Showing papers by "Kevin E. Vowles published in 2015"

Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis.

Abstract: Opioid use in chronic pain treatment is complex, as patients may derive both benefit and harm. Identification of individuals currently using opioids in a problematic way is important given the substantial recent increases in prescription rates and consequent increases in morbidity and mortality. The present review provides updated and expanded information regarding rates of problematic opioid use in chronic pain. Because previous reviews have indicated substantial variability in this literature, several steps were taken to enhance precision and utility. First, problematic use was coded using explicitly defined terms, referring to different patterns of use (ie, misuse, abuse, and addiction). Second, average prevalence rates were calculated and weighted by sample size and study quality. Third, the influence of differences in study methodology was examined. In total, data from 38 studies were included. Rates of problematic use were quite broad, ranging from <1% to 81% across studies. Across most calculations, rates of misuse averaged between 21% and 29% (range, 95% confidence interval [CI]: 13%-38%). Rates of addiction averaged between 8% and 12% (range, 95% CI: 3%-17%). Abuse was reported in only a single study. Only 1 difference emerged when study methods were examined, where rates of addiction were lower in studies that identified prevalence assessment as a primary, rather than secondary, objective. Although significant variability remains in this literature, this review provides guidance regarding possible average rates of opioid misuse and addiction and also highlights areas in need of further clarification.

Pain as a predictor of heavy drinking and any drinking lapses in the COMBINE study and the UK Alcohol Treatment Trial.

Abstract: Aims To test the association between pain and heavy drinking lapses during and following treatment for alcohol use disorders (AUD).

Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect.

Abstract: Objective: Physical pain and negative affect have been described as risk factors for alcohol use following alcohol treatment. The current study was a secondary analysis of 2 clinical trials for alcohol use disorder (AUD) to examine the associations between pain, negative affect and AUD treatment outcomes. Method: Participants included 1,383 individuals from the COMBINE Study (COMBINEStudyResearchGroup,2003 ; 31% female, 23% ethnic minorities, average age � 44.4 [SD � 10.2]), a multisite combination pharmacotherapy and behavioral intervention study for AUD in the United States, and 742 individuals from the United Kingdom Alcohol Treatment Trial (UKATT Research Team, 2001 ; 25.9% female, 4.4% ethnic minorities, average age � 41.6 [SD � 10.1]) a multisite behavioral intervention study for AUD in the United Kingdom. The Form-90 was used to collect alcohol use data, the Short Form Health Survey and Quality of Life measures were used to assess pain, and negative affect was assessed using the Brief Symptom Inventory (COMBINE) and the General Health Questionnaire (UKATT). Results: Pain scores were significantly associated with drinking outcomes in both datasets. Greater pain scores were associated with greater negative affect and increases in pain were associated with increases in negative affect. Negative affect significantly mediated the association between pain and drinking outcomes and this effect was moderated by social behavior network therapy (SBNT) in the UKATT study, with SBNT attenuating the association between pain and drinking. Conclusion: Findings suggest pain and negative affect are associated among individuals in AUD treatment and that negative affect mediated pain may be a risk factor for alcohol relapse. What is the public health significance of this article? This study highlights the important associations between physical pain interference and intensity, negative affect, and alcohol use following treatment for an alcohol use disorder. Social network behavior therapy, which is one type of behavioral intervention for alcohol use disorders, may be particularly useful for preventing alcohol use in response to physical pain and negative affect.

Living Well with Pain: Development and Preliminary Evaluation of the Valued Living Scale

Abstract: Objectives Encouraging individuals with chronic pain to focus on nonpain-related goals that are consistent with personal values is a goal of most psychosocial pain interventions. A valid and reliable measure of goal-related variables would be useful to evaluate the importance of these to patient quality of life and as factors that may explain treatment outcome. Design We developed items for a measure (the Valued Living Scale, VLS) to assess goal importance, success, and confidence with respect to eight value domains and 26 specific values-related goals, and administered these items to individuals with three chronic pain conditions (low back pain, N = 58; fibromyalgia, N = 55; headache, N = 61). Results Analyses supported: 1) a two-factor model of the VLS items assessing goal-related variables associated with a) health and productivity and b) social relations; 2) VLS scale score reliability, with Cronbach's alphas greater than 0.70; and 3) VLS scale score validity, as indicated by significant associations with pain intensity, depression, and pain interference in the expected directions. Conclusions The VLS items can be administered and scored to assess: 1) the importance of as well as 2) confidence in and 3) success in achieving values-consistent goals. The measure can be used by clinicians to monitor and track changes in patient's perceptions about their goals with treatment. Researchers can use the VLS to test theoretical models of the roles that patient perceptions about goal importance, confidence, and success play in chronic pain treatment outcome. This study described the development and preliminary validation of a measure that assesses: 1) the importance of as well as 2) confidence in and 3) success in achieving valued life goals. The measure may be used to monitor and track changes in patient perceptions of their goals during treatment, and researchers may use the measure to test the role that patient perceptions about goal importance, confidence, and success play in chronic pain treatment outcome.

Chronic noncancer pain and opioids: Risks, benefits, and the public health debate.

Abstract: Psychologists involved with treatment teams deciding whether to pursue opioid pharmacotherapy for patients with chronic noncancer pain face a challenging dilemma. Although opioids offer a valuable treatment option for the millions of Americans who suffer from chronic pain, these medications also pose a significant risk for aberrant use among a subset of patients. The lack of clear information on this topic makes it difficult to determine how to proceed in professional practice. Notwithstanding empirical efforts to examine this complex issue, the prevalence rates of opioid abuse and dependence vary widely, and the accuracy in which the most popular assessment methods can predict aberrant use remains unclear. Furthermore, there is a paucity of data on the extent to which the long-term use of opioids can contribute to improvements in functioning and quality of life. The present paper highlights the key issues for this topic relevant to professional psychologists by reviewing the evidence regarding the benefits and risks associated with opioid use as a treatment for chronic pain and exploring areas of significant concern relevant to public health policy. At the current time, there are no simple solutions to this dilemma, and this review concludes with areas in need of further research in order to help clinicians make more informed decisions.

Editorial overview: Third wave behavior therapies

Abstract: NM 87131, USA k.e.vowles@gmail.comKevin completed his PhD in clinicalpsychology at West Virginia University in2004 and post-doctoral fellowship at theUniversity of Virginia the following year. From2005 to 2012, he held joint positions in and with the National HealthService in the United Kingdom. He has beenon faculty in the Department of Psychology atthe University of New Mexico since 2012,where he is an Associate Professor. Hisclinical and academic activities have focusedon the assessment and effectiverehabilitation of individuals with chronic pain,an area within which he has published over55 articles since beginning his doctoraltraining in 2002.

On the importance of clear comparisons and a methodologically rigorous empirical literature in evaluating opioid use in chronic pain: a response to Scholten and Henningfield.

Abstract: recommendations: a quantitative review of 50 years of research. Med Care 2004;42:200–9. [3] Institute of Medicine of the National Academies. Relieving pain in America. The National Acedamies Press. Washington: 2011. [4] Minozzi S, Amato L, Davoli M. Development of dependence following treatment with opioid analgesics for pain relief: a systematic review. Addiction 2013;108:688–98. [5] Noble M, Tregear SJ, Treadwell JR, Schoelles K. Long-Term Opioid Therapy for Chronic Noncancer Pain: A Systematic Review and MetaAnalysis of Efficacy and Safety. Review Article. J Pain Symptom Manage 2008;35:214–28. [6] Vowles KE, Mindy L, McEntee ML, Julnes PS, Frohe T, Ney JP, Van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. PAIN 2015;15:569–76. [7] World Health Organization. Ensuring balance in national policies on controlled substances, guidance for accessibility and availability of controlled medicines. World Health Organization. Geneva: 2011.