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Randomized Controlled Trial
. 2014 Nov 1:144:283-7.
doi: 10.1016/j.drugalcdep.2014.09.014. Epub 2014 Oct 2.

Opioid attentional bias and cue-elicited craving predict future risk of prescription opioid misuse among chronic pain patients

Eric L Garland  1 , Matthew O Howard  2
Affiliations
Randomized Controlled Trial

Opioid attentional bias and cue-elicited craving predict future risk of prescription opioid misuse among chronic pain patients

Eric L Garland et al. Drug Alcohol Depend. .

Abstract

Background: Some chronic pain patients receiving long-term opioid analgesic pharmacotherapy are at risk for misusing opioids. Like other addictive behaviors, risk of opioid misuse may be signaled by an attentional bias (AB) towards drug-related cues. The purpose of this study was to examine opioid AB as a potential predictor of opioid misuse among chronic pain patients following behavioral treatment.

Methods: Chronic pain patients taking long-term opioid analgesics (n=47) completed a dot probe task designed to assess opioid AB, as well as self-report measures of opioid misuse and pain severity, and then participated in behavioral treatment. Regression analyses examined opioid AB and cue-elicited craving as predictors of opioid misuse at 3-month posttreatment follow-up.

Results: Patients who scored high on a measure of opioid misuse risk following treatment exhibited significantly greater opioid AB scores than patients at low risk for opioid misuse. Opioid AB for 200 ms cues and cue-elicited craving significantly predicted opioid misuse risk 20 weeks later, even after controlling for pre-treatment opioid dependence diagnosis, opioid misuse, and pain severity (Model R(2)=.50).

Conclusion: Biased initial attentional orienting to prescription opioid cues and cue-elicited craving may reliably signal future opioid misuse risk following treatment. These measures may therefore provide potential prognostic indicators of treatment outcome.

Keywords: Attentional bias; Chronic pain; Cue-reactivity; Dot probe; Implicit cognition; Opioid misuse.

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Conflict of interest statement

Conflict of Interest: Neither ELG nor MOH have any conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Between-groups differences in pre-treatment opioid attentional bias scores (higher number = greater AB) for patients with elevated opioid misuse risk (n = 28) and low risk for opioid misuse (n = 19) 3 months following completion of behavioral treatment for chronic pain and opioid misuse. Error bars indicate ±1 standard error of measurement.
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