Pain-Drug Craving Not Linked With Risk of Misuse

Patients who are receiving opioid analgesics for chronic pain but are not substance-dependent or addicted often experience cravings to take more medication, according to researchers from the Harvard Medical School. However, the cravings are not associated with pain levels or spikes in pain intensity.

The researchers evaluated self-reports of cravings in 62 patients for whom opioid analgesic medications were prescribed and who were at low or high risk for medication misuse to determine whether craving is associated with the desire to take more opioids, preoccupations with the next scheduled dose, and mood changes. They hypothesized that craving reports would be reduced through frequent patient monitoring and motivational counseling. The patients were seen monthly, completed electronic diaries, were given urine drug tests, and had monthly contact with their physicians.

The patients who were receiving opioids but were not dependent or addicted experienced drug cravings. 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 and that craving is a common experience with opioid therapy that may not be related to substance abuse disorders and a higher risk for drug misuse. They noted that further studies are needed to determine whether craving is a useful indicator for eventual development of drug dependence or addiction. The research was reported in The Journal of Pain, a journal of the American Pain Society.