The Mediating Role of Psychological Flexibility and Inflexibility Between Impulsivity and Opioid Misuse in People With Chronic Noncancer Pain

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-05-26 DOI:10.1002/ejp.70048

Victoria Barrado-Moreno, Rosa Esteve, Lance M. McCracken, Carmen Ramírez-Maestre

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Abstract

Background

The prescription of opioid medication is a frequent therapeutic approach in chronic noncancer pain, as is misuse of prescribed opioids. There is previous evidence for associations between personal variables such as impulsivity and opioid misuse. Psychological flexibility and inflexibility have also been associated with pain-related outcomes and opioid misuse. The aim of this cross-sectional study was to examine the combined role of a dispositional variable (impulsivity) along with psychological factors (Psychological Flexibility and Inflexibility) in pain outcomes and opioid misuse.

Methods

The sample comprised 155 people with chronic noncancer pain. A hypothetical model was tested using correlation and structural equation modelling analyses.

Results

The results show significant associations between impulsivity and Psychological Flexibility, Psychological Inflexibility and opioid misuse. Psychological Flexibility and Inflexibility were related to pain intensity, interference and opioid misuse. Structural equation modelling showed significant associations between impulsivity, Psychological Inflexibility and pain interference, and opioid misuse. Associations between Psychological Flexibility and pain interference and opioid misuse were nonsignificant. These results support the hypothesis that impulsivity and Psychological Inflexibility are factors that contribute to pain interference and opioid misuse, but do not support the hypothesis that Psychological Flexibility reduces opioid misuse.

Conclusions

It is recommended to assess these psychological aspects prior to the prescription of opioid medication, and, if necessary, offering Acceptance and Commitment and Mindfulness Based Therapies could be desirable.

Significance

The results of this study provide further evidence of the role of trait impulsivity as a transdiagnostic antecedent variable in opioid misuse, both by a direct association and through psychological inflexibility. It can be drawn from these results that psychological transdiagnostic variables, rather than pain outcomes alone, would be key factors influencing opioid misuse. These findings underscore the need for comprehensive psychological assessments prior to the prescription of opioids.

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查看原文本刊更多论文

慢性非癌性疼痛患者冲动性与阿片类药物滥用的中介作用：心理灵活性和非灵活性

阿片类药物处方是慢性非癌性疼痛的常用治疗方法，滥用处方阿片类药物也是如此。先前有证据表明，冲动和阿片类药物滥用等个人变量之间存在关联。心理灵活性和不灵活性也与疼痛相关的结果和阿片类药物滥用有关。本横断面研究的目的是检查性格变量（冲动性）和心理因素（心理灵活性和不灵活性）在疼痛结果和阿片类药物滥用中的综合作用。方法155例慢性非癌性疼痛患者。利用相关和结构方程模型分析对假设模型进行了检验。结果冲动性与心理灵活性、心理不灵活性和阿片类药物滥用之间存在显著相关性。心理灵活性和不灵活性与疼痛强度、干扰和阿片类药物滥用有关。结构方程模型显示冲动性、心理不灵活性和疼痛干扰与阿片类药物滥用之间存在显著关联。心理灵活性与疼痛干扰和阿片类药物滥用之间的关联不显著。这些结果支持冲动性和心理不灵活性是导致疼痛干扰和阿片类药物滥用的因素的假设，但不支持心理灵活性减少阿片类药物滥用的假设。结论建议在处方阿片类药物之前对这些心理方面进行评估，如有必要，提供接受、承诺和正念治疗是可取的。本研究的结果进一步证明了特质冲动性作为阿片类药物滥用的一个跨诊断前因变量的作用，无论是通过直接关联还是通过心理不灵活性。从这些结果可以得出，心理跨诊断变量，而不仅仅是疼痛结果，将是影响阿片类药物滥用的关键因素。这些发现强调了在处方阿片类药物之前进行全面心理评估的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.