Psychosocial, Functional, and Emotional Correlates of Long-Term Opioid Use in Patients with Chronic Back Pain: A Cross-Sectional Case–Control Study

Kenta Wakaizumi; Andrew D. Vigotsky; Rami Jabakhanji; Maryam Abdallah; Joana Barroso; Thomas J. Schnitzer; Apkar Vania Apkarian; Marwan N. Baliki

doi:10.1007/s40122-021-00257-w

Psychosocial, Functional, and Emotional Correlates of Long-Term Opioid Use in Patients with Chronic Back Pain: A Cross-Sectional Case–Control Study

Kenta Wakaizumi, Andrew D. Vigotsky, Rami Jabakhanji, Maryam Abdallah, Joana Barroso, Thomas J. Schnitzer, Apkar Vania Apkarian^*, Marwan N. Baliki^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Introduction: The opiate epidemic has severe medical and social consequences. Opioids are commonly prescribed in patients with chronic pain, and are a main contributor to the opiate epidemic. The adverse effects of long-term opioid usage have been studied primarily in dependence/addiction disorders, but not in chronic pain. Here, we examine the added iatrogenic effects, psychology, and brain morphology of long-term opioid use in matched patients with chronic pain with and without opioid use (case–controlled design). Methods: We compared psychosocial, functional, and psychological measures between patients with chronic back pain (CBP) who were managing their pain with or without opioids, thereby controlling for the effect of pain on these outcomes. In addition, we investigated brain morphological differences associated with long-term opioid usage. We recruited 58 patients with CBP, 29 of them on long-term opioids and 29 who did not use opioids, and who were matched in terms of age, sex, pain intensity, and pain duration. Questionnaires were used to assess pain quality, pain psychology, negative and positive emotions, physical, cognitive, sensory, and motor functions, quality of life, and personality traits. Results: Patients with CBP on opioids displayed more negative emotion, poorer physical function, and more pain interference (p < 0.001), whereas there were no statistical differences in cognitive and motor functions and personality traits. Voxel-based morphometry using structural brain imaging data identified decreased gray matter density of the dorsal paracingulate cortex (family-wise error-corrected p < 0.05) in patients with opioids, which was associated with negative emotion (p = 0.03). Finally, a volumetric analysis of hippocampal subfields identified lower volume of the left presubiculum in patients on opioids (p < 0.001). Conclusion: Long-term opioid use in chronic pain is associated with adverse negative emotion and disabilities, as well as decreased gray matter volumes of specific brain regions.

Original language	English (US)
Pages (from-to)	691-709
Number of pages	19
Journal	Pain and Therapy
Volume	10
Issue number	1
DOIs	https://doi.org/10.1007/s40122-021-00257-w
State	Published - Jun 2021

Funding

We are grateful to all the participants in this study. This study was supported by the NIH Grant (1P50DA044121-01A1). This material is based upon work supported by the National Science Foundation Graduate Research Fellowship under Grant no. DGE-1324585. The journal?s Rapid Service was funded by NIH NIDA P50 DA044121. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. KW analyzed the data, and wrote a first draft of the manuscript. ADV, RJ supported the data analyses. MA, JB, TJS participated in the data collection. AVA, MNB designed and conducted the study and supervised the data analysis. All authors revised the first draft for important intellectual content and contributed to the final manuscript. Kenta Wakaizumi, Andrew D Vigotsky, Rami Jabakhanji, Maryam Abdallah, Joana Barroso, Thomas J Schnitzer, Apkar Vania Apkarian and Marwan N Baliki have nothing to disclose. This study was performed in accordance with the Helsinki Declaration of 1964 and its later amendments. All participants understood the purpose of the study, procedures to be completed, possible benefits and potential risks, and signed a consent form prior to any study-related activities. The protocols were approved by Northwestern University IRB (STU00207384, STU00205398). The data will be made available on OpenPain (www.openpain.org) once the full study and analysis are completed. Until then, data are available upon reasonable request. This study was supported by the NIH Grant (1P50DA044121-01A1). This material is based upon work supported by the National Science Foundation Graduate Research Fellowship under Grant no. DGE-1324585. The journal\u2019s Rapid Service was funded by NIH NIDA P50 DA044121.

Keywords

Back pain
Morphometry
NIH Toolbox
Neuroimaging
Opioids
Psychology

ASJC Scopus subject areas

Clinical Neurology
Anesthesiology and Pain Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s40122-021-00257-w

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title = "Psychosocial, Functional, and Emotional Correlates of Long-Term Opioid Use in Patients with Chronic Back Pain: A Cross-Sectional Case–Control Study",

abstract = "Introduction: The opiate epidemic has severe medical and social consequences. Opioids are commonly prescribed in patients with chronic pain, and are a main contributor to the opiate epidemic. The adverse effects of long-term opioid usage have been studied primarily in dependence/addiction disorders, but not in chronic pain. Here, we examine the added iatrogenic effects, psychology, and brain morphology of long-term opioid use in matched patients with chronic pain with and without opioid use (case–controlled design). Methods: We compared psychosocial, functional, and psychological measures between patients with chronic back pain (CBP) who were managing their pain with or without opioids, thereby controlling for the effect of pain on these outcomes. In addition, we investigated brain morphological differences associated with long-term opioid usage. We recruited 58 patients with CBP, 29 of them on long-term opioids and 29 who did not use opioids, and who were matched in terms of age, sex, pain intensity, and pain duration. Questionnaires were used to assess pain quality, pain psychology, negative and positive emotions, physical, cognitive, sensory, and motor functions, quality of life, and personality traits. Results: Patients with CBP on opioids displayed more negative emotion, poorer physical function, and more pain interference (p < 0.001), whereas there were no statistical differences in cognitive and motor functions and personality traits. Voxel-based morphometry using structural brain imaging data identified decreased gray matter density of the dorsal paracingulate cortex (family-wise error-corrected p < 0.05) in patients with opioids, which was associated with negative emotion (p = 0.03). Finally, a volumetric analysis of hippocampal subfields identified lower volume of the left presubiculum in patients on opioids (p < 0.001). Conclusion: Long-term opioid use in chronic pain is associated with adverse negative emotion and disabilities, as well as decreased gray matter volumes of specific brain regions.",

keywords = "Back pain, Morphometry, NIH Toolbox, Neuroimaging, Opioids, Psychology",

author = "Kenta Wakaizumi and Vigotsky, {Andrew D.} and Rami Jabakhanji and Maryam Abdallah and Joana Barroso and Schnitzer, {Thomas J.} and Apkarian, {Apkar Vania} and Baliki, {Marwan N.}",

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year = "2021",

month = jun,

doi = "10.1007/s40122-021-00257-w",

language = "English (US)",

volume = "10",

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T1 - Psychosocial, Functional, and Emotional Correlates of Long-Term Opioid Use in Patients with Chronic Back Pain

T2 - A Cross-Sectional Case–Control Study

AU - Wakaizumi, Kenta

AU - Vigotsky, Andrew D.

AU - Jabakhanji, Rami

AU - Abdallah, Maryam

AU - Barroso, Joana

AU - Schnitzer, Thomas J.

AU - Apkarian, Apkar Vania

AU - Baliki, Marwan N.

PY - 2021/6

Y1 - 2021/6

N2 - Introduction: The opiate epidemic has severe medical and social consequences. Opioids are commonly prescribed in patients with chronic pain, and are a main contributor to the opiate epidemic. The adverse effects of long-term opioid usage have been studied primarily in dependence/addiction disorders, but not in chronic pain. Here, we examine the added iatrogenic effects, psychology, and brain morphology of long-term opioid use in matched patients with chronic pain with and without opioid use (case–controlled design). Methods: We compared psychosocial, functional, and psychological measures between patients with chronic back pain (CBP) who were managing their pain with or without opioids, thereby controlling for the effect of pain on these outcomes. In addition, we investigated brain morphological differences associated with long-term opioid usage. We recruited 58 patients with CBP, 29 of them on long-term opioids and 29 who did not use opioids, and who were matched in terms of age, sex, pain intensity, and pain duration. Questionnaires were used to assess pain quality, pain psychology, negative and positive emotions, physical, cognitive, sensory, and motor functions, quality of life, and personality traits. Results: Patients with CBP on opioids displayed more negative emotion, poorer physical function, and more pain interference (p < 0.001), whereas there were no statistical differences in cognitive and motor functions and personality traits. Voxel-based morphometry using structural brain imaging data identified decreased gray matter density of the dorsal paracingulate cortex (family-wise error-corrected p < 0.05) in patients with opioids, which was associated with negative emotion (p = 0.03). Finally, a volumetric analysis of hippocampal subfields identified lower volume of the left presubiculum in patients on opioids (p < 0.001). Conclusion: Long-term opioid use in chronic pain is associated with adverse negative emotion and disabilities, as well as decreased gray matter volumes of specific brain regions.

AB - Introduction: The opiate epidemic has severe medical and social consequences. Opioids are commonly prescribed in patients with chronic pain, and are a main contributor to the opiate epidemic. The adverse effects of long-term opioid usage have been studied primarily in dependence/addiction disorders, but not in chronic pain. Here, we examine the added iatrogenic effects, psychology, and brain morphology of long-term opioid use in matched patients with chronic pain with and without opioid use (case–controlled design). Methods: We compared psychosocial, functional, and psychological measures between patients with chronic back pain (CBP) who were managing their pain with or without opioids, thereby controlling for the effect of pain on these outcomes. In addition, we investigated brain morphological differences associated with long-term opioid usage. We recruited 58 patients with CBP, 29 of them on long-term opioids and 29 who did not use opioids, and who were matched in terms of age, sex, pain intensity, and pain duration. Questionnaires were used to assess pain quality, pain psychology, negative and positive emotions, physical, cognitive, sensory, and motor functions, quality of life, and personality traits. Results: Patients with CBP on opioids displayed more negative emotion, poorer physical function, and more pain interference (p < 0.001), whereas there were no statistical differences in cognitive and motor functions and personality traits. Voxel-based morphometry using structural brain imaging data identified decreased gray matter density of the dorsal paracingulate cortex (family-wise error-corrected p < 0.05) in patients with opioids, which was associated with negative emotion (p = 0.03). Finally, a volumetric analysis of hippocampal subfields identified lower volume of the left presubiculum in patients on opioids (p < 0.001). Conclusion: Long-term opioid use in chronic pain is associated with adverse negative emotion and disabilities, as well as decreased gray matter volumes of specific brain regions.

KW - Back pain

KW - Morphometry

KW - NIH Toolbox

KW - Neuroimaging

KW - Opioids

KW - Psychology

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Psychosocial, Functional, and Emotional Correlates of Long-Term Opioid Use in Patients with Chronic Back Pain: A Cross-Sectional Case–Control Study

Abstract

Funding

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ASJC Scopus subject areas

UN SDGs

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