Journal
CLINICAL JOURNAL OF PAIN
Volume 38, Issue 10, Pages 595-600Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/AJP.0000000000001063
Keywords
chronic pain; low back pain; opioid use; depression; quantitative sensory testing
Categories
Funding
- Patient-Centered Outcomes Research Institute (PCORI) Award [OPD-1601-33860]
- University of Wisconsin-Madison School of Medicine and Public Health
- Department of Family Medicine and Community Health
- Brigham and Women's Hospital, Harvard Medical School
- University of Utah College of Social Work
- Pennsylvania State University Department of Family and Community Medicine
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This study aimed to explore the associations between endogenous pain modulation, chronic pain, and negative affective factors. The findings suggest that reduced pain-inhibitory capacity is associated with elevated self-reported pain intensity in adults with opioid-treated chronic low back pain, particularly among those with higher severity of depression symptoms.
Introduction: Endogenous pain modulatory processes appear to play an important role in shaping pain-related outcomes, but we know relatively little about the influence of psychosocial factors on those pain modulatory processes. The primary objective of this study was to explore associations between endogenous pain modulation (ie, conditioned pain modulation, CPM; temporal summation, TS), chronic pain, and negative affective factors (ie, depression, anxiety symptoms) in a sample of participants with chronic low back pain (CLBP) treated with long-term daily opioids. Methods: Adults with opioid-treated CLBP (N=107) completed questionnaires assessing pain, pain symptoms, and psychological measures. CPM and TS were evaluated as predictors of pain intensity ratings (Brief Pain Inventory), with depression scores (Hospital Anxiety and Depression Scale, depression subscale) examined as potential moderators of those associations. Results: Moderation analyses demonstrated associations between CPM and back pain intensity ratings, moderated by depression symptom scores (B=-0.002, SE=0.0008, P<0.01) when controlling for daily opioid dose, with participants with higher depression scores showing a relatively stronger link between lower CPM and increased pain intensity ratings. Significant associations were observed between depression, pain intensity, and CPM-derived outcomes. Conclusion: Our findings suggest that reduced pain-inhibitory capacity is associated with elevated self-reported pain intensity in adults with opioid-treated CLBP, particularly among those with higher severity of depression symptoms.
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