19- 5063FULLDOC. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018. store.samhsa.gov/system/files/sma18-5063fulldoc.pdf.

Risk Factors for Opioid Use Disorder (OUD)

  • Substance use disorder (SUD) (personal or family history)
  • Current mental health disorder
  • Age ≤45 years
  • Caucasian
  • Significant history of legal problems or incarceration
  • Recent release from incarceration
  • Recent completion of inpatient treatment

Reference

Edlund MJ, et al. Pain. 2007;129(3):355-362; Liebschutz JM, et al. J Pain. 2010;11(11):1047-1055; Webster LR. Anesth Analg. 2017;125(5):1741-1748.

Diagnostic Criteria for Opioid Use Disorder (OUD)

  • Using in larger amounts or for longer than intended.
  • Wanting to cut down or stop using, but not managing to.
  • Spending a lot of time to get, use, or recover from use.
  • Craving.
  • Inability to manage commitments due to use.
  • Continuing to use, even when it causes problems in relationships.
  • Giving up important activities because of use.
  • Continuing to use, even when it puts you in danger.
  • Continuing to use, even when physical or psychological problems may be made worse by use.
  • Increasing tolerance.
  • Withdrawal symptoms.

Note: Fewer than 2 symptoms = no disorder; 2-3 = mild disorder; 4-5 = moderate disorder; 6 or more = severe disorder

Reference

US Department of Health and Human Services, Office of the Surgeon General. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016. addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf.

Pain in Those with Opioid Use Disorder

  • Prevalence of 29–60%
  • Evidence of hyperalgesia

References

  • Peles E, et al. Significantly higher methadone dose for methadone maintenance treatment (MMT) patients with chronic pain. Pain 2005;113:340–346. Drug Alcohol Depend 2004;76(2):213–215.
  • Rosenblum A, et al. Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. J Am Med Assoc 2003;289(18):2370–2378.
  • Sheu R, et al. Prevalence and characteristics of chronic pain in patients admitted to an outpatient drug and alcohol treatment program. Pain Med 2008;9(7):911–917.

Cycle of Pain and Addiction

  • Positive reinforcement
  • Negative reinforcement

Pain Treatment Considerations in OUD

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