Factors associated with opioid craving, opioid intake, and opioid misuse in patients with chronic pain: insights from an ecological momentary assessment study

Many patients with chronic noncancer pain (CNCP) are prescribed opioid medication. However, concerns have been raised about the use of high opioid doses and the misuse of opioids in these patients. Research is needed to better understand the factors that influence day-to-day opioid intake patterns and opioid misuse behaviors in patients with CNCP. The first objective of this study was to examine the contribution of pain intensity, psychological factors, and physical dependence symptoms to daily opioid craving and opioid intake in patients with CNCP. The contribution of these factors to opioid misuse was also examined. In this ecological momentary assessment study, patients with CNCP prescribed short-acting opioids completed diaries, in between opioid doses, for 10 consecutive days. Diaries assessed a host of pain, psychological, and opioid-related variables. Diaries also assessed total daily morphine equivalent doses (MED) used by patients. Multilevel analyses indicated that intra-day increases in pain intensity, negative affect, catastrophizing, and withdrawal symptoms were associated with higher opioid craving (all P 's < 0.05). Day-to-day increases in pain intensity, catastrophizing, and craving were associated with greater opioid intake (ie, MED) (all P 's < 0.05). Patients' daily opioid craving contributed to daily opioid misuse even after accounting for other daily variables ( P < 0.05). Our findings provide new insights into the factors contributing to daily opioid craving, opioid intake, and opioid misuse among patients with CNCP. Interventions targeting these factors could potentially prevent opioid dose escalations and opioid-related harms among those maintained on opioid therapy.