Mindful interoceptive mapping: Elucidating a novel mechanism for treating opioid misuse and chronic pain

项目摘要 基于正念的干预(Mbi)正在成为1150万人的有效治疗选择。 美国慢性疼痛患者长期接受阿片类止痛药治疗，但所有正念练习- 结构是不一样的。大多数mbi使用呼吸作为正念练习的焦点；正念 定向恢复增强(更多)使用疼痛。更多的是教慢性疼痛患者用心去做- 将疼痛感知构建为其构成的情感配值的物理感觉，并映射每种感觉的前 简明身体位置。这种有意识的内感映射(MIM)过程典型地揭示了非 愉悦的感觉(例如，刺伤)，身体内完全没有感觉的空间，甚至 愉快的感觉(例如，“温暖”)在任何给定的时刻都是共存的。通过这种方式，MIM拓宽了 疼痛管理不仅仅是近视，重点是减轻症状。培养愉悦的体感意识-- SATES对阿片类药物治疗的慢性疼痛患者特别有疗效，因为(I)令人愉快的费用- 疼痛是止痛药，(Ii)慢性疼痛和阿片类药物暴露都会导致享乐性缺陷，以及(Iii)Iina- 无法体验自然愉悦是成瘾行为的核心机制。有一个紧急的和未得到满足的 需要确定增加慢性疼痛患者体验性疼痛的非药物治疗方法 在减轻他们的疼痛和阿片类药物使用的服务中获得乐趣。如果没有更好的疼痛管理技术， 脆弱的阿片类药物治疗的慢性疼痛患者将继续面临从处方过渡的风险 阿片类药物用于疼痛控制，阿片类药物滥用和成瘾。与治疗相一致(有助于结束 长期上瘾)，我们的长期目标是加强疼痛管理，预防OPI- 通过优化阿片类药物治疗的慢性疼痛患者的mbi来实现旧的滥用。拟议项目的核心假设是- 最重要的是，MIM指导将使慢性疼痛患者能够将不愉快的感觉重新设置为 在更大的愉悦身体感觉领域中的一个躯体方面，从而改变他们对 疼痛和他们对止痛药的渴望。这个项目是研究计划的下一个合乎逻辑的步骤 我们(I)创造了唯一可以同时评估愉快和不愉快的数字感觉人体模型 身体感觉，(Ii)形成了心理测量学上健全的和临床上有用的愉悦感比率(请- 蚂蚁/令人不快)，以及(Iii)进行了两个初步的随机临床试验，在这些试验中，我们发现了正念 训练增加了快感比率(↑愉悦/不愉悦)，这反过来又降低了阿片类药物的欲望 以及与阿片类药物滥用(AMRB)和疼痛功能相关的异常药物相关行为- 人为干扰。我们的初步数据显示，MIM和传统的正念呼吸都增加了恳求- 蚂蚁感觉比率。我们不知道的是，MIM和专注呼吸是否会对愉悦感觉产生不同的影响- 站位比。知道哪种类型的正念训练最有效地增加快感 TIOS将使我们能够更好地补救享乐性缺陷，从而更好地治疗阿片类药物滥用和成瘾。

PROJECT ABSTRACT Mindfulness-based interventions (MBIs) are emerging as efficacious treatment options for the 11.5 million Americans with chronic pain on long-term opioid analgesic pharmacotherapy, but all mindfulness practice in- structions are not the same. Most MBIs use the breath as the focal point of mindfulness practice; Mindfulness Oriented Recovery Enhancement (MORE) uses pain. MORE teaches chronic pain patients to mindfully decon- struct a pain percept into its constituent affectively-valenced physical sensations and map each sensation’s pre- cise bodily location. This mindful interoceptive mapping (MIM) process typically reveals a combination of un- pleasant sensations (e.g., “stabbing”), spaces within the body that are entirely absent of sensation, and even pleasant sensations (e.g., “warmth”) co-existing at any given moment. In this way, MIM broadens the scope of pain management beyond a myopic focus on symptom reduction. Cultivating awareness of pleasant bodily sen- sations stands to be particularly therapeutic for opioid-treated chronic pain patients because (i) pleasant expe- riences are analgesic, (ii) both chronic pain and opioid exposure can lead to hedonic deficits, and (iii) the ina- bility to experience natural pleasure is a core mechanism of addictive behavior. There is an urgent and unmet need to identify non-pharmacological techniques that increase chronic pain patients’ embodied experience of pleasure in the service of decreasing their pain and opioid use. Without better pain management techniques, vulnerable opioid-treated chronic pain patients will continue to be at risk for transitioning from prescription opioid use for pain management to opioid misuse and addiction. Consistent with the HEAL (Helping to End Addiction Long-term) Initiative priorities, our long-term goal is to enhance pain management and prevent opi- oid misuse by optimizing MBIs for opioid-treated chronic pain patients. The proposed project’s central hypoth- esis is that MIM instruction will enable chronic pain patients to recontextualize unpleasant sensation as only one somatic aspect in a larger field of pleasant bodily sensation, and thereby alter their subjective experience of pain and their desire for pain medication. This project is the next logical step in a program of research in which we (i) created the only digital sensation manikin that simultaneously assesses both pleasant and unpleasant bodily sensations, (ii) developed a psychometrically sound and clinically useful pleasant sensation ratio (pleas- ant/unpleasant), and (iii) conducted two preliminary randomized clinical trials in which we found mindfulness training increased the pleasant sensation ratio (↑pleasant/unpleasant), which in turn decreased opioid desire and pain as well as aberrant medication-related behavior associated with opioid misuse (AMRB) and pain func- tional interference. Our preliminary data suggests both MIM and traditional mindful breathing increase pleas- ant sensation ratios. What we do not know is if MIM and mindful breathing differentially impact pleasant sen- sation ratios. Knowing which type of mindfulness instruction most effectively increases pleasant sensation ra- tios will allow us to better remediate hedonic deficits and, thereby, better treat opioid misuse and addiction.