Kenta Wakaizumi1,2,3,4, Andrew D Vigotsky3,5,6, Rami Jabakhanji1,2,3, Maryam Abdallah2,3, Joana Barroso2,3, Thomas J Schnitzer2,3, Apkar Vania Apkarian7,8,9, Marwan N Baliki10,11,12. 1. Shirley Ryan AbilityLab, Chicago, IL, USA. 2. Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 East Erie St, Chicago, IL, 60611, USA. 3. Center for Translational Pain Research, and Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University Feinberg School of Medicine, Chicago, USA. 4. Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan. 5. Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA. 6. Department of Statistics, Northwestern University, Evanston, IL, USA. 7. Center for Translational Pain Research, and Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University Feinberg School of Medicine, Chicago, USA. a-apkarian@northwestern.edu. 8. Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, USA. a-apkarian@northwestern.edu. 9. Department of Anesthesia, Feinberg School of Medicine, Northwestern University, Tarry Bldg. 7-705, Chicago, IL, 60611, USA. a-apkarian@northwestern.edu. 10. Shirley Ryan AbilityLab, Chicago, IL, USA. marwanbaliki2008@u.northwestern.edu. 11. Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 East Erie St, Chicago, IL, 60611, USA. marwanbaliki2008@u.northwestern.edu. 12. Center for Translational Pain Research, and Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University Feinberg School of Medicine, Chicago, USA. marwanbaliki2008@u.northwestern.edu.
Abstract
INTRODUCTION: The opiate epidemic has severe medical and social consequences. Opioids are commonly prescribed in patients with chronic pain, and are a main contributor to the opiate epidemic. The adverse effects of long-term opioid usage have been studied primarily in dependence/addiction disorders, but not in chronic pain. Here, we examine the added iatrogenic effects, psychology, and brain morphology of long-term opioid use in matched patients with chronic pain with and without opioid use (case-controlled design). METHODS: We compared psychosocial, functional, and psychological measures between patients with chronic back pain (CBP) who were managing their pain with or without opioids, thereby controlling for the effect of pain on these outcomes. In addition, we investigated brain morphological differences associated with long-term opioid usage. We recruited 58 patients with CBP, 29 of them on long-term opioids and 29 who did not use opioids, and who were matched in terms of age, sex, pain intensity, and pain duration. Questionnaires were used to assess pain quality, pain psychology, negative and positive emotions, physical, cognitive, sensory, and motor functions, quality of life, and personality traits. RESULTS: Patients with CBP on opioids displayed more negative emotion, poorer physical function, and more pain interference (p < 0.001), whereas there were no statistical differences in cognitive and motor functions and personality traits. Voxel-based morphometry using structural brain imaging data identified decreased gray matter density of the dorsal paracingulate cortex (family-wise error-corrected p < 0.05) in patients with opioids, which was associated with negative emotion (p = 0.03). Finally, a volumetric analysis of hippocampal subfields identified lower volume of the left presubiculum in patients on opioids (p < 0.001). CONCLUSION: Long-term opioid use in chronic pain is associated with adverse negative emotion and disabilities, as well as decreased gray matter volumes of specific brain regions.
INTRODUCTION: The opiate epidemic has severe medical and social consequences. Opioids are commonly prescribed in patients with chronic pain, and are a main contributor to the opiate epidemic. The adverse effects of long-term opioid usage have been studied primarily in dependence/addiction disorders, but not in chronic pain. Here, we examine the added iatrogenic effects, psychology, and brain morphology of long-term opioid use in matched patients with chronic pain with and without opioid use (case-controlled design). METHODS: We compared psychosocial, functional, and psychological measures between patients with chronic back pain (CBP) who were managing their pain with or without opioids, thereby controlling for the effect of pain on these outcomes. In addition, we investigated brain morphological differences associated with long-term opioid usage. We recruited 58 patients with CBP, 29 of them on long-term opioids and 29 who did not use opioids, and who were matched in terms of age, sex, pain intensity, and pain duration. Questionnaires were used to assess pain quality, pain psychology, negative and positive emotions, physical, cognitive, sensory, and motor functions, quality of life, and personality traits. RESULTS:Patients with CBP on opioids displayed more negative emotion, poorer physical function, and more pain interference (p < 0.001), whereas there were no statistical differences in cognitive and motor functions and personality traits. Voxel-based morphometry using structural brain imaging data identified decreased gray matter density of the dorsal paracingulate cortex (family-wise error-corrected p < 0.05) in patients with opioids, which was associated with negative emotion (p = 0.03). Finally, a volumetric analysis of hippocampal subfields identified lower volume of the left presubiculum in patients on opioids (p < 0.001). CONCLUSION: Long-term opioid use in chronic pain is associated with adverse negative emotion and disabilities, as well as decreased gray matter volumes of specific brain regions.
Entities:
Keywords:
Back pain; Morphometry; NIH Toolbox; Neuroimaging; Opioids; Psychology
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