Keywords
1. Childhood trauma opioid craving
2. Emotional regulation chronic pain
3. Adverse Childhood Experiences (ACEs)
4. Heart rate variability (HRV) opioid use
5. Opioid-treated chronic pain management
In a recent study published in the 2019 August edition of ‘Development and Psychopathology,’ researchers have uncovered evidence demonstrating that adverse childhood experiences (ACEs) can significantly affect autonomic indices of emotion regulation and increase cravings in response to negative emotional cues among female opioid-treated chronic pain patients. The finding bears important implications for the assessment of opioid use disorder (OUD) risk in this vulnerable population.
The study, led by Dr. Eric L. Garland and colleagues from the University of Utah, sought to unravel the complex relationship between early life trauma, emotion dysregulation, craving, and the risk of developing opioid dependency in women managing chronic pain through long-term opioid pharmaceutical treatments. The publication DOI is: 10.1017/S0954579419000622.
Background and Implications
Chronic pain affects a significant portion of the adult population, with opioids often being prescribed for long-term management. The increasing prevalence of opioid use has concurrently given rise to an epidemic of opioid use disorder (OUD), raising questions about the risk factors that contribute to opioid addiction among chronic pain patients. One such factor is the presence of adverse childhood experiences (ACEs) like childhood abuse, which may predispose individuals to emotion regulation challenges later in life. This vulnerability may be especially potent in the face of negative emotional contexts where opioids provide a maladaptive method of coping.
Research Design and Findings
In this randomized controlled trial, a sample of women (N = 36, mean age = 51.2 ± 9.5) undergoing long-term opioid analgesic therapy (mean morphine equivalent daily dose = 87.1 ± 106.9 mg) participated in a task that involved viewing and reappraising negative affective stimuli. During the task, researchers measured the participants’ heart rate variability (HRV) and self-reported craving. HRV is considered an autonomic indicator of the body’s ability to regulate emotion.
The study revealed two critical outcomes. Firstly, ACEs were significantly correlated with blunted HRV during attempts to regulate negative emotions, indicating a physiological marker of impaired emotion regulation capacity. Secondly, ACEs and the duration of opioid use were both significant predictors of increased craving when subjects were exposed to negative emotional cues.
These results suggest that childhood trauma contributes to alterations in autonomic nervous system functioning. Specifically, it affects the regulation of heart rate in situations demanding emotional regulation, which in turn, could exacerbate craving and risk for OUD in adult female patients with chronic pain.
The study’s conclusions advocate for a deeper understanding and monitoring of OUD risk among chronic pain patients, especially in those with a history of ACEs. The findings reinforce the importance of considering personal histories of trauma when initiating extended, high-dose opioid treatments for pain management. The research supports the urgent need for personalized care strategies that incorporate assessments of past trauma and emotion regulation capabilities.
References
1. Garland, E. L., Reese, S. E., Bedford, C. E., & Baker, A. K. (2019). Adverse childhood experiences predict autonomic indices of emotion dysregulation and negative emotional cue-elicited craving among female opioid-treated chronic pain patients. Development and Psychopathology, 31(3), 1101–1110. doi: 10.1017/S0954579419000622
2. Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C. H., Perry, B. D., … & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. European archives of psychiatry and clinical neuroscience, 256(3), 174-186.
3. Chou, R., Turner, J. A., Devine, E. B., Hansen, R. N., Sullivan, S. D., Blazina, I., … & Deyo, R. A. (2015). The effectiveness and risks of long-term opioid treatment of chronic pain. Evidence report/technology assessment, (218), 1-219.
4. McEwen, B. S., & Stellar, E. (1993). Stress and the individual. Mechanisms leading to disease. Archives of internal medicine, 153(18), 2093-2101.
5. Bremner, J. D., Randall, P., Scott, T. M., Capelli, S., Delaney, R., McCarthy, G., & Charney, D. S. (1995). Deficits in short-term memory in adult survivors of childhood abuse. Psychiatry Research, 59(1-2), 97–107.
Conclusion
The research conducted by Garland and his team establishes a vital connection between adverse childhood experiences and the autonomic regulation of emotions, which has the potential to induce cravings and elevate the risk of developing opioid use disorders in adult women with chronic pain. Their work not only contributes to our understanding of the underpinnings of addiction vulnerabilities but also underscores the importance of integrating patient histories and psychological assessments into pain treatment plans. As the opioid crisis continues to demand attention, such critical insights pave the way for more effective and compassionate interventions aimed at those at greatest risk.