Abstract
In the field of chronic pain therapy, considerable concerns about dependence to opioids occur in patients with chronic non-cancer pain, sometimes even taking the form of opiate phobia (opioidphobia). For this reason, current studies of this topic, drawing from neuro-psycho-pharmacological research, seek to develop a conceptual framework of dependence development in patients suffering from chronic pain.
The addictive use of opioids is understood as a result of a cycle that starts with chronic pain and negative feelings, and is reinforced by opiate-dopamine interaction leading to attention hypervigilance to pain and stimuli associated with medication, a dysfunctional connection between cognitive control networks in the brain and the allostatic dysregulation of systems that respond to stress and reward. Not only the screening model of determining dependence, but some multimodal therapeutic approaches are also introduced as a potentially efficient approach to breaking dependence and facilitating the treatment of chronic non-cancer pain and dependence.
The chapter also describes specific neuropsychological and cognitive deficits developed in patients with opioid dependence; in the literature, these deficits are not distinguished with respect to the population of patients with dependence and patients with chronic non-cancer pain treated with opioids. The aim of this chapter is to describe how opioids interact with cognitive, affective and psychological factors that are involved in chronic pain, and with behaviour related to dependence.
Finally, the clinical consequences of this model for psychotherapeutic treatment of patients with chronic non-cancer pain are described.