Mindfulness-Oriented Recovery Enhancement Reduces Opioid Dose in Primary Care by Strengthening Autonomic Regulation During Meditation
Mindfulness-Oriented Recovery Enhancement Reduces Opioid Dose in Primary Care by Strengthening Autonomic Regulation During Meditation
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DOI：
10.1037/amp0000638
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发表时间：
2020-09-01
影响因子：
16.4
通讯作者：
Nakamura, Yoshio
中科院分区：
文献类型：
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作者：
Garland, Eric L.;Hudak, Justin;Nakamura, Yoshio
当前的阿片类药物危机是由于慢性疼痛患者阿片类药物剂量的增加而加剧的。然而，对于长期接受阿片类镇痛药治疗的慢性疼痛患者来说，减少阿片类药物剂量的循证心理干预措施很少。正念导向恢复增强 (MORE) 旨在针对慢性疼痛和阿片类药物滥用的基础机制，在两项随机临床试验 (RCT) 中显示出有希望的结果，并且可以通过加强自我调节来促进阿片类药物的节约和逐渐减少。在这里，我们通过对第二阶段随机对照试验的数据进行二次分析来检验这一假设。接受长期阿片类药物治疗的慢性疼痛患者 (N = 95) 被随机分配接受 8 周的 MORE 治疗或在初级保健中接受支持组 (SG) 对照治疗。通过 3 个月的随访时间线随访评估阿片类药物剂量。正念冥想期间的心率变异性（HRV）被量化为自我调节能力的指标。通过随访，MORE 参与者的阿片类药物剂量下降幅度更大（下降 32%），F(2, 129.77) = 5.35，p = .006，d = 1.07。与 SG 相比，MORE 与冥想期间 HRV 的显着增加相关。冥想引起的 HRV 变化部分介导了 MORE 对阿片类药物剂量减少的影响 (p = .034)。更多可以通过正念增强自我调节能力，从而促进对阿片类药物使用的自我控制，从而减少慢性疼痛患者的阿片类药物剂量。
The current opioid crisis was fueled by escalation of opioid dosing among patients with chronic pain. Yet, there are few evidence-based psychological interventions for opioid dose reduction among chronic pain patients treated with long-term opioid analgesics. Mindfulness-Oriented Recovery Enhancement (MORE), which was designed to target mechanisms underpinning chronic pain and opioid misuse, has shown promising results in 2 randomized clinical trials (RCTs) and could facilitate opioid sparing and tapering by bolstering self-regulation. Here we tested this hypothesis with secondary analyses of data from a Stage 2 RCT. Chronic pain patients (N = 95) on long-term opioid therapy were randomized to 8 weeks of MORE or a support group (SG) control delivered in primary care. Opioid dose was assessed with the Timeline Followback through 3-month follow-up. Heart rate variability (HRV) during mindfulness meditation was quantified as an indicator of self-regulatory capacity. Participants in MORE evidenced a greater decrease in opioid dosing (a 32% decrease) by follow-up than did the SG, F(2, 129.77) = 5.35, p = .006, d = 1.07. MORE was associated with a significantly greater increase in HRV during meditation than was the SG. Meditation-induced change in HRV partially mediated the effect of MORE on opioid dose reduction (p = .034). MORE may boost self-regulatory strength via mindfulness and thereby facilitate self-control over opioid use, leading to opioid dose reduction in people with chronic pain.