Pain, hedonic regulation, and opioid misuse: Modulation of momentary experience by Mindfulness-Oriented Recovery Enhancement in opioid-treated chronic pain patients
Pain, hedonic regulation, and opioid misuse: Modulation of momentary experience by Mindfulness-Oriented Recovery Enhancement in opioid-treated chronic pain patients
复制标题
DOI：
10.1016/j.drugalcdep.2016.07.033
复制
发表时间：
2017-04-01
影响因子：
4.2
通讯作者：
Howard, Matthew O.
中科院分区：
文献类型：
--
作者：
Garland, Eric L.;Bryan, Craig J.;Howard, Matthew O.
背景资料：鉴于长期阿片类药物治疗的慢性疼痛患者存在阿片类药物滥用的风险，因此需要非药物治疗。此外，鉴于这一人群的享乐缺陷，增强积极影响的疗法可能是有用的。本研究的目的是检查正念导向恢复增强（MORE）干预对疼痛和积极情感体验的生态瞬时评估（EMA）的影响，并确定疼痛、情感及其相互作用的变化是否与治疗后阿片类药物滥用相关。方法：本研究检查了来自先前发表的MORE与支持组（SG）对照的RCT（NCT 01505101）中一个受试者子集（N = 55）的未发表EMA数据。在为期8周的治疗中，患者完成了多达224项EMA疼痛和情感测量。多层次模型和广义估计方程的治疗效果的瞬间疼痛和积极的影响，和广义线性模型研究疼痛和影响和阿片类药物滥用的变化post-treatment.Results：患者在MORE报告的改善显着更大的瞬间疼痛（p = 0.01）和积极的影响（p = 0.004）比患者在SG之间的关联。此外，在整个治疗过程中，MORE组患者比SG组患者更有可能表现出积极的情感调节（OR= 2.75）。最后，积极的影响（但不是疼痛）在干预过程中的改善与降低风险滥用阿片类药物的治疗后（p= 0.02）。结论：更多的可能是一个有用的非药物治疗慢性疼痛患者的疼痛和享乐缺陷阿片类药物滥用的风险。(C)2017年，作者。出版社：Elsevier爱尔兰Ltd.
Background: Given the risk of opioid misuse among chronic pain patients being treated with longterm opioid pharmacotherapy, non-pharmacological treatments are needed. Further, in light of hedonic deficits in this population, therapies that enhance positive affect may be useful. The purpose of this study was to examine effects of a Mindfulness-Oriented Recovery Enhancement (MORE) intervention on ecological momentary assessments (EMA) of pain and positive affective experience, and to determine if changes in pain, affect, and their interaction were associated with opioid misuse at post-treatment.Methods: This study examined unpublished EMA data from a subset of participants (N = 55) in a previously published RCT (NCT01505101) of MORE versus a support group (SG) control. Across 8 weeks of treatment, patients completed up to 224 EMA measures of pain and affect. Multilevel models and generalized estimating equations examined effects of treatment on momentary pain and positive affect, and generalized linear models examined associations between pain and affect and changes in opioid misuse by post-treatment.Results: Patients in MORE reported significantly greater improvements in momentary pain (p = 0.01) and positive affect (p = 0.004) than patients in the SG. Further, over the entire course of treatment, patients in MORE were significantly more likely to exhibit positive affect regulation (OR= 2.75) than patients in the SG. Finally, improvements in positive affect (but not pain) over the course of intervention were associated with reduced risk of misusing opioids by post-treatment (p= 0.02).Conclusion: MORE may be a useful non-pharmacological treatment for pain and hedonic deficits among chronic pain patients at risk for opioid misuse. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.