Dependency-like behaviors and pain coping styles in subjects with chronic migraine and medication overuse

Results from a 1-year follow-up study

Bruno Biagianti, Licia Grazzi, Susanna Usai, Orsola Gambini

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Even after successful detoxification, 20-40% of subjects presenting chronic migraine with symptomatic medication overuse (CMwMO) relapse into medication overuse within one year. In this restrospective analysis on subjects referred to our center for detoxification, we investigated whether personality traits, dependency-like behaviors and pain coping styles predicted those who relapsed into medication overuse within the 12 months following the detoxification and those who did not.Methods: 63 patients with CMwMO were assessed for personality traits, mood and anxiety, pain coping styles and dependency-like behaviors prior-to and one year after a detoxification program.Results: Of the 42 subjects who attended 1-year follow-up interviews, 11 relapsed into medication overuse despite a temporary benefit from detoxification and did not show clinical or psychological improvement, instead reporting increased anxiety and unmodified perpetuation of severe dependency-like behaviors. In contrast, subjects who did not relapse into medication overuse had clinical improvements that generalized to untreated domains, including decreased depressive symptoms and dependency-like behaviors, although showing unmodified low internal control over pain.Conclusions: Subjects who did not fall into medication overuse throughout the 12 months following the detoxification showed improved clinical, affective and dependence-related outcomes, but not pain coping strategies. Conversely, subjects who relapsed within one year into CMwMO continued to experience significant disability, pain intensity, and dependency-like behaviors. We believe that the persistence of maladaptive pain coping strategies and residual symptomatology increase the risk for recurrent relapses, against which pharmacological interventions are only partially effective. Further studies investigating predictors of relapse are needed to inform multi-disciplinary interventions for CMwMO.

Original languageEnglish
Article number181
JournalBMC Neurology
Volume14
Issue number1
DOIs
Publication statusPublished - Sep 19 2014

Fingerprint

Psychological Adaptation
Migraine Disorders
Pain
Recurrence
Personality
Anxiety
Prescription Drug Overuse
Dependency (Psychology)
Pharmacology
Interviews
Depression
Psychology

Keywords

  • Chronic migraine
  • Dependency-like behaviors
  • Headache-related disability
  • Medication overuse
  • Pain locus of control

ASJC Scopus subject areas

  • Clinical Neurology
  • Medicine(all)

Cite this

Dependency-like behaviors and pain coping styles in subjects with chronic migraine and medication overuse : Results from a 1-year follow-up study. / Biagianti, Bruno; Grazzi, Licia; Usai, Susanna; Gambini, Orsola.

In: BMC Neurology, Vol. 14, No. 1, 181, 19.09.2014.

Research output: Contribution to journalArticle

@article{9ba4cb9fe10a4c9192144a40115e9008,
title = "Dependency-like behaviors and pain coping styles in subjects with chronic migraine and medication overuse: Results from a 1-year follow-up study",
abstract = "Background: Even after successful detoxification, 20-40{\%} of subjects presenting chronic migraine with symptomatic medication overuse (CMwMO) relapse into medication overuse within one year. In this restrospective analysis on subjects referred to our center for detoxification, we investigated whether personality traits, dependency-like behaviors and pain coping styles predicted those who relapsed into medication overuse within the 12 months following the detoxification and those who did not.Methods: 63 patients with CMwMO were assessed for personality traits, mood and anxiety, pain coping styles and dependency-like behaviors prior-to and one year after a detoxification program.Results: Of the 42 subjects who attended 1-year follow-up interviews, 11 relapsed into medication overuse despite a temporary benefit from detoxification and did not show clinical or psychological improvement, instead reporting increased anxiety and unmodified perpetuation of severe dependency-like behaviors. In contrast, subjects who did not relapse into medication overuse had clinical improvements that generalized to untreated domains, including decreased depressive symptoms and dependency-like behaviors, although showing unmodified low internal control over pain.Conclusions: Subjects who did not fall into medication overuse throughout the 12 months following the detoxification showed improved clinical, affective and dependence-related outcomes, but not pain coping strategies. Conversely, subjects who relapsed within one year into CMwMO continued to experience significant disability, pain intensity, and dependency-like behaviors. We believe that the persistence of maladaptive pain coping strategies and residual symptomatology increase the risk for recurrent relapses, against which pharmacological interventions are only partially effective. Further studies investigating predictors of relapse are needed to inform multi-disciplinary interventions for CMwMO.",
keywords = "Chronic migraine, Dependency-like behaviors, Headache-related disability, Medication overuse, Pain locus of control",
author = "Bruno Biagianti and Licia Grazzi and Susanna Usai and Orsola Gambini",
year = "2014",
month = "9",
day = "19",
doi = "10.1186/s12883-014-0181-4",
language = "English",
volume = "14",
journal = "BMC Neurology",
issn = "1471-2377",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Dependency-like behaviors and pain coping styles in subjects with chronic migraine and medication overuse

T2 - Results from a 1-year follow-up study

AU - Biagianti, Bruno

AU - Grazzi, Licia

AU - Usai, Susanna

AU - Gambini, Orsola

PY - 2014/9/19

Y1 - 2014/9/19

N2 - Background: Even after successful detoxification, 20-40% of subjects presenting chronic migraine with symptomatic medication overuse (CMwMO) relapse into medication overuse within one year. In this restrospective analysis on subjects referred to our center for detoxification, we investigated whether personality traits, dependency-like behaviors and pain coping styles predicted those who relapsed into medication overuse within the 12 months following the detoxification and those who did not.Methods: 63 patients with CMwMO were assessed for personality traits, mood and anxiety, pain coping styles and dependency-like behaviors prior-to and one year after a detoxification program.Results: Of the 42 subjects who attended 1-year follow-up interviews, 11 relapsed into medication overuse despite a temporary benefit from detoxification and did not show clinical or psychological improvement, instead reporting increased anxiety and unmodified perpetuation of severe dependency-like behaviors. In contrast, subjects who did not relapse into medication overuse had clinical improvements that generalized to untreated domains, including decreased depressive symptoms and dependency-like behaviors, although showing unmodified low internal control over pain.Conclusions: Subjects who did not fall into medication overuse throughout the 12 months following the detoxification showed improved clinical, affective and dependence-related outcomes, but not pain coping strategies. Conversely, subjects who relapsed within one year into CMwMO continued to experience significant disability, pain intensity, and dependency-like behaviors. We believe that the persistence of maladaptive pain coping strategies and residual symptomatology increase the risk for recurrent relapses, against which pharmacological interventions are only partially effective. Further studies investigating predictors of relapse are needed to inform multi-disciplinary interventions for CMwMO.

AB - Background: Even after successful detoxification, 20-40% of subjects presenting chronic migraine with symptomatic medication overuse (CMwMO) relapse into medication overuse within one year. In this restrospective analysis on subjects referred to our center for detoxification, we investigated whether personality traits, dependency-like behaviors and pain coping styles predicted those who relapsed into medication overuse within the 12 months following the detoxification and those who did not.Methods: 63 patients with CMwMO were assessed for personality traits, mood and anxiety, pain coping styles and dependency-like behaviors prior-to and one year after a detoxification program.Results: Of the 42 subjects who attended 1-year follow-up interviews, 11 relapsed into medication overuse despite a temporary benefit from detoxification and did not show clinical or psychological improvement, instead reporting increased anxiety and unmodified perpetuation of severe dependency-like behaviors. In contrast, subjects who did not relapse into medication overuse had clinical improvements that generalized to untreated domains, including decreased depressive symptoms and dependency-like behaviors, although showing unmodified low internal control over pain.Conclusions: Subjects who did not fall into medication overuse throughout the 12 months following the detoxification showed improved clinical, affective and dependence-related outcomes, but not pain coping strategies. Conversely, subjects who relapsed within one year into CMwMO continued to experience significant disability, pain intensity, and dependency-like behaviors. We believe that the persistence of maladaptive pain coping strategies and residual symptomatology increase the risk for recurrent relapses, against which pharmacological interventions are only partially effective. Further studies investigating predictors of relapse are needed to inform multi-disciplinary interventions for CMwMO.

KW - Chronic migraine

KW - Dependency-like behaviors

KW - Headache-related disability

KW - Medication overuse

KW - Pain locus of control

UR - http://www.scopus.com/inward/record.url?scp=84908123446&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908123446&partnerID=8YFLogxK

U2 - 10.1186/s12883-014-0181-4

DO - 10.1186/s12883-014-0181-4

M3 - Article

VL - 14

JO - BMC Neurology

JF - BMC Neurology

SN - 1471-2377

IS - 1

M1 - 181

ER -