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Advisory Committee Chair

Leanne R Cianfrini

Advisory Committee Members

Katherine S Fabrizio

Alan Randich

David E Vance

Document Type

Dissertation

Date of Award

2014

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

Introduction: Patients commonly complain of subjective side effects of opioid use, including forgetfulness, slowed processing speed, confusion, and sedation - which have raised concerns about potential cognitive impairment. However, research on the effects of opioids on objective neuropsychological performance is thus far equivocal and, unfortunately, many of the studies cited as support for opioid-related impairment do not fully account for the neuropsychological effects of chronic pain, which has been shown to affect many of the same neuropsychological domains purported to be affected by opioids. To that end, we sought to examine whether: 1) chronic nociceptive pain itself results in objective neuropsychological impairment, and 2) stable use of immediate-release opioid analgesics ameliorates any neuropsychological impairment by virtue of relieving chronic pain intensity. Methods: 90 participants divided into three groups: 1) 30 individuals with no chronic pain or opioid use; 2) 30 individuals with chronic pain but no opioid use; and 3) 30 individuals with chronic pain treated with immediate-release oral opioid use. Participants completed a one-time appointment divided into five main portions: 1) informed consent; 2) adherence checks including a urine drug screen and 72-hour medication recall form; c) neuropsychological assessment battery; d) self-report questionnaires; and e) debriefing and $40 gift card compensation. Results: Findings garnered some support for our first hypothesis, which included statistically significant effects of chronic pain on commission error, F (2, 86) = 3.33, p < .05, partial n² = .07, and short delay auditory verbal recall, F (2, 89) = 3.42, p < .05, partial n² = .08, scores. These findings were observed despite statistically controlling for the effects of depression, concomitant medication use, and demographic variables. However, although statistically significant, these effect sizes are small and thus lacked clinical significance. Regarding our second hypothesis, no significant effects of opioid analgesics were observed on neuropsychological function. Discussion: Chronic pain resulted in small but statistically significant changes in attentional control, though these changes are not meaningful enough to be considered clinically significant. No opioid effect was observed on participants' neuropsychological function. Results of the present study are reframed in light of an emerging self-regulatory model of chronic pain.

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