‘Negative Emotions’ Linked to Higher Opioid Use Costs in Sickle Cell Disease

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In a small study that used data from the patient’s daily electronic diaries, Johns Hopkins researchers said they found an association between negative emotions, such as sadness and anxiety, and increased opioid use in people with sickle cell disease whose pain levels are self -reported to be relatively low

The researchers cautioned that their study was not prepared to show that bad feelings or thinking CAUSE people who take more opioid pills but only to see if there is a partner.

People with inherited disease lack red blood cells that clog blood vessels, causing chronic pain and periods of severe pain that often send patients to emergency rooms.

Their study, described online Sept. 21 at The Journal of Pain, increased efforts to better identify those at risk of opioid overuse, improve pain control and reduce dependence and side effects of long -term opioid use.

“We show that the way we think about pain is associated with opioid use even when our pain levels are short,” he said. Patrick Finan, Ph.D., assistant professor of psychiatry and ethical science at Johns Hopkins University School of Medicine. “These data argue that physicians need better communication with patients on how to take their medications on a daily basis to minimize changes in line with condition or thinking.”

Patients with sickle cell disease are usually prescribed a daily, long-term painkiller taken in regular doses, and a short painkiller that needs to be done for the more severe stages. pain. Medications that have long worked include morphine, oxycodone, methadone and a fentanyl patch, and painkillers to save include oxycodone, hydromorphone, meperidine, tramadol and hydrocodone.

To determine the factors that can put opioid overuse at risk, the researchers recruited 85 adults from Baltimore with sickle cell disease to fill out electronic diaries in a handhand personal computer every night for 90 days.

For their analysis, the researchers included only 45 participants, who filled the diary more than 25 percent of the time and took opioid pills at least once during the study. Participants had an average age of 37; 71 percent are women and 93 percent are African-American.

At the start of the study, participants reported on the dose and type of opioid pill prescribed for long-term daily and short-term activities. The daily diary collected data on the number of long-acting and short-acting opioid pills taken daily. Participants rated their daily pain level on a scale of zero to 10, with zero pain and 10 being the worst pain imaginable. Participants also individually rated positive emotions-including happy, calm and happy-and negative emotions-including loneliness, sadness, worry and fatigue-on a scale of zero to 10 none. zero emotion and 10 were the worst felt. Scores were adjusted from a zero to 100 scale for data analysis.

Separately, the researchers measured negative thinking (as opposed to negative emotions) by using a Pain Catastrophizing Scale to rate “anxiety,” or focus on pain, loss and size in a present. state of pain.

Among the 31 participants who took long-acting, daily opioids, negative emotions were associated with increased levels of use of opioid pills. Opioid dose increased to 3.4 milligram morphine equivalent standard is a standard resistance that compares doses between different opioids¾every 10-point increase in negative feelings. Daily levels of pain, positive emotions and negative thinking through disaster have become not affect the amount of long-acting, daily opioids taken.

“If a person is prescribed a daily, long-acting opioid, it usually should be in a set dose and the level of pain or emotion should not dictate whether they eat much of it. prescription or not, ”Finan said. “Even if we can’t prove medication misuse in our study, this data suggests that doctors and patients need to be clear about how patients are taking their daily, long-term. already working opioids to reduce potential misuse. “

Looking at the levels of short-acting opioids taken during hours of pain, the researchers found that the level of pain and negative thinking by risk was related to the level of short-acting opioid. For every 10-point increase in the risk scale, the amount of short-acting opioids was increased by 1.8 milligrams of morphine, and for every 10-point increase in the risk scale, the dose was pain medication added to 2.5 milligram morphine equivalent. Positive and negative emotion had no effect on the level of use of short -acting opioids.

“If pain is reported as low, sickle cell disease patients report higher opioid use when they are hurting, or focusing their attention on their pain, than when not,” Finan said.

“If the disease level is higher, negative thinking is less likely to influence opioid use,” he added.

Finan cautions that studies like his have some weaknesses, including the fact that self-reports are often uncertain, and the study only looks at one hourly point each day, though. if a person’s mood can change throughout the day based on life events and experience.

For future studies, Finan wants to use smartphone technology that can detect random feelings throughout the day.

“If there was a more intensive study to track mood variations throughout the day, we would know when it’s appropriate to send messages via text to intervene and affect patient behavior,” Finan said. .

About 100,000 Americans have sickle cell disease, or one in every 365 births of African-Americans, according to the Centers for Disease Control and Prevention.

Other authors of the study included C. Patrick Carroll, Gyasi Moscou-Jackson, Claudia Campbell, Alex Pressman, Jean-Michel Tremblay, Sophie Lanzkron and Jennifer Haythornthwaite of Johns Hopkins; Marc Martel of McGill University and Joshua Smyth of Pennsylvania State University.

Funding for this study was provided by grants from the National Heart, Lung, and Blood Institute (R01 HL098110), National Institute on Drug Abuse (K23 DA035915) and National Institute of Neurological Disorders and Stroke (K23 NS070933).

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