Correlation between NARX Score and Food Addictive Behavioral Patterns in Chronic Pain Patients

Abstract

Setting and Objective.  With still rising drug overdose deaths already at unprecedented alarming levels, reliable indicators of addiction and addiction-vulnerability are urgently needed.  In the U.S., NARX scores are widely accepted as providing objective measures / predictors of drug-addiction risk.  NARX scores are deemed especially useful when informing a broad patient-profile.  Such profiles may to good advantage be enriched by patients’ answers to standard health questionnaires dealing with drug usage, but the advantage is blunted by questionable candor of patients’ answers.  Use of questionnaires – and, thereby, NARX scores – would be enhanced by questions eliciting more honest answers. 

Design and Participants.  Our research explores the utility of questions relating to food-addictive behaviors as proxies for and/or adjuncts to standard questionnaires.  Our questions’ respondents were 100+ chronic pain patients with well-developed patient-profiles, including up-to-date NARX scores.  The patients responded to the same areas of inquiry found on standard questionnaires directly probing patients’ drug exposure / use / abuse / addiction, but with food categories as selection-choices: Questions regarding what a patient would intake for improvement of mood; in the absence of which, the patient experiences withdrawal; intake of which, diminishes participation in normal activities; etc., were followed by selection-choices of such foods as ‘Chocolate’ and ‘Meat’ in place of selection-choices of drugs – with a total of eight questions, each presenting an identical set of four food selection-choices.  Our questionnaire elicited over 800 question-selection pairs (e.g., mood-Chocolate; mood-Meat; withdrawal-Chocolate; withdrawal-Meat).  Relationships between NARX scores and respondents’ choices were assessed by linear regression and t-distribution analyses. 

Results.  For particular question-selection pairings, the statistical analyses demonstrated strong correlations between risk factors reflected in NARX scores and food-addictive behavioral patterns.  Notably, Meat as the selection for those high-correlation questions was associated with the chronic pain patients with the highest NARX scores (i.e., at highest risk); Cheese, the lowest.  Other foods reported with high frequency were sodas and sweets, underscoring the role of sugar in chronic pain syndromes. 

Conclusions.  Questionnaires probing selected food-addictive behaviors, with higher expectation than drug-related questions of eliciting honest answers, may serve to complement patient-profiles with regard to addiction-vulnerability and, thereby, enhance the use of NARX scores in confronting current rising tides of drug addiction, such as those currently manifested in the growing opioid epidemic.  We note the utility of such food-centric questionnaires in building addiction profiles in demographics that may not have informative NARX scores, such as recent immigrants.  We advocate further clinical studies exploring food-addictive behaviors as proxies for and/or adjuncts to drug-addictive behaviors.