Mindfulness-Oriented Recovery Enhancement For Chronic Pain Patients Receiving Opi

接受 OPI 的慢性疼痛患者以正念为导向的康复增强

• 批准号: 8216332
• 负责人: Eric Lee Garland
• 金额: $ 3.68万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8216332
• 关键词: Absence of pain sensation; Addictive Behavior; Address; Affect; Affective; Aftercare; Alcohol or Other Drugs use; American; Anxiety; Arousal; Award; Behavior; Behavior Therapy; Characteristics; Chronic; Clinical; Clinical Trials; Cognitive; Communities; Consumption; Control Groups; Coupled; Creativeness; Cues; Data; Development; Diagnosis; Dose; Educational Intervention; Emotions; Ensure; Equilibrium; Esthesia; Feedback; Fellowship; Florida; Foundations; Fright; Funding; Future; Galvanic Skin Response; Grant; Hyperalgesia; Individual; Inpatients; Institutes; Intervention; Investments; Logistics; Manuals; Measures; Mediating; Mediator of activation protein; Medical; Mental Depression; Methodology; Modification; Neurobiology; Neurocognitive; Opiate Addiction; Opioid; Opioid Analgesics; Oral; Outcome; Pain; Participant; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Physical Dependence; Process; Protocols documentation; Psychophysiology; Public Health; Randomized; Randomized Controlled Trials; Recovery; Regulation; Relative (related person); Research; Research Personnel; Rewards; Risk; Sample Size; Sampling Studies; Science; Seeds; Societies; Stimulus; Stress; Support Groups; Symptoms; System; Testing; Training; Translational Research; Universities; addiction; adverse outcome; base; biobehavior; biological adaptation to stress; chronic pain; cognitive control; cognitive training; compare effectiveness; coping; cost; craving; cue reactivity; design; follow-up; heart rate variability; hedonic; improved; intervention effect; mindfulness; multi-component intervention; neuroadaptation; novel; operation; opioid misuse; opioid withdrawal; pilot trial; positive emotional state; prescription opioid; programs; psychologic; response; theories; therapy development; trait; treatment strategy; trial comparing; willingness

DESCRIPTION (provided by applicant): Opioids are commonly prescribed to relieve chronic pain symptoms. Although generally effective in the short- term, opioid therapy confers significant risk of long-term addiction. As many as 18% of patients become addicted to prescribed opioid analgesics, and nearly one quarter of chronic pain patients display signs of opioid misuse which may herald the transition from opioid use to addiction. Opioid craving and heightened sensitivity to pain predict the occurrence of opioid misuse behaviors and represent key targets for intervention. A number of mechanisms underlie these intervention targets. Hyperalgesia, amplified by stress and negative emotions, may result in increased opioid craving and consumption. Moreover, individuals may use opioids to self- medicate the negative affect, stress, and autonomic arousal that cause, co-occur with, and result from pain. In turn, opioid use among chronic pain patients may be driven by implicit neurocognitive operations, such as attentional biases towards opioid- and pain-related stimuli, which can initiate automatic, nonvolitional drug- seeking responses. Furthermore, chronic use of opioids may result in impaired processing of natural rewards, compelling users to consume higher doses to achieve hedonic equilibrium. Presently, few behavioral interventions address these pathogenic mechanisms. To that end, we propose to conduct a pilot randomized controlled trial (RCT) of a novel, dual-process intervention, Mindfulness-Oriented Recovery Enhancement (MORE), which unites complementary aspects of mindfulness training, cognitive restructuring, and positive emotion induction into an integrative treatment strategy. The PI has designed and adapted MORE to modify attentional biases, affective dysregulation, and autonomic stress responses underlying the feedback loop between chronic pain and opioid craving. In the proposed RCT, patients with a chronic pain diagnosis who have been treated with prescription opioids for more than 3 months will be randomly assigned to 8 weeks of MORE or a therapist-led, conventional support group. Assessments will be conducted at pre-, mid-, and post- treatment, as well as at a 3-month follow-up. Based on theory and previous research, we hypothesize that MORE will reduce pain, opioid craving, and opioid misuse behaviors while increasing well-being relative to the support group condition. We hypothesize that improvements in these clinical outcomes will be mediated by: decreased attentional biases and psychophysiological cue-reactivity to opioid and pain-related stimuli; increased cognitive control of automatic responses; increased affective processing of natural reward stimuli; decreased stress and negative affect; and increased pain coping and positive psychological processes. Opioid misuse and addiction in chronic pain patients is an emerging public health threat that exacts a tremendous cost to society. This application seeks SOAR grant support to bolster the execution, power, and precision of the proposed trial by allowing for a larger study sample and a more sophisticated biobehavioral assessment methodology. Study results will guide the development and implementation of a full-scale, R01-funded RCT. PUBLIC HEALTH RELEVANCE: Persons suffering from chronic pain who are treated with long-term opioid therapy are at risk of misusing prescription opioids and developing opioid addiction. Mindfulness training interventions have been shown reduce chronic pain symptoms, addictive processes, and substance use. The objective of the proposed study is to utilize a mindfulness-oriented cognitive intervention to decrease pain, opioid craving, and opioid misuse behaviors among chronic pain patients receiving opioid therapy

描述（由申请人提供）：阿片类药物通常用于缓解慢性疼痛症状。虽然阿片类药物治疗通常在短期内有效，但具有长期成瘾的显著风险。多达18%的患者对处方阿片类镇痛药成瘾，近四分之一的慢性疼痛患者显示阿片类药物滥用的迹象，这可能预示着从阿片类药物使用到成瘾的转变。阿片类药物渴求和对疼痛的高度敏感性预测阿片类药物滥用行为的发生，并代表干预的关键目标。这些干预目标的基础是若干机制。痛觉过敏，由压力和负面情绪放大，可能会导致阿片类药物的渴望和消费增加。此外，个体可以使用阿片类药物来自我抑制引起疼痛、与疼痛同时发生以及由疼痛引起的负面情绪、压力和自主觉醒。反过来，慢性疼痛患者中阿片类药物的使用可能是由内隐神经认知操作驱动的，例如对阿片类药物和疼痛相关刺激的注意力偏差，这可以启动自动的、非意志性的药物寻求反应。此外，长期使用阿片类药物可能导致自然奖赏的加工受损，迫使使用者消耗更高剂量以实现享乐平衡。目前，很少有行为干预解决这些致病机制。为此，我们建议进行一项试点随机对照试验（RCT）的一种新的，双过程干预，正念导向恢复增强（MORE），它结合了正念训练，认知重建和积极情绪诱导的互补方面到一个综合的治疗策略。PI设计并调整了MORE，以改变慢性疼痛和阿片类药物渴望之间反馈回路的注意力偏差，情感失调和自主应激反应。在拟议的随机对照试验中，患有慢性疼痛诊断并接受处方阿片类药物治疗超过3个月的患者将被随机分配到8周的MORE或治疗师领导的传统支持组。将在治疗前、治疗中和治疗后以及3个月随访时进行评估。根据理论和以前的研究，我们假设MORE将减少疼痛，阿片类药物渴望和阿片类药物滥用行为，同时增加相对于支持组条件的幸福感。我们假设，这些临床结果的改善将介导：减少注意力偏差和心理生理线索反应阿片类药物和疼痛相关的刺激;增加自动反应的认知控制;增加自然奖励刺激的情感处理;减少压力和负面影响;增加疼痛应对和积极的心理过程。慢性疼痛患者中的阿片类药物滥用和成瘾是一种新出现的公共卫生威胁，给社会带来了巨大的成本。该申请寻求SOAR拨款支持，以通过允许更大的研究样本和更复杂的生物行为评估方法来支持拟议试验的执行，权力和精度。研究结果将指导R 01资助的全面RCT的开发和实施。 公共卫生关系：长期接受阿片类药物治疗的慢性疼痛患者有滥用处方阿片类药物和发展阿片类药物成瘾的风险。正念训练干预已被证明可以减少慢性疼痛症状，成瘾过程和物质使用。本研究的目的是利用正念导向的认知干预来减少接受阿片类药物治疗的慢性疼痛患者的疼痛、阿片类药物渴求和阿片类药物滥用行为