Pain, the Opioid Epidemic, and Depression

Auteur
Jeffrey F. Scherrer PhD is Vice-Chair for Research and Professor in the Department of Family and Community Medicine and dually appointed Professor in the Department of Psychiatry and Behanioral Neuroscience at Saint Louis Univeristy School of Medicine, Missouri, US. He received his doctoral degree in health services research. He began his academic career at Washington University in St. Louis focusing on twin studies of substance use disorder and comorbid mental illness. He transferred to Saint Louis University in 2013 and has since devoted considerable time to researching mental and psychosocial outcomes following long-term prescription opioid use. His approach is grounded in observational cohort studies using both retrospective medical record and medical claims data and prospective cohort designs to better understand the inter-relationships between pain, prescription opioid use and misuse and psychiatric disorders. Jane C. Ballantyne MD FRCA is Professor of Anesthesiology and Pain Medicine at the Univerity of Washington, Seattle, Washington, US. She trained in medicine and anaesthesia in the UK before moving to Boston, MA in 1990. She became Chief of the Division of Pain Medicine in the Massachusetts General Hospital in 1999. She moved to the University of Washington in 2011 as Professor of Anesthesiology and Pain Medicine. She has editorial roles in several leading journals and textbooks and is a widely published author. She was an early advocate for restraint in opioid prescribing for chronic pain, and has continued to focus her teaching and research on the clinical implications of evolving opioid science.

Texte du rabat

Bringing together siloed areas to offer a comprehensive summary of decades of research, Pain, the Opioid Epidemic, and Depression is a comprehensive evaluation of the evidence for bi-directional and mutually reinforcing effects of pain, prescription opioid use, and mental illness, with a focus on depression.

Résumé
Long-term prescription opioid use occurs in a substantial proportion of new opioid users. Most concerning is that high risk patients with comorbid depression, anxiety, nicotine dependence, and substance use disorders, compared to patients without these factors, continue to be prescribed higher opioid doses for longer durations, and are more likely to receive opioids with high abuse potential. To understand this phenomenon, we must consider the relationships between pain, mental illness, substance use disorder and long-term prescription opioid use. While separate fields have investigated the bi-directional relationships between depression, pain, and long-term prescription opioid use independently of one another, there is no text which has brought together the complex interaction of all three together. Drawing on contributions from neuroscience, pain psychiatry, clinical epidemiology, pharmacoepidemiology, clinical trials and research on social determinants of health, Pain, the Opioid Epidemic, and Depression is the first book to integrate currently siloed areas of investigation and clinical knowledge. This book takes a comprehensive approach, from neurophysiology to epidemiology to clinical practice, and explains the processes driving maintenance of chronic pain, persistent depression, and long-term prescription opioid use, as well as taper and buprenorphine treatment for opioid use disorder. Readers will come to understand the central role of depression, other psychiatric disorders, and social determinants that contribute to pain management outcomes, the opioid epidemic, and our response to opioid dependence and opioid use disorder. By taking a multidisciplinary approach to compiling what is known about the relationships between pain, depression, other psychiatric disorders and opioids, this volume will be a valuable clinical resource for a range of healthcare and mental health professionals who encounter chronic pain and comorbid mood disorders, while also spawning new directions for researchers.

Contenu

• Chapter 1. Overview and Purpose

• Chapter 2. Neurophysiology of Pain, Depression, and Exogenous Opioids

• Chapter 3. Looking Beyond Tissue Damage: Pain as a Homeostatic Function

• Chapter 4. Prescription Opioid Use and Risk of Depression and Worsening Mental Health

• Chapter 5. Depression and Pain: Bi-directional Relationship and Changes with Psychological Treatment

• Chapter 6. Other Psychiatric Disorders, Psychosocial Factors and Pain

• Chapter 7. The Impact of Social and Structural Determinants on Depression, Prescription Opioid Use, Opioid Misuse, and Opioid Use Disorder

• Chapter 8. Opioid Taper and Complex Prescription Opioid Dependence: The Role of Depression

• Chapter 9. Potential Role for Buprenorphine in the Management of Comorbid Depression Among People with Chronic Pain and Long-term Opioid Therapy Dependence

• Chapter 10. Future Directions in Pain Management, Implications for Depression and Mental Health