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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., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: Withdrawal syndrome stands out as the strongest risk factor for prescription opioid-use disorder (POUD) and is related to psychological and pain impairment in the chronic pain population. This study aimed to identify profiles of chronic pain patients with opioid withdrawal based on psychological factors and to explore the association between the classes and demographic, clinical, and substance use variables., Method: This cross-sectional descriptive study involved 391 patients, 221 with interdose withdrawal (mean age = 57.91±13.61 years; 68.3% female). Latent class analysis and bivariate and logistic regression analyses were performed., Results: Two latent classes were identified (Bayesian information criterion = 4020.72, entropy = .70, likelihood ratio tests p < .01): Withdrawal syndrome with No Psychological Distress (WNPD; 45.2%, n = 100) and Withdrawal syndrome with Psychological Distress (WPD; 54.8%, n = 121). The WPD class was more likely to experience craving, anxiety, and depression and to report higher levels of pain intensity and interference ( p < .01). Patients in this class were younger, visited a higher number of specialists, and showed higher rates of high-dose opioid use, misuse, moderate-severe POUD, and tobacco and anxiolytics use ( p < .05). Only moderate-severe POUD (odds ratio [OR] = 2.64) and tobacco use (OR = 2.28) increased the risk of WPD class membership., Conclusions: Although it is common for chronic pain patients to experience withdrawal symptoms during opioid treatment, more than half of the participants reported concomitant psychological distress. Establishing differential profiles can help to improve withdrawal syndrome management during the treatment of chronic pain with opioids.