Breaking News
January 19, 2019 - FDA Approves Ontruzant (trastuzumab-dttb), a Biosimilar to Herceptin
January 19, 2019 - Tobacco use linked with higher use of opioids and sedatives
January 19, 2019 - Study delves deeper into developmental dyslexia
January 19, 2019 - Anti-vaccination movement one of the top health threats in 2019 says WHO
January 19, 2019 - Newly developed risk score more effective at identifying type 1 diabetes
January 19, 2019 - Highly effective protocol to prepare cannabis samples for THC/CBD analysis
January 19, 2019 - Prinston Pharmaceutical Inc. Issues Voluntary Nationwide Recall of Irbesartan and Irbesartan HCTZ Tablets Due to Detection of a Trace Amount of Unexpected Impurity, N-Nitrosodiethylamine (NDEA) in the Products
January 19, 2019 - How does solid stress from brain tumors cause neuronal loss, neurologic dysfunction?
January 19, 2019 - $14.7 million partnership to supercharge vaccine development
January 19, 2019 - Ian Fotheringham receives Charles Tennant Memorial Lecture award
January 19, 2019 - Brain vital signs detect neurophysiological impairments in players with concussions
January 19, 2019 - Lack of job and poor housing conditions increased likelihood of people attending A&E
January 19, 2019 - Novel targeted drug delivery system improves conventional cancer treatments
January 19, 2019 - Rutgers study finds gene responsible for spread of prostate cancer
January 19, 2019 - Complications Higher Than Expected for Invasive Lung Tests
January 19, 2019 - 3-D printed implant promotes nerve cell growth to treat spinal cord injury
January 19, 2019 - Automated texts lead to improved outcomes after total knee or hip replacement surgery
January 19, 2019 - Poor cardiorespiratory fitness could increase risk of future heart attack, finds new study
January 19, 2019 - Drinking soft drinks while exercising in hot weather may increase risk of kidney disease
January 19, 2019 - Formlabs 3D prints anatomical models
January 19, 2019 - Heart-Healthy Living Also Wards Off Type 2 Diabetes
January 19, 2019 - Teaching Kids to Be Smart About Social Media (for Parents)
January 19, 2019 - Metabolite produced by gut microbiota from pomegranates reduces inflammatory bowel disease
January 19, 2019 - Researchers examine how spray from showers and toilets expose us to disease causing bacteria
January 19, 2019 - Behavioral experiments confirm that additional neurons improve brain function
January 19, 2019 - New study compares performance of real-time infectious disease forecasting models
January 19, 2019 - Obesity can be risk factor for developing renal cell carcinoma, confirms study
January 19, 2019 - New regulation designs on cigarette packs direct smokers’ attention to health warnings
January 19, 2019 - QIAGEN receives first companion diagnostic approval in Japan
January 19, 2019 - Study explores role of Dunning-Kruger effect in anti-vaccine attitudes
January 19, 2019 - Newly identified subset of immune cells may be key to fighting chronic inflammation
January 19, 2019 - New immune response regulators discovered
January 18, 2019 - Poor blood oxygenation during sleep predicts chance of heart-related death
January 18, 2019 - First international consensus on the diagnosis and management of fibromuscular dysplasia
January 18, 2019 - Rapid resistance gene sequencing technology can hasten identification of antibiotic-resistant bacteria
January 18, 2019 - Researchers develop artificial enzymatic pathway for synthesizing isoprenoids in E. coli
January 18, 2019 - Scientists advise caution in immunotherapy research
January 18, 2019 - How children across the world develop language
January 18, 2019 - Columbia Medical Student Receives McDonogh Scholarship
January 18, 2019 - Secretive ‘Rebate Trap’ Keeps Generic Drugs For Diabetes And Other Ills Out Of Reach
January 18, 2019 - Plant based diet could be the best option for the planet says commission
January 18, 2019 - New conservation practice could reduce nitrogen from agricultural drainage, study shows
January 18, 2019 - UIC researchers receive $1.7 million NCI grant to study Southeast Asian fruit
January 18, 2019 - New study determines the fate of DNA derived from genetically modified food
January 18, 2019 - Scientists develop new gene therapy that prevents axon destruction in mice
January 18, 2019 - Study finds critically low HPV vaccination rates among younger adolescents in the U.S.
January 18, 2019 - Brain cells involved in memory play key role in reducing future eating behavior
January 18, 2019 - Risk for Conversion of MS Varies With Different Therapies
January 18, 2019 - Investigational cream may help patients with inflammatory skin disease
January 18, 2019 - Medical school news office receives six writing awards | News Center
January 18, 2019 - County By County, Researchers Link Opioid Deaths To Drugmakers’ Marketing
January 18, 2019 - Research reveals risk for developing more than one mental health disorder
January 18, 2019 - Scientists discover a dramatic pattern of bone growth in female mice
January 18, 2019 - Study finds link between lengthy periods of undisturbed maternal sleep and stillbirths
January 18, 2019 - New nuclear medicine method could improve detection of primary and metastatic melanoma
January 18, 2019 - Combination therapy shows high efficacy in treating people with leishmaniasis and HIV
January 18, 2019 - Health Tip: Don’t Ignore Changes in Skin Color
January 18, 2019 - Dietary Recommendations for Healthy Children
January 18, 2019 - Eliminating the latent reservoir of HIV
January 18, 2019 - Pain From The Government Shutdown Spreads. This Time It’s Food Stamps
January 18, 2019 - Newly discovered regulatory mechanism helps control fat metabolism
January 18, 2019 - New rapid blood tests could speed up TB diagnosis, save the NHS money
January 18, 2019 - Researchers develop intelligent system for ‘tuning’ powered prosthetic knees
January 18, 2019 - Monoclonal antibody pembrolizumab prolongs survival in patients with squamous cell carcinoma
January 18, 2019 - Maintaining an active lifestyle in older age could prevent dementia
January 18, 2019 - New research detects mosquito known to transmit malaria for the first time in Ethiopia
January 18, 2019 - Researchers identify new genes linked to development of age-related macular degeneration
January 18, 2019 - Computerized method helps better protect pharma patents
January 18, 2019 - New guidelines to make swallowing safer for people in Australian nursing homes
January 18, 2019 - Lumex Instruments’ RA-915AM monitor installed at Hg treatment plant in Almadén, Spain
January 18, 2019 - ACCC survey finds multiple threats to growth of cancer programs
January 18, 2019 - Meeting the challenge of engaging men in HIV prevention and treatment
January 18, 2019 - Furloughed Feds’ Health Coverage Intact, But Shutdown Still Complicates Things
January 18, 2019 - Experts discuss various aspects on health risks posed by fumigated containers
January 18, 2019 - Researchers use gene-editing tool CRISPR/Cas9 to limit impact of parasitic diseases
January 18, 2019 - Alpha neurofeedback training could be a means of enhancing learning success
January 18, 2019 - Innovative ‘light’ method demonstrates positive results in fight against malignant tumors
January 18, 2019 - The cytoskeleton of neurons found to play role in Alzheimer’s disease
January 18, 2019 - New resource-based approach to improve HIV care in low- and middle-income countries
January 18, 2019 - Bedfont appoints Dr Jafar Jafari as first member of the Gastrolyzer Medical Advisory Board
‘Negative emotions’ linked to higher rates of opioid use in sickle cell disease

‘Negative emotions’ linked to higher rates of opioid use in sickle cell disease

image_pdfDownload PDFimage_print
Credit: CC0 Public Domain

In a small study using data from daily electronic patient diaries, Johns Hopkins researchers say they have found a link between negative emotions, such as sadness and anxiety, and higher opioid use in people with sickle cell disease whose pain levels were self-reported as relatively low.

The researchers caution that their study wasn’t set up to show that negative emotions or thinking causes people to take more opioid pills but only to see if there was an association.

People with the inherited disorder have misshapen red blood cells that clog blood vessels, causing chronic pain and episodes of severe pain that frequently send patients to emergency rooms.

Their study, described online on Sept. 21 in The Journal of Pain, adds to efforts to better identify those at risk for overuse of opioids, improve pain control and decrease dependency and side effects of long-term opioid use.

“We showed that the way we think about pain is associated with opioid use even if our pain levels are low,” says Patrick Finan, Ph.D., assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “These data argue that physicians need better communication with patients on how to take their medications from day to day to minimize fluctuations based on mood or way of thinking.”

Patients with sickle cell disease are commonly prescribed a daily, long-acting painkiller taken at a constant dose, and a short-acting painkiller to be taken as needed for episodes of more severe pain. Long-acting drugs include morphine, oxycodone, methadone and a fentanyl patch, and rescue pain killers include oxycodone, hydromorphone, meperidine, tramadol and hydrocodone.

To determine the factors that could put one at risk of overusing opioids, the researchers recruited 85 adults from Baltimore with sickle cell disease to fill out electronic diaries on a handheld personal computer every evening for 90 days.

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

At the start of the study, participants reported on the dosage and type of opioid pill they were prescribed for long-acting daily and short-acting use. The daily diary collected data on the number of long-acting and short-acting opioid pills taken per day. Participants rated their daily pain level on a scale of zero to 10, with zero being no pain and 10 being worst pain imaginable. Participants also individually rated positive emotions—including happy, calm and cheerful—and negative emotions—including lonely, sad, anxious and tired—on a scale of zero to 10 with zero being no emotion and 10 being the most intense emotion. The scores were converted to a zero to 100 scale for the data analysis.

Separately, the researchers measured negative thinking (different than negative emotions) by using a Pain Catastrophizing Scale to rate “rumination,” or focus on pain, helplessness and magnification of a current pain situation.

Among the 31 participants who took long-acting, daily opioids, negative emotions were associated with increased levels of using opioid pills. Opioid dosage increased by 3.4 morphine milligram equivalents ¾a standard measurement that compares dosages between various opioids¾for every 10-point increase of negative emotions. Daily pain level, positive emotions and negative thinking through catastrophizing did not affect the amount of long-acting, daily opioids taken.

“When someone is prescribed a daily, long-acting opioid, it is typically supposed to be at a fixed dose and their pain level or emotions shouldn’t dictate whether they take more of this prescription or not,” says Finan. “Although we can’t prove misuse of the medication in our study, these data suggest that physicians and patients should clearly communicate about how patients should be taking their daily, long-acting opioids in order to minimize the potential for misuse.”

When looking at levels of short-acting opioids taken at times of pain, the researchers found that pain levels and negative thinking by catastrophizing were associated with levels of short-acting opioid use. For every 10-point increase on the pain scale, the amount of short-acting opioids increased by 1.8 morphine milligram equivalents, and for every 10-point increase on the catastrophizing scale, pain medicine dosage increased by 2.5 morphine milligram equivalents. Positive and negative emotions had no effect on the use levels of short-acting opioids.

“When pain was reported as low, sickle cell disease patients reported higher opioid use if they catastrophized, or focused their thinking on their pain, than if they didn’t,” says Finan.

“When pain levels were higher, negative thinking played less of a role in influencing opioid use,” he adds.

Finan cautions that studies such as his have some weaknesses, including the fact that self-reports are always uncertain, and the study only looked at one time point per day, although a person’s mood may fluctuate throughout the day based on life events and experiences.

For future studies, Finan wants to use smartphone technology that can assess moods randomly throughout the day.

“Once we have a more intensive study to track mood variations throughout the day, then we can determine when it will be appropriate to send messages through text to intervene and affect patient behavior,” Finan says.

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


Explore further:
Drugstore pain pills as effective as opioids in ER patients

More information:
Patrick H. Finan et al. Daily Opioid Use Fluctuates as a Function of Pain, Catastrophizing, and Affect in Patients with Sickle Cell Disease: an Electronic Daily Diary Analysis, The Journal of Pain (2017). DOI: 10.1016/j.jpain.2017.08.010

Journal reference:
Journal of Pain

Provided by:
Johns Hopkins University School of Medicine

Tagged with:

About author

Related Articles