Mindfulness-Oriented Recovery Enhancement Reduces Opioid Misuse Risk via Analgesic and Positive Psychological Mechanisms: A Randomized Controlled Trial
Mindfulness-Oriented Recovery Enhancement Reduces Opioid Misuse Risk via Analgesic and Positive Psychological Mechanisms: A Randomized Controlled Trial
复制标题
DOI：
10.1037/ccp0000390
复制
发表时间：
2019-10-01
影响因子：
5.9
通讯作者：
Howard, Matthew O.
中科院分区：
文献类型：
--
作者：
Garland, Eric L.;Hanley, Adam W.;Howard, Matthew O.
目的：尽管当前处方阿片类药物危机日益紧迫，但对长期接受阿片类镇痛药的慢性疼痛患者的心理治疗却很少进行评估。目前的心理疼痛治疗主要侧重于改善消极情感过程，但基础科学表明阿片类药物滥用的风险与缺乏积极情感有关。调节积极心理过程的干预措施可能会对阿片类药物治疗的慢性疼痛患者产生治疗效果。本研究的目的是对正念导向恢复增强 (MORE) 的第二阶段随机对照试验的近期结果数据进行理论驱动的机制分析，MORE 是一种旨在促进积极心理健康的综合干预措施。方法：接受阿片类药物治疗的慢性疼痛患者（N = 95；年龄 = 56.8 +/- 11.7；66% 为女性）被随机分配接受治疗师主导的 MORE 或支持小组 (SG) 干预措施，为期 8 周。潜在的积极心理健康变量由积极情感、生活意义和自我超越措施组成，作为 MORE 对治疗后疼痛严重程度变化和 3 个月随访时阿片类药物滥用风险影响的中介因素进行了检查。结果：与 SG 参与者相比，MORE 参与者报告治疗后疼痛严重程度显着降低 (p = .03)，3 个月随访后阿片类药物滥用风险显着降低 (p = .03)，积极心理健康状况显着提高 (p < .001)。积极心理健康的增加介导了 MORE 对治疗后疼痛严重程度的影响 (p = .048)，这反过来又预测随访后阿片类药物滥用风险的降低 (p = .02)。结论：通过 MORE 和其他心理干预措施针对积极的心理机制可能会降低接受长期阿片类药物治疗的慢性疼痛患者阿片类药物滥用的风险。
Objective: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health. Method: Patients with opioid-treated chronic pain (N = 95; age = 56.8 +/- 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up. Results: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p < .001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p = .048), which in turn predicted decreases in opioid misuse risk by follow-up (p = .02). Conclusions: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy.