Opioid Craving in Chronic Pain Management: A Structural Equation Model of Veterans in Pain Rehabilitation.

introductionCraving is a significant factor in the use and misuse of various substances, but its relevance to prescription opioids in individuals with chronic pain remains unclear. The opioid epidemic has dramatically changed prescription guidelines, highlighting the importance of understanding factors affecting opioid use. Despite this critical need, there is a notable scarcity of empirical data on opioid craving in chronic pain populations, with most existing research focused on individuals with substance use disorders. Our study addresses this significant knowledge gap by providing rare prospective data on craving in patients using prescription opioids for pain management. We hypothesized that pre-treatment opioid craving would predict changes in opioid use during treatment. In this observational study (N = 104), we aim to expand on previous research by examining the relationship between opioid craving and opioid tapering among veterans with chronic pain undergoing intensive pain rehabilitation treatment. MATERIALS AND

methodsWe employed structural equation modeling (SEM), with the change in opioid dose (Morphine Equivalent Daily Dose) during treatment as the dependent variable. The predictor variables included pre-treatment subjective opioid craving (both as observed and latent variable), pre-treatment pain catastrophizing, depression, pain intensity, and baseline opioid intake, as well as treatment goal and satisfaction.

resultsContrary to our hypothesis, we found no significant relationship between pre-treatment self-reported opioid craving and post-treatment changes in prescription opioid use. SEM revealed several other significant relationships. Pre-treatment opioid intake dose and treatment satisfaction both showed significant associations with reduction in prescription opioids following treatment, with higher treatment satisfaction associated with greater dose reduction. Additionally, we observed a significant positive relationship between pre-treatment depression and opioid craving.

conclusionsOur results, drawn from one of the few existing datasets examining opioid craving in chronic pain patients without substance use disorder, suggest that the use of prescription opioids for chronic pain management differs from other forms of substance use or misuse in that craving does not appear to predict continued use. Although our study has limitations, including the single-timepoint measurement of craving, the uniqueness of our dataset provides valuable preliminary evidence that challenges assumptions about craving derived from substance use disorder populations. This distinction may reflect fundamental differences between patients using opioids for pain management without substance use disorder vs. those with diagnosed SUD (substance use disorder). Further research with multiple craving assessments is needed, but our findings represent an important step toward understanding the complex relationship between craving and opioid use in this understudied population.