Abstract
Opioid-related deaths in the United States have become a public health problem, with accidental and unintended overdoses being especially troubling. Screening for psychological risk factors is an important first step in safeguarding against nonadherence practices and identifying patients who may be vulnerable to the risks associated with opioid therapy. Validated screening instruments can aid in this attempt as a complementary tool to clinicians' assessments. A structured screening is imperative as part of an assessment, as clinician judgment is not the most reliable method of identifying nonadherence. As a complement to formal screening, we present for discussion and possible future study certain psychological variables observed during years of clinical practice that may be linked to medication nonadherence and accidental overdose. These variables include catastrophizing, fear, impulsivity, attention deficit disorders, existential distress, and certain personality disorders. In our experience, chronic pain patients with dual diagnoses may become "chemical copers" as a way of coping with their negative emotion. For these patients, times of stress could lead to accidental overdose. Behavioral, cognitive-behavioral (acceptance and commitment, dialectical behavior), existential (meaning-centered, dignity), and psychotropic therapies have been effective in treating these high-risk comorbidities, while managing expectations of pain relief appears key to preventing accidental overdose. Wiley Periodicals, Inc.
| Original language | English (US) |
|---|---|
| Journal | Pain Medicine |
| Volume | 12 |
| Issue number | SUPPL. 2 |
| DOIs | |
| State | Published - Jan 1 2011 |
| Externally published | Yes |
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Keywords
- Aberrant drug-related behavior
- Accidental overdose
- Chronic pain
- Opioids
- Pain management
- Risk assessment
ASJC Scopus subject areas
- Clinical Neurology
- Anesthesiology and Pain Medicine
Cite this
Psychological variables potentially implicated in opioid-related mortality as observed in clinical practice. / Passik, Steven D.; Allison, Amy Elizabeth.
In: Pain Medicine, Vol. 12, No. SUPPL. 2, 01.01.2011.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Psychological variables potentially implicated in opioid-related mortality as observed in clinical practice
AU - Passik, Steven D.
AU - Allison, Amy Elizabeth
PY - 2011/1/1
Y1 - 2011/1/1
N2 - Opioid-related deaths in the United States have become a public health problem, with accidental and unintended overdoses being especially troubling. Screening for psychological risk factors is an important first step in safeguarding against nonadherence practices and identifying patients who may be vulnerable to the risks associated with opioid therapy. Validated screening instruments can aid in this attempt as a complementary tool to clinicians' assessments. A structured screening is imperative as part of an assessment, as clinician judgment is not the most reliable method of identifying nonadherence. As a complement to formal screening, we present for discussion and possible future study certain psychological variables observed during years of clinical practice that may be linked to medication nonadherence and accidental overdose. These variables include catastrophizing, fear, impulsivity, attention deficit disorders, existential distress, and certain personality disorders. In our experience, chronic pain patients with dual diagnoses may become "chemical copers" as a way of coping with their negative emotion. For these patients, times of stress could lead to accidental overdose. Behavioral, cognitive-behavioral (acceptance and commitment, dialectical behavior), existential (meaning-centered, dignity), and psychotropic therapies have been effective in treating these high-risk comorbidities, while managing expectations of pain relief appears key to preventing accidental overdose. Wiley Periodicals, Inc.
AB - Opioid-related deaths in the United States have become a public health problem, with accidental and unintended overdoses being especially troubling. Screening for psychological risk factors is an important first step in safeguarding against nonadherence practices and identifying patients who may be vulnerable to the risks associated with opioid therapy. Validated screening instruments can aid in this attempt as a complementary tool to clinicians' assessments. A structured screening is imperative as part of an assessment, as clinician judgment is not the most reliable method of identifying nonadherence. As a complement to formal screening, we present for discussion and possible future study certain psychological variables observed during years of clinical practice that may be linked to medication nonadherence and accidental overdose. These variables include catastrophizing, fear, impulsivity, attention deficit disorders, existential distress, and certain personality disorders. In our experience, chronic pain patients with dual diagnoses may become "chemical copers" as a way of coping with their negative emotion. For these patients, times of stress could lead to accidental overdose. Behavioral, cognitive-behavioral (acceptance and commitment, dialectical behavior), existential (meaning-centered, dignity), and psychotropic therapies have been effective in treating these high-risk comorbidities, while managing expectations of pain relief appears key to preventing accidental overdose. Wiley Periodicals, Inc.
KW - Aberrant drug-related behavior
KW - Accidental overdose
KW - Chronic pain
KW - Opioids
KW - Pain management
KW - Risk assessment
UR - http://www.scopus.com/inward/record.url?scp=79958776837&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79958776837&partnerID=8YFLogxK
U2 - 10.1111/j.1526-4637.2011.01130.x
DO - 10.1111/j.1526-4637.2011.01130.x
M3 - Article
C2 - 21668755
AN - SCOPUS:79958776837
VL - 12
JO - Pain Medicine
JF - Pain Medicine
SN - 1526-2375
IS - SUPPL. 2
ER -