Analgesic and Opioid Sparing Brain Mechanisms of Mindfulness-Oriented Recovery Enhancement for Chronic Low Back Pain

镇痛剂和阿片类药物保护慢性腰痛正念导向恢复的大脑机制

• 批准号: 10518975
• 负责人: Eric Lee Garland
• 金额: $ 63.66万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10518975
• 关键词: Address; Adjuvant; Affect; Affective; Aftercare; American; Analgesics; Analysis of Variance; Behavior; Behavioral; Belief; Brain; Breathing; Brief Pain Inventory; Characteristics; Chronic; Chronic disabling pain; Chronic low back pain; Clinical; Clinical Trials; Data; Distress; Dose; Economic Burden; Electroencephalogram; Evidence based intervention; Expectancy; Functional Magnetic Resonance Imaging; Future; Goals; Group Psychotherapy; Health; Individual; Individual Differences; Informal Social Control; Integrative Medicine; Interdisciplinary Study; Intervention; Literature; Mediating; Meditation; Mind-Body Intervention; Mindfulness Training; Modeling; Morbidity - disease rate; Nociception; Opioid; Opioid Analgesics; Outcome; Pain; Patients; Persons; Pharmaceutical Preparations; Physical therapy; Placebo Effect; Placebos; Process; Psychophysics; Psychotherapy; Public Health; Publishing; Randomized Clinical Trials; Recovery; Regulation; Research; Rest; Rewards; Science; Severities; Social support; Techniques; Testing; Thalamic structure; Therapeutic; Therapeutic Effect; TimeLine; Training; Translational Research; Treatment Efficacy; Work; arterial spin labeling; behavioral response; biobehavior; central pain; chronic pain; chronic pain management; chronic pain patient; chronic painful condition; clinical pain; cost effective; effective therapy; effectiveness research; expectation; follow-up; improved; innovation; insight; mindfulness; mindfulness intervention; mindfulness meditation; mortality; negative affect; neuroimaging; neuromechanism; neuropsychopharmacology; novel; opioid epidemic; opioid misuse; opioid sparing; opioid therapy; opioid use; opioid use disorder; pain patient; pain processing; pain relief; pain symptom; placebo controlled study; prescription opioid; relating to nervous system; response; reward processing; skills; therapy development; treatment as usual

ABSTRACT Chronic low back pain (cLBP) is the most common clinical pain condition worldwide, and the top chronic non-cancer condition for which opioids are prescribed. The current opioid crisis in the U.S. emerged in large part from overuse and misuse of opioids by patients with cLBP. Yet, there are few evidence-based interventions to reduce opioid use and misuse among patients with cLBP. Faced with a lack of effective treatment options, some cLBP patients become ensnared in a downward spiral of opioid dose escalation. Mindfulness-based interventions reduce chronic pain and opioid dosing. However, lack of mechanistic data has limited the deployment of these cost-effective and non-pharmacological treatment approaches. Multiple clinical trials indicate that Mindfulness-Oriented Recovery Enhancement (MORE), a novel mind-body therapy that integrates mindfulness with other affect regulation techniques, alleviates chronic pain symptoms as well as opioid use among people with cLBP. Yet, the active brain mechanisms of action underlying MORE’s analgesic and opioid sparing effects remain unknown. Further, no known placebo-controlled studies have disentangled the specific neural mechanisms of MORE or other mindfulness-based interventions for cLBP from nonspecific therapeutic factors like beliefs, expectancy, and social support. As such, the proposed study will employ one of the most rigorous control conditions in the mindfulness literature to date—a validated sham-mindfulness meditation technique combined with supportive psychotherapy (Sham-MORE). Integrating functional neuroimaging and psychophysics (noxious heat and behavioral pain ratings), the overarching aims of the proposed R01 study are to a) identify the neural mechanisms supporting the immediate analgesic effects of MORE (versus Sham-MORE and treatment-as- usual), and b) to determine if changes in default mode network functional connectivity predict individual differences in cLBP relief and opioid dose reduction following treatment with MORE. Ultimately, the proposed work will yield insight into the fundamental neuro-functional processes mediating the therapeutic effects of mindfulness-based interventions for cLBP, thereby facilitating the optimization of novel biobehavioral treatments for this highly prevalent and disabling chronic pain condition that helped to fuel the ongoing opioid crisis.

摘要 慢性腰痛（cLBP）是全球最常见的临床疼痛状况， 开阿片类药物治疗的慢性非癌症病症。当前的阿片类药物危机 美国在很大程度上是由于cLBP患者过度使用和滥用阿片类药物。然而， 很少有基于证据的干预措施来减少阿片类药物的使用和滥用， cLBP。由于缺乏有效的治疗方案，一些cLBP患者陷入困境， 阿片类药物剂量的螺旋式上升基于正念的干预措施减少慢性 疼痛和阿片类药物给药。然而，缺乏机械数据限制了这些系统的部署。 具有成本效益和非药物治疗方法。多项临床试验表明 正念导向恢复增强（MORE），一种新颖的身心疗法， 将正念与其他情绪调节技术相结合，缓解慢性疼痛症状， 以及阿片类药物的使用。然而，活跃的大脑活动机制 潜在的MORE的镇痛和阿片样物质保留作用仍然未知。此外，未知 安慰剂对照研究已经解开了MORE或其他 基于正念的cLBP干预来自非特异性治疗因素，如信念， 期望和社会支持。因此，拟议的研究将雇用最多的人之一 迄今为止，正念文献中严格的控制条件-一种经过验证的假正念 冥想技术结合支持性心理治疗（Sham-MORE）。整合 功能性神经影像学和精神物理学（有害热和行为疼痛评级）， 拟议的R 01研究的首要目标是：a）确定神经机制 支持MORE的即时镇痛作用（相对于假手术MORE和 通常），以及B）确定是否预测默认模式网络功能连通性的改变 MORE治疗后cLBP缓解和阿片类药物剂量减少的个体差异。 最终，拟议的工作将深入了解基本的神经功能过程 介导基于正念的cLBP干预的治疗效果，从而 促进了针对这种高度流行和 导致慢性疼痛的致残性疾病，助长了持续的阿片类药物危机。