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（MBIs）正在成为1150万人的有效治疗选择 美国慢性疼痛的长期阿片类镇痛药物治疗，但所有的正念练习- 结构不一样。大多数MBIs使用呼吸作为正念练习的焦点; 定向恢复增强（更多）使用疼痛。更多的是教慢性疼痛患者有意识地解毒- 将一种疼痛感受结构化为它的情感性生理感觉，并映射每一种感觉的前 确定身体位置这种有意识的内感受映射（MIM）过程通常揭示了一个组合， 愉快的感觉（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”在任何时候都是共存的。通过这种方式，MIM拓宽了 疼痛管理超越了对症状减轻的短视关注。培养愉快的身体感觉的意识- Sations对于阿片类药物治疗的慢性疼痛患者特别有治疗作用，因为（i）愉快的体验， 阿片类药物是镇痛药，（ii）慢性疼痛和阿片类药物暴露都可能导致享乐缺陷，（iii） 体验自然愉悦的能力是成瘾行为的核心机制。有一个紧迫的和未得到满足的 需要确定非药物技术，增加慢性疼痛患者的具体经验， 享受减少疼痛和阿片类药物使用的服务。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管理到阿片类药物滥用和成瘾。帮助结束（Helping to End） 成瘾长期）倡议优先事项，我们的长期目标是加强疼痛管理和预防阿片类药物， 通过优化阿片类药物治疗慢性疼痛患者的MBIs来防止滥用。该项目的核心假设- 这是MIM指令将使慢性疼痛患者重新语境不愉快的感觉， 一个躯体方面在一个更大的领域愉快的身体感觉，从而改变他们的主观经验， 疼痛和他们对止痛药的渴望。该项目是研究计划的下一个合乎逻辑的步骤， 我们（i）创造了唯一一个同时评估愉快和不愉快的数字感觉模型 身体感觉，（ii）开发了一个心理测量学上的声音和临床上有用的愉快感觉比率（请- 蚂蚁/不愉快），（iii）进行了两项初步的随机临床试验，其中我们发现正念 训练增加了快感比率（↑愉快/不愉快），这反过来又降低了阿片类药物的欲望 和疼痛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， 干扰。我们的初步数据表明，MIM和传统的正念呼吸都能增加愉悦感- 蚂蚁感觉比率我们不知道的是，MIM和正念呼吸是否会对愉快的感觉产生不同的影响。 饱和比。知道哪种类型的正念指导最有效地增加了愉快的感觉， tios将使我们能够更好地补救享乐缺陷，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.