Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards.
Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards.
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DOI：
10.1017/s0033291721003834
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发表时间：
2023-04
影响因子：
6.9
通讯作者：
Froeliger, Brett
中科院分区：
文献类型：
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作者：
Garland, Eric L.;Fix, Spencer T.;Hudak, Justin P.;Bernat, Edward M.;Nakamura, Yoshio;Hanley, Adam W.;Donaldson, Gary W.;Marchand, William R.;Froeliger, Brett
在慢性疼痛的背景下，长期阿片类药物治疗（LTOT）的神经精神药理学效应可能导致主观快感缺乏，并伴有对自然奖励的注意力下降。然而，对于与慢性阿片类药物使用相关的快感缺失和奖励缺陷，还没有已知的有效治疗方法。正念导向的恢复增强（MORE）是一种将正念训练与自然奖励相结合的新型行为干预，可能有望治疗LTOT中的快感缺失。接受LTOT治疗慢性疼痛的退伍军人（N = 63）被随机分配到8周的MORE或支持组（SG）心理治疗对照组。在8周治疗组之前和之后，我们评估了MORE对观看和上调对自然奖励线索的反应（即品味）期间的脑电图和皮肤电导水平（SCL）的晚正电位（LPP）的影响。然后，我们研究了这些神经生理学效应是否与4个月随访时主观快感缺失的减少有关。接受MORE治疗的患者表现出对自然奖励线索的LPP和SCL显著增加，相对于SG患者，主观快感缺失的降低幅度更大。MORE对减少快感缺乏的作用在统计学上是由品尝期间LPP反应的增加介导的。MORE增强了LTOT慢性疼痛患者对自然奖励线索的主动注意力，这一点可以通过增加皮层电反应和交感神经系统反应来证明。鉴于临床靶点参与的神经生理学证据，MORE可能是慢性阿片类药物使用者，慢性疼痛患者和有阿片类药物使用障碍风险的患者中快感缺失的有效治疗方法。
Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Yet, there are no known efficacious treatments for anhedonia and reward deficits associated with chronic opioid use. Mindfulness-Oriented Recovery Enhancement (MORE), a novel behavioral intervention combining training in mindfulness with savoring of natural rewards, may hold promise for treating anhedonia in LTOT. Veterans receiving LTOT (N = 63) for chronic pain were randomized to 8 weeks of MORE or a supportive group (SG) psychotherapy control. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. We then examined whether these neurophysiological effects were associated with reductions in subjective anhedonia by 4-month follow-up. Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. The effect of MORE on reducing anhedonia was statistically mediated by increases in LPP response during savoring. MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder.