Cited by 277Opioid Use Disorder TreatmentPain Management and Opioid UseSubstance Abuse Treatment and Outcomes

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The downward spiral of chronic pain, prescription opioid misuse, and addiction: Cognitive, affective, and neuropsychopharmacologic pathways

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Garland, Eric L., Froeliger, Brett, Zeidan, Fadel, Partin, Kaitlyn, Howard, Matthew O.·2013·Neuroscience & Biobehavioral Reviews

DOI 10.1016/j.neubiorev.2013.08.006PMC PMC3967721

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Abstract

Prescription opioid misuse and addiction among chronic pain patients are emerging public health concerns of considerable significance. Estimates suggest that more than 10% of chronic pain patients misuse opioid analgesics, and the number of fatalities related to nonmedical or inappropriate use of prescription opioids is climbing. Because the prevalence and adverse consequences of this threat are increasing, there is a pressing need for research that identifies the biobehavioral risk chain linking chronic pain, opioid analgesia, and addictive behaviors. To that end, the current manuscript draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to prescription opioid misuse and addiction among chronic pain patients receiving opioid analgesic pharmacotherapy. Addictive use of opioids is described as the outcome of a cycle initiated by chronic pain and negative affect and reinforced by opioidergic-dopamingeric interactions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. Implications for clinical practice are discussed; multimodal, mindfulness-oriented treatment is introduced as a potentially effective approach to disrupting the downward spiral and facilitating recovery from chronic pain and opioid addiction.

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Self-citation

Authors: Garland, E. L., Froeliger, B., Zeidan, F., Partin, K., & Howard, M. O.
Affiliations: University of Utah (US)
Medical University of South Carolina (US)
Wake Forest University (US)
University of North Carolina at Chapel Hill (US)
Corresponding author: Garland, Eric L.
ORCID: Garland, Eric L.
Froeliger, Brett
Zeidan, Fadel
Howard, Matthew O.
Venue: Neuroscience & Biobehavioral Reviews
Publisher: Elsevier BV
Published: 2013-12
Volume: 37
Issue: 10
Pages: 2597-2607
ISSN: 0149-7634 (ISSN-L)
DOI: 10.1016/j.neubiorev.2013.08.006
PMC: PMC3967721
OpenAlex: W2110728022
Cited by: 277
References: 189
Citations by year: 2026: 14 · 2025: 19 · 2024: 16 · 2023: 21 · 2022: 25 · 2021: 27 · 2020: 47 · 2019: 28 · 2018: 12 · 2017: 22 · 2016: 17 · 2015: 14 · 2014: 15
FWCI: 2.19
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Neuroscience & Biobehavioral Reviews (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
UNC Libraries
Funders: Fahs-Beck Fund for Research and Experimentation
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords: chronic pain, prescription opioid misuse, opioid use disorder, downward spiral, opioid analgesia, negative affect, opioid-dopamine interaction, drug cue reactivity, cognitive control network, mindfulness-based interventions, multimodal therapy
MeSH terms: Analgesics, Opioid, Cognition Disorders, Humans, Opioid-Related Disorders, Mood Disorders, Chronic Pain, Prescription Drug Misuse

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The downward spiral of chronic pain, prescription opioid misuse, and addiction: Cognitive, affective, and neuropsychopharmacologic pathways

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