Mindfulness-Oriented Recovery Enhancement For Chronic Pain Patients Receiving Opi

接受 OPI 的慢性疼痛患者以正念为导向的康复增强

• 批准号: 8216332
• 负责人: Eric Lee Garland
• 金额: $ 3.68万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8216332
• 关键词: Absence of pain sensation; Addictive Behavior; Address; Affect; Affective; Aftercare; Alcohol or Other Drugs use; American; Anxiety; Arousal; Award; Behavior; Behavior Therapy; Characteristics; Chronic; Clinical; Clinical Trials; Cognitive; Communities; Consumption; Control Groups; Coupled; Creativeness; Cues; Data; Development; Diagnosis; Dose; Educational Intervention; Emotions; Ensure; Equilibrium; Esthesia; Feedback; Fellowship; Florida; Foundations; Fright; Funding; Future; Galvanic Skin Response; Grant; Hyperalgesia; Individual; Inpatients; Institutes; Intervention; Investments; Logistics; Manuals; Measures; Mediating; Mediator of activation protein; Medical; Mental Depression; Methodology; Modification; Neurobiology; Neurocognitive; Opiate Addiction; Opioid; Opioid Analgesics; Oral; Outcome; Pain; Participant; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Physical Dependence; Process; Protocols documentation; Psychophysiology; Public Health; Randomized; Randomized Controlled Trials; Recovery; Regulation; Relative (related person); Research; Research Personnel; Rewards; Risk; Sample Size; Sampling Studies; Science; Seeds; Societies; Stimulus; Stress; Support Groups; Symptoms; System; Testing; Training; Translational Research; Universities; addiction; adverse outcome; base; biobehavior; biological adaptation to stress; chronic pain; cognitive control; cognitive training; compare effectiveness; coping; cost; craving; cue reactivity; design; follow-up; heart rate variability; hedonic; improved; intervention effect; mindfulness; multi-component intervention; neuroadaptation; novel; operation; opioid misuse; opioid withdrawal; pilot trial; positive emotional state; prescription opioid; programs; psychologic; response; theories; therapy development; trait; treatment strategy; trial comparing; willingness

DESCRIPTION (provided by applicant): Opioids are commonly prescribed to relieve chronic pain symptoms. Although generally effective in the short- term, opioid therapy confers significant risk of long-term addiction. As many as 18% of patients become addicted to prescribed opioid analgesics, and nearly one quarter of chronic pain patients display signs of opioid misuse which may herald the transition from opioid use to addiction. Opioid craving and heightened sensitivity to pain predict the occurrence of opioid misuse behaviors and represent key targets for intervention. A number of mechanisms underlie these intervention targets. Hyperalgesia, amplified by stress and negative emotions, may result in increased opioid craving and consumption. Moreover, individuals may use opioids to self- medicate the negative affect, stress, and autonomic arousal that cause, co-occur with, and result from pain. In turn, opioid use among chronic pain patients may be driven by implicit neurocognitive operations, such as attentional biases towards opioid- and pain-related stimuli, which can initiate automatic, nonvolitional drug- seeking responses. Furthermore, chronic use of opioids may result in impaired processing of natural rewards, compelling users to consume higher doses to achieve hedonic equilibrium. Presently, few behavioral interventions address these pathogenic mechanisms. To that end, we propose to conduct a pilot randomized controlled trial (RCT) of a novel, dual-process intervention, Mindfulness-Oriented Recovery Enhancement (MORE), which unites complementary aspects of mindfulness training, cognitive restructuring, and positive emotion induction into an integrative treatment strategy. The PI has designed and adapted MORE to modify attentional biases, affective dysregulation, and autonomic stress responses underlying the feedback loop between chronic pain and opioid craving. In the proposed RCT, patients with a chronic pain diagnosis who have been treated with prescription opioids for more than 3 months will be randomly assigned to 8 weeks of MORE or a therapist-led, conventional support group. Assessments will be conducted at pre-, mid-, and post- treatment, as well as at a 3-month follow-up. Based on theory and previous research, we hypothesize that MORE will reduce pain, opioid craving, and opioid misuse behaviors while increasing well-being relative to the support group condition. We hypothesize that improvements in these clinical outcomes will be mediated by: decreased attentional biases and psychophysiological cue-reactivity to opioid and pain-related stimuli; increased cognitive control of automatic responses; increased affective processing of natural reward stimuli; decreased stress and negative affect; and increased pain coping and positive psychological processes. Opioid misuse and addiction in chronic pain patients is an emerging public health threat that exacts a tremendous cost to society. This application seeks SOAR grant support to bolster the execution, power, and precision of the proposed trial by allowing for a larger study sample and a more sophisticated biobehavioral assessment methodology. Study results will guide the development and implementation of a full-scale, R01-funded RCT. PUBLIC HEALTH RELEVANCE: Persons suffering from chronic pain who are treated with long-term opioid therapy are at risk of misusing prescription opioids and developing opioid addiction. Mindfulness training interventions have been shown reduce chronic pain symptoms, addictive processes, and substance use. The objective of the proposed study is to utilize a mindfulness-oriented cognitive intervention to decrease pain, opioid craving, and opioid misuse behaviors among chronic pain patients receiving opioid therapy

描述（由申请人提供）：阿片类药物通常用于缓解慢性疼痛症状。尽管阿片类药物在短期内通常有效，但长期成瘾的风险很大。多达 18% 的患者对处方阿片类镇痛药上瘾，近四分之一的慢性疼痛患者表现出阿片类药物滥用的迹象，这可能预示着从阿片类药物使用到成瘾的转变。阿片类药物的渴求和对疼痛的敏感性增强可预测阿片类药物滥用行为的发生，并代表干预的关键目标。这些干预目标背后有许多机制。压力和负面情绪加剧的痛觉过敏可能会导致阿片类药物的渴望和消费增加。此外，个体可以使用阿片类药物来自我治疗引起疼痛、与疼痛同时发生或由疼痛引起的负面情绪、压力和自主神经唤醒。反过来，慢性疼痛患者中阿片类药物的使用可能是由隐性神经认知操作驱动的，例如对阿片类药物和疼痛相关刺激的注意力偏差，这可以引发自动的、非自愿的药物寻求反应。此外，长期使用阿片类药物可能会导致自然奖励处理受损，迫使使用者消耗更高剂量以实现享乐平衡。目前，很少有行为干预措施能够解决这些致病机制。为此，我们建议开展一项新颖的双过程干预的试点随机对照试验（RCT），即以正念为导向的恢复增强（MORE），它将正念训练、认知重建和积极情绪诱导的互补方面结合起来综合治疗策略。 PI 设计并调整了 MORE，以改变慢性疼痛和阿片类药物渴求之间反馈循环背后的注意力偏差、情感失调和自主应激反应。在拟议的 RCT 中，已接受处方阿片类药物治疗超过 3 个月的慢性疼痛诊断患者将被随机分配到为期 8 周的 MORE 组或治疗师主导的常规支持组。评估将在治疗前、治疗中、治疗后以及 3 个月的随访中进行。根据理论和之前的研究，我们假设 MORE 将减少疼痛、阿片类药物的渴望和阿片类药物滥用行为，同时相对于支持小组的状况增加幸福感。我们假设这些临床结果的改善将通过以下因素介导：减少注意力偏差和对阿片类药物和疼痛相关刺激的心理生理提示反应；增强对自动反应的认知控制；增加对自然奖励刺激的情感处理；减少压力和负面影响；并增加疼痛应对和积极的心理过程。慢性疼痛患者的阿片类药物滥用和成瘾是一种新出现的公共卫生威胁，给社会带来巨大成本。该申请寻求 SOAR 拨款支持，通过允许更大的研究样本和更复杂的生物行为评估方法来增强拟议试验的执行、功效和精度。研究结果将指导 R01 资助的全面随机对照试验的开发和实施。 公共卫生相关性：长期接受阿片类药物治疗的慢性疼痛患者有滥用处方阿片类药物和发展阿片类药物成瘾的风险。正念训练干预已被证明可以减少慢性疼痛症状、成瘾过程和物质使用。拟议研究的目的是利用以正念为导向的认知干预来减少接受阿片类药物治疗的慢性疼痛患者的疼痛、阿片类药物渴望和阿片类药物滥用行为