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

基本信息

  • 批准号:
    8335373
  • 负责人:
  • 金额:
    $ 3.68万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 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

项目摘要

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 stimul, 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.
阿片类药物通常用于缓解慢性疼痛症状。虽然在短期内普遍有效, 长期而言,阿片类药物治疗具有长期成瘾的重大风险。多达18%的患者 成瘾的处方阿片类镇痛药,近四分之一的慢性疼痛患者显示阿片类药物的迹象 滥用可能预示着从阿片类药物使用到成瘾的过渡。对阿片类药物的渴望和高度敏感 疼痛预测阿片类药物滥用行为的发生,并代表干预的关键目标。一些 这些干预目标背后的机制。痛觉过敏,被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,个人可以使用阿片类药物自我- 消除引起疼痛、与疼痛同时发生以及由疼痛引起的负面情绪、压力和自主神经唤醒。在 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- 寻求回应。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达到享乐平衡。目前,少数行为 干预措施针对这些致病机制。为此,我们建议进行一项试验, 一项新的双过程干预的对照试验(RCT),正念导向恢复增强 (更多),它结合了正念训练,认知重建和积极的补充方面 情绪诱导纳入综合治疗策略。PI设计并调整了MORE以修改 注意力偏差、情感失调和反馈回路下的自主应激反应 慢性疼痛和对阿片类药物的渴求之间的联系在拟议的RCT中,患有慢性疼痛诊断的患者 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至8周的 更多或治疗师领导的,传统的支持小组。评估将在评估前、评估中和评估后进行。 治疗,以及3个月的随访。基于理论和先前的研究,我们假设, 更多的将减少疼痛,阿片类药物的渴望,阿片类药物滥用行为,同时增加幸福相对于 支持组条件。我们假设这些临床结局的改善将通过以下方式介导: 减少对阿片类和疼痛相关刺激的注意力偏差和心理生理线索反应; 增加对自动反应的认知控制;增加对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。阿片 慢性疼痛患者的滥用和成瘾是一种新兴的公共卫生威胁,需要付出巨大的代价 对社会的贡献此应用程序寻求SOAR赠款支持,以加强执行,权力和精度的 通过允许更大的研究样本和更复杂的生物行为评估, 方法论研究结果将指导R 01资助的全面RCT的开发和实施。

项目成果

期刊论文数量(14)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Mindfulness is Associated With Increased Hedonic Capacity Among Chronic Pain Patients Receiving Extended Opioid Pharmacotherapy.
  • DOI:
    10.1097/ajp.0000000000000379
  • 发表时间:
    2017-02
  • 期刊:
  • 影响因子:
    0
  • 作者:
    Thomas EA;Garland EL
  • 通讯作者:
    Garland EL
Allostatic dysregulation of natural reward processing in prescription opioid misuse: autonomic and attentional evidence.
  • DOI:
    10.1016/j.biopsycho.2015.01.005
  • 发表时间:
    2015-02
  • 期刊:
  • 影响因子:
    2.6
  • 作者:
    Garland, Eric L.;Froeliger, Brett;Howard, Matthew O.
  • 通讯作者:
    Howard, Matthew O.
Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial.
State Mindfulness During Meditation Predicts Enhanced Cognitive Reappraisal.
  • DOI:
    10.1007/s12671-013-0250-6
  • 发表时间:
    2015-04-01
  • 期刊:
  • 影响因子:
    3.6
  • 作者:
    Garland, Eric L.;Hanley, Adam;Farb, Norman A.;Froeliger, Brett
  • 通讯作者:
    Froeliger, Brett
Effects of Mindfulness-Oriented Recovery Enhancement on reward responsiveness and opioid cue-reactivity.
  • DOI:
    10.1007/s00213-014-3504-7
  • 发表时间:
    2014-08
  • 期刊:
  • 影响因子:
    3.4
  • 作者:
    Garland, Eric L.;Froeliger, Brett;Howard, Matthew O.
  • 通讯作者:
    Howard, Matthew O.
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Eric Lee Garland其他文献

Eric Lee Garland的其他文献

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{{ truncateString('Eric Lee Garland', 18)}}的其他基金

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
  • 财政年份:
    2022
  • 资助金额:
    $ 3.68万
  • 项目类别:
Mindful interoceptive mapping: Elucidating a novel mechanism for treating opioid misuse and chronic pain
正念内感受映射:阐明治疗阿片类药物滥用和慢性疼痛的新机制
  • 批准号:
    10378500
  • 财政年份:
    2021
  • 资助金额:
    $ 3.68万
  • 项目类别:
Targeting Military Opioid Misuse with Mindfulness-Oriented Recovery Enhancement
通过以正念为导向的恢复增强来打击军事阿片类药物滥用
  • 批准号:
    8655958
  • 财政年份:
    2013
  • 资助金额:
    $ 3.68万
  • 项目类别:
Targeting Military Opioid Misuse with Mindfulness-Oriented Recovery Enhancement
通过以正念为导向的恢复增强来打击军事阿片类药物滥用
  • 批准号:
    8731855
  • 财政年份:
    2013
  • 资助金额:
    $ 3.68万
  • 项目类别:
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
  • 财政年份:
    2011
  • 资助金额:
    $ 3.68万
  • 项目类别:

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