Research Review

Pain Drug Craving Occurs With or Without Risk for Misuse

Patients taking opioid analgesics for chronic pain who are not substance-dependent or addicted can frequently experience cravings to take more medication, but this behavior is not associated with pain levels or spikes in pain intensity, according to research reported in The Journal of Pain.

Researchers from Harvard Medical School studied drug craving in 62 patients prescribed opioid analgesic medications who were at low or high risk for medication misuse. There is no definitive evidence that craving is indicative of drug addiction, since patients who are not addicted have reported drug cravings.

The purpose of the study was to evaluate self reports of cravings to determine if craving is associated with the desire to take more opioids, preoccupations with the next scheduled dose and mood changes. The authors hypothesized that craving reports would be reduced through frequent patient monitoring and motivational counseling.

Patients in the study were seen monthly, completed electronic diaries, were given urine drug tests, and had monthly contact with their physicians.

The results showed that patients taking opioids who are not dependent or addicted, according to accepted measurements, do experience drug cravings. Further, levels of craving were weakly associated with current levels of pain or average pain over 24 hours. The authors concluded that craving is a mental experience distinct from pain itself. Also, the results show that craving is a common experience with opioid therapy and may or may not be related to substance abuse disorders and higher risks for drug misuse.

The authors noted that further studies are needed to determine if craving is a useful indicator for eventual development of drug dependence or addiction, and added that craving could reflect drug withdrawal in between medication doses.

— Source: American Pain Society