依存症研究と治療ジャーナル

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Opponent-Process Theory Predicts Cues Influence Drug Responses, Pain, and Opioid Abuse

Schachtman TR, Calton JL

Opponent-process theory describes the responses to drugs during exposure. It defines the processes that can contribute to addiction, and predicts the time course of drug responses, tolerance, withdrawal symptoms, and accidental overdose. Moreover, Siegel and many others have provided considerable evidence showing the influence of environmental cues in such effects. Cues present at the time of drug intake can become associated with the drug through Pavlovian conditioning. If narcotic pain relievers are administered in a consistent environment (e.g., at home or in a hospital room), then those cues can become associated with the drug. When opioid administration is discontinued, the conditioned location cues are predicted to induce hyperalgesia, leading to discomfort and pain. Patients may think they need to continue opioid usage when the pain they are experiencing is not due to their injuries (which are long healed); instead, the pain is due to these associative effects. These processes likely contribute to the widespread and tragic problem of opioid addiction, and provide implications for treatment of acute and chronic pain.