Chronic pain, negative affect, and prescription opioid abuse

• Chronic pain is a growing public health concern.
• There has been a dramatic increase in prescriptions of analgesic opioids in the United States.
• Psychiatric co-morbidity is frequently associated with opioid misuse, abuse, and/or diversion.
• Many screening questionnaires currently exist to assess a patient's risk for opioid misuse.
• Behavioral interventions can be effective in improving opioid compliance.

Chronic pain is an international health issue that is influenced by both physical and psychological factors. This article outlines the benefits and complications of opioid medications in chronic pain treatment and explores the roles of negative affect and craving in exacerbating chronic noncancer pain. The role of psychiatric comorbidity and use of validated assessment tools helpful in identifying those individuals who are at greatest risk for opioid misuse are discussed. Additionally, interventional treatment strategies for chronic pain patients who are at risk for opioid misuse are presented. Specific behavioral interventions are also reviewed such as frequent monitoring, motivational counseling, periodic urine screens and opioid checklists designed to improve compliance with prescription opioids among persons treated for chronic pain.