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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.

The DSM-5-TR diagnostic criteria for Prescription Opioid-Use Disorder (POUD) have undergone significant changes when using opioids medically supervised. However, there is a lack of research supporting these changes. This prospective study aimed to analyze the influence of tolerance, withdrawal symptoms, and craving on the severity of POUD in chronic pain population on long-term opioid therapy. Initial individual interviews and follow-ups at 6 and 12 months were conducted on 62 patients to assess tolerance, withdrawal symptoms, craving, and POUD severity. Information on sociodemographic, clinical, and psychological variables was also collected. Unadjusted and covariate-adjusted multinomial repeated measures mixed models were run. Results showed that, compared to not having POUD, tolerance was the sole variable that significantly predicted mild disorder, while interdose withdrawal symptoms, craving, depressive symptoms, and younger age predicted moderate-severe POUD. The effect of time was also significant in predicting moderate-severe POUD, increasing rates at 6- and 12-month follow-ups compared to initial assessment. These findings highlight that maintaining opioid therapy over time is associated with an increased likelihood of having a more severe disorder. Furthermore, although tolerance and withdrawal symptoms have been removed from POUD diagnosis, their assessment and early management remain critical even during supervised opioid treatment for chronic pain., Competing Interests: Declaration of competing interest All authors have no conflicts of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Most epidemiological surveys focus on adult gambling behaviors related to traditional gambling forms, while studies on novel forms often focus on loot boxes and cryptocurrency trading individually. This study examines the co-ocurrence of emergent gambling and gambling-like practices, analyzing the demographic and psychological characteristics of involved gamblers. A cross-sectional study surveyed 1429 Spanish individuals aged 18-65, using a web-based questionnaire. The survey assessed participation in 19 gambling (e.g., lotteries, sports betting) and gambling-like activities (e.g., trading of cryptocurrencies and other assets, buying loot-boxes), along with sociodemographic and substance use. Problem gambling (PGSI), Impulsivity (UPPS-P), and cognitive distortions (Labrador's cognitive distortions scale) were also assessed. Participants who gambled over the past year (n = 921) were classified into four groups: traditional gambling (TG) only (64.5%, n = 594), TG with trading activities (27.5%, n = 253), TG with gambling withing video games or streaming platforms (2.5%, n = 23), and TG with both trading and video gambling (5.5%, n = 51). Most gamblers engaged exclusively in traditional formats, but 35.5% also participated in novel gambling forms. Those involved in both trading and video gambling were generally younger, male, with higher levels of impulsivity and gambling-related cognitive distortions compared to TG-only gamblers (p < 0.001). This group also exhibited higher rates of problem gambling and substance use (p < 0.001). This study emphasize the importance of including emerging gambling activities, which are particularly prevalent among high-risk gamblers, in epidemiological surveys. Identifying new gambling patterns and associated risk factors could help optimize public policies and develop more effective regulatory and prevention strategies., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

An assessment of the different aspects of tobacco addiction is central to adapting interventions to the profiles and needs of smokers. The Glover−Nilsson Smoking Behavioral Questionnaire (GN-SBQ) is one of the few and most used scales to evaluate the behavioral aspects of tobacco addiction. However, few studies involve the validation of the GN-SBQ in clinical settings. Thus, this study aimed to analyze the psychometric properties of the GN-SBQ in a sample of Spanish smokers. A total of 341 smokers attending clinical services in Spain participated in this cross-sectional study. Measures included the psychological factors related to tobacco addiction, assessed with the GN-SBQ, the physical factors of nicotine addiction, withdrawal symptoms, smoking-related variables, and alcohol use. Data analysis included descriptive statistics, internal consistency coefficients, confirmatory factor analyses, Spearman correlations, and the Kruskal−Wallis test. The GN-SBQ showed adequate reliability (α = 0.76 and ω = 0.76) and a unidimensional structure. GN-SBQ scores also provided evidence of convergent and concurrent validity. GN-SBQ scores significantly correlated with the physical symptoms of addiction, age, number of cigarettes, and withdrawal symptoms. The results of discriminant validity were also adequate, as no correlation was observed between GN-SBQ scores and CO levels or alcohol use. Significant differences were found between all levels of psychological addiction based on the GN-SBQ scores regarding physical nicotine addiction, withdrawal symptoms, and age. Thus, this questionnaire is a reliable and valid instrument to assess the psychological aspects of tobacco addiction in smokers in clinical settings. The short length of the GN-SBQ proves advantageous for its use in time-limited assessments, which are common in public health services.

Opioid withdrawal is characterized by a set of physical and psychological symptoms that depend on both opioid and patient specific characteristics. The present study aims to identify different latent classes of chronic pain patients according to the type of opioid withdrawal symptoms experienced, and to analyze the relationships between the classes and demographic, opioid therapy, psychological and substance use variables. This cross-sectional descriptive study included 391 chronic pain patients on long-term opioid therapy. A Latent Class Analysis (LCA) identified 3 classes (BIC = 7051.89, entropy = .87, LRTs P < .01). The mild withdrawal class showed low probabilities of presenting physical and psychological symptoms, the moderate withdrawal class was characterized by experiencing psychological symptoms, and the severe withdrawal class stood out for high probabilities of presenting both types of symptoms. The classes differed from each other, with higher rates of moderate-severe POUD, opioid misuse, anxiety, depression, and greater pain intensity and interference in more severe withdrawal classes (P < .05). The multinomial logistic regression showed that moderate-severe POUD and anxiety were the strongest variables related to moderate (OR POUD  = 3.34, OR Anxiety  = 2.58) and severe withdrawal classes (OR POUD  = 4.26, OR Anxiety  = 5.15). Considering that POUD and anxiety were strongly related to a more severe withdrawal syndrome, the inclusion of psychological interventions in pain management seems critical in this population. PERSPECTIVE: Although interdose opioid withdrawal is common in chronic pain patients, this study shows 3 different patterns in its experience (mild, moderate, and severe withdrawal). A more severe withdrawal may result in reduced effectiveness of opioids in relieving pain and increased negative consequences, such as higher risk of POUD. Findings that could help improve chronic pain management., (Copyright © 2022 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Background: The DSM-5 diagnostic criteria for Prescription Opioid-Use Disorder (POUD) have undergone some significant changes. One of the most controversial changes has been the elimination of the withdrawal symptoms criterion when opioid use is under appropriate medical supervision. For this reason, the goal of this study was to analyze factors associated with opioid withdrawal in patients with chronic non-cancer pain (CNCP)., Methods: This cross-sectional descriptive study involved 404 patients who use prescription opioids for long-term treatment (≥90 days) of CNCP. Measures included sociodemographic and clinical characteristics, POUD, withdrawal symptoms, craving, anxiety-depressive symptoms, and pain intensity and interference., Results: Forty-seven percent (n = 193) of the sample reported moderate-severe withdrawal symptoms, which were associated with lower age, higher daily morphine dose and duration of treatment with opioids, moderate-severe POUD, use of psychotropic drugs, higher anxiety-depressive symptoms, and greater pain intensity and interference (p < .05). Binary logistic regression analysis showed that moderate-severe POUD (OR = 2.82), anxiety (OR = 2.21), depression (OR = 1.81), higher pain interference (OR = 1.05), and longer duration of treatment with opioids were the strongest factors associated with moderate-severe withdrawal symptoms (p < .05)., Conclusion: Psychological factors seem to play a key role in the severity of withdrawal symptoms. Since greater intensity of these symptoms increases the risk of developing POUD, knowing the factors associated with withdrawal may be useful in developing preventive psychological interventions., (Copyright © 2021 Elsevier Inc. All rights reserved.)