Psychological Factors

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Evidence suggests that opioid craving is heightened among patients with SUD and high levels of negative affect. Some studies have shown that high vs low levels of negative affect double and triple the likelihood of prescription opioid misuse.11,13,14

Other factors may include low coping skills and self-efficacy beliefs, depression, anxiety, and chronic stress, as well as pre-existing personality traits such as impulsivity and catastrophizing.12, 20-22

Pathophysiologic mechanisms postulated to affect craving include increased noradrenergic and dopaminergic activity in cortical and subcortical mesolimbic areas associated with regulation of negative affect.23-26 Negative affect has also been linked to decreased levels of serotonin, a neurotransmitter central to the regulation of craving and drug use.27-29

Routine Assessments Needed

From a pain management standpoint, the clinical implications of the current body of knowledge suggest that opioid craving should be routinely assessed and monitored over the course of opioid therapy, particularly among patients with high levels of negative affect.

Pharmacologic and behavioral interventions that aim to alter the association between craving and opioid use represent a promising approach to reducing prescription opioid misuse.14

Robust longitudinal treatment studies will be needed to determine the most efficient ways to reduce craving in patients requiring long-term opioid therapy, and to further explore the psychological and neurobiological factors that may contribute to opioid craving in patients with pain.


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