The study provides the first evidence of the Introduction:
Central sensitization ( CS) involves dysfunctional pain modulation of the central nervous system resulting in increased pain perception. Central sensitization is not commonly assessed among patients with opioid use disorder (OUD), although pain has been implicated in the development, maintenance, and relapse of OUD and chronic opioid use can produce opioid-induced hyperalgesia. . Central sensitization is a plausibly important mechanism underlying the complex relationship between OUD and chronic pain. However, this premise is largely untested.
Methods:
Participants with OUD (n = 141) were recruited from an academic addiction treatment center in Columbus, Ohio. An established surrogate measure of SC, the American College of Rheumatology 2011 Fibromyalgia Survey Criteria , was administered via an electronic survey. Participants also answered questions about pain interference (Brief Pain Inventory), quality of life (RAND-36), and items related to beliefs about pain and expectations of pain and addiction treatment. Descriptive analyses, Spearman’s rho correlations, and Mann-Whitney U tests were performed.
Results:
Hypothesized relationships between degree of CS, pain interference, and health-related quality of life were confirmed.
The degree of SC was also positively correlated with greater acceptance of pain as a reason for the initiation, maintenance, and increase of OUD; delay in treatment; and OUD relapse. Participants with American College of Rheumatology 2011 Fibromyalgia Survey Criteria ≥13 had significantly higher endorsement of pain as a reason to delay OUD treatment, continue and increase opioid use, and precipitate OUD relapse.
Frequency of self-reported pain by body region. Anatomical illustration of the ACR-FMS/Michigan body map.14 ACR-FMS, American College of Rheumatology 2011 Fibromyalgia Survey Criteria.
Conclusions: This study provides preliminary evidence that CS may underlie previously observed connections between clinically salient features of chronic pain and OUD, which could inform future mechanistic research and precision treatments. |
Comments
This first-of-its-kind study by researchers at The Ohio State University Wexner Medical Center and the University of Michigan Medical School and College of Medicine explored a potential mechanism, central sensitization , among people with use disorder. of opioids (OUD).
Scientists have long noted a connection between opioid use disorder (OUD) and chronic pain , however, the brain mechanisms linking OUD and chronic pain are poorly understood. This first-of-its-kind study explored a potential mechanism, central sensitization , among people with OUD.
Central sensitization refers to abnormal pain processing in the brain and spinal cord. People with central sensitization have spinal cords that are unusually good at sending pain signals to the brain that struggles to turn off those signals once they arrive. This means that people with greater central sensitization tend to experience more pain than others.
“Our study is the first to give patients with OUD a scale that measures central sensitization,” said Dr. O. Trent Hall, lead author of the study and an addictions physician in the Department of Psychiatry and Behavioral Health at Ohio State. "Our study provides the first evidence of central sensitization underlying the relationship between chronic pain and OUD and demonstrates a new tool to easily measure central sensitization among people with OUD."
The study findings are published in the journal PAIN Reports , an official publication of the International Association for the Study of Pain.
Researchers recruited 141 study participants from the Ohio State Wexner Medical Center addiction treatment center in Columbus, Ohio. As part of the study, researchers administered the American College of Rheumatology 2011 Fibromyalgia Survey Criteria via an electronic survey. Participants also answered questions about pain interference, quality of life, and items related to beliefs about pain and expectations of pain and addiction treatment.
Chronic pain can lead to OUD, and people with chronic pain and OUD have a harder time quitting opioids than people with OUD alone. Therefore, it is essential to find answers about how pain and OUD are connected in the brain. The researchers measured quality of life in eight life domains, including general health, physical functioning, mental health, social functioning, vitality, bodily pain, function limitations due to physical health, and function limitations. functions due to emotional problems. According to Hall, they found that greater central sensitization was associated with poorer quality of life among patients with OUD.
“In addition, patients with higher central sensitization were more likely to report pain as a major reason their opioid addiction began, as well as postpone addiction treatment, continue and increase their opioid use, and fear to the pain that causes an OUD relapse in the future,” said lead author Dr. Daniel J. Clauw, director of the Chronic Pain and Fatigue Research Center at the University of Michigan.
This study suggests that central sensitization may be an important underlying factor complicating the treatment of chronic pain and OUD. This provides an example for other clinicians and researchers to measure central sensitization in OUD, which could help them produce better treatments for people suffering from chronic pain and OUD.
As a physician with experience in both pain and addiction, Hall has seen many patients suffering deeply with both conditions and realizes that treatment options are limited.
“It’s important for me to look for new ways to help,” Hall said. “But we can’t create better treatments for chronic pain and OUD without first understanding how the two are related. “I did this study because I believed it could offer a new window into what happens in the brains of patients who need help with pain and addiction.”
Next, Hall plans to follow patients with central sensitization and OUD over time to find out if they respond differently to treatments or have different outcomes. She also plans to study whether existing treatments for central sensitization are beneficial for patients with chronic pain and OUD.
Other Ohio State Wexner Medical Center researchers who participated in this study include Dr. Julie Teater, Dr. Kara M. Rood, and Dr. K. Luan Phan.
Funding was provided by Care Innovation and Community Improvement Plan (CICIP), a program of the Ohio Department of Medicaid.
