Date Presented 04/04/19
SUD impacts the individual and his family's daily occupations while posing a massive health and societal concern. OTs may contribute a unique perspective in understanding this phenomenon. This is the first study to explore pain sensitivity and SMD in SUD. Findings demonstrate that while pain and SMD coexist, SMD may serve as a risk factor for having SUD, thus indicating a potential additive value for OTs in SUD therapy.
Primary Author and Speaker: Tami Bar-Shalita
Additional Authors and Speakers: Naama Asayag
Contributing Authors: Yoram Bonneh, Shula Parush
PURPOSE: Substance use disorder (SUD) is a health condition characterized by cognitive, behavioral, and physiological symptoms including pain. Interestingly, pain and sensory modulation disorder (SMD) were found to be associated in other clinical populations. While scarce evidence demonstrates sensory modulation alterations in SUD, no studies investigating pain and SMD in SUD were reported. The aim of this study was to explore SMD and pain among individuals with SUD residing in a therapeutic community.
DESIGN: Using a convenience sampling, this cross-sectional experimental study included 123 participants aged 18-54: sixty- three diagnosed with SUD (study group), and 60 healthy controls. The study group comprised of individuals residing in a Therapeutic community for substance use disorder, meeting the DSM -IV diagnostic criteria for SUD based on clinical judgment, with SUD severity ranging from moderate to severe. No group differences were found for age and sex distribution (p>0.05).
METHOD: Participants completed two self-report questionnaires; The sensory responsiveness questionnaire-Intensity scale (SRQ-IS), and the Pain sensitivity questionnaire (PSQ). Participants also performed two psychophysical tests (i) von-Frey Monofilaments testing pinprick pain in 3 forces of 75g.; 127g.; 281g., repeated 3 times each in a pseudorandom order, and (ii) the Battery of Aversiveness to Sounds (BAS)-Revised for testing auditory pain and unpleasantness, comprised of 6 ecological sounds, repeated 3 times each in a randomized order. Pain and unpleasantness ratings were modelled using repeated measures analysis of covariance, and logistic regression modeling was performed to identify risk factors for having SUD.
RESULTS: Fifty four percent of individuals in the study group vs. 11.7% in the control group were identified with SMD (χ2 (1) = 24.61; p<0.0001), and both SRQ-IS mean group scores (Hedonic and Aversive) were found higher in the study group (p= 0.0002/ <.0001, respectively). Statistically significant group differences were also found in the PSQ-total, -moderate, and -minor scores indicating higher scores in the study group (p<0.0001). Further, group differences were found on the BAS for both pain and unpleasantness scores (LSMeans differences, p<0.0001; p<0.0001, respectively). No group differences were found for pinprick pain estimations. Finally, logistic regression modeling revealed that the risk for having SUD is 8.43 times higher for individuals with SMD (p< 0.0001) while it is 16.6 times higher for individuals with over-responsive type of SMD (p< 0.0001).
CONCLUSION: Findings demonstrate that SMD and pain sensitivity co-exist in SUD. Further, SMD and more so the over-responsive type may be a risk factor for having SUD. Results may serve as an important foundation for Occupational Therapy's unique contribution in this under-treated population.
References
Bashapoor, S., Hosseini-Kiasari, S. T., Daneshvar, S., & Kazemi-Taskooh, Z. (2015). Comparing Sensory Information Processing and Alexithymia between People with Substance Dependency and Normal. Addiction & health, 7(3-4), 174. doi:10.1016/j.bbr.2009.09.015
Weissman-Fogel, I., Granovsky, Y., & Bar-Shalita T. (2018). Sensory over-responsiveness among healthy subjects is associated with a pro-nociceptive state. Pain Practice 8, (4), 473–486. DOI. 10.1111/papr.12619
