Transdiagnostic factors predicting prescription opioid-use disorder severity: A 12-month prospective study in patients on long-term opioid therapy for chronic pain.

Background: Research has suggested that transdiagnostic factors related to reward, cognitive, and regulatory processes are involved in addictive behaviors and the experience of pain. However, studies of Prescription Opioid-Use Disorder (POUD) in a chronic pain population are scarce. This study aimed to analyze the predictive power of anticipatory pleasure experience, obsessive-compulsive behavior, cognitive control, emotion dysregulation, and sleep on POUD severity in chronic pain patients on long-term opioid therapy.

Methods: A three-wave prospective study was conducted in a sample of 67 patients. Individual interviews were held to collect self-reported data on transdiagnostic factors, POUD, and sociodemographic and clinical variables. Statistical analysis included repeated measures multinomial mixed models, unadjusted and covariate-adjusted.

Results: Rates of moderate-severe POUD significantly increased at 6- and 12-month follow-ups compared to initial assessment. The inability to experience anticipatory pleasure (OR [95 %CI] = 0.93 [0.89-0.98]), emotion dysregulation (OR = 1.06 [1.03-1.10]), and poorer sleep quality (OR = 1.25 [1.07-1.45]) predicted moderate-severe POUD even in the adjusted models (p< 0.05). In contrast, obsessive-compulsive behavior (OR = 1.02 [0.99-1.06]) was no longer significant after adjustment for covariates (p> 0.05). In addition, cognitive control was the only factor that predicted both mild (OR = 0.96 [0.93-0.99]) and moderate-severe (OR = 0.94 [0.90-0.98]) disorder (p< 0.05). Furthermore, when all transdiagnostic factors were included in a single model, cognitive control and anticipatory pleasure experience emerged as the strongest predictors of POUD severity, respectively (p< 0.05).

Conclusions: The identification of key transdiagnostic factors related to POUD severity allows for a more specific profiling of patients at increased risk, potentially leading to improved treatment targets for chronic pain population on opioid therapy.