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

项目摘要 基于正念的干预措施 (MBI) 正在成为 1150 万人的有效治疗选择 患有慢性疼痛的美国人接受长期阿片类镇痛药物治疗，但所有正念练习都是在- 说明不一样。大多数 MBI 将呼吸作为正念练习的焦点；正念 定向恢复增强（MORE）利用疼痛。 MORE 教导慢性疼痛患者有意识地解构 将疼痛感知构建为其组成的情感效价的身体感觉，并映射每种感觉的预 正确的身体位置。这种正念内感受映射（MIM）过程通常揭示了非 愉悦的感觉（例如“刺痛”）、身体内完全没有感觉的空间，甚至 愉悦的感觉（例如“温暖”）在任何特定时刻同时存在。通过这种方式，MIM 拓宽了范围 疼痛管理不仅仅是短视地关注减轻症状。培养愉悦身体感觉的意识 对于接受阿片类药物治疗的慢性疼痛患者来说，这种疗法尤其具有治疗作用，因为（i）令人愉快的体验 药物具有镇痛作用，(ii) 慢性疼痛和阿片类药物暴露均可导致享乐缺陷，以及 (iii) 体验自然快乐的能力是成瘾行为的核心机制。有一个紧急且未满足的问题 需要确定能够增加慢性疼痛患者的具体体验的非药物技术 为减少他们的疼痛和阿片类药物的使用而感到高兴。如果没有更好的疼痛管理技术， 接受阿片类药物治疗的慢性疼痛患者将继续面临从处方药过渡的风险 阿片类药物用于疼痛管理、阿片类药物滥用和成瘾。与治愈一致（帮助结束 成瘾长期）倡议优先事项，我们的长期目标是加强疼痛管理并预防阿片类药物成瘾 通过优化阿片类药物治疗的慢性疼痛患者的 MBI 来防止阿片类药物滥用。拟议项目的中心假设 最重要的是，MIM 指导将使慢性疼痛患者能够重新认识不愉快的感觉，因为这只是 在更大的令人愉快的身体感觉领域中的一个躯体方面，从而改变他们的主观体验 疼痛和他们对止痛药的渴望。该项目是研究计划的下一个逻辑步骤，其中 我们 (i) 创建了唯一可以同时评估愉快和不愉快的数字感觉模型 身体感觉，（ii）开发了心理测量学上合理且临床上有用的愉悦感比率（请- 蚂蚁/不愉快），以及（iii）进行了两项初步随机临床试验，其中我们发现了正念 训练增加了愉悦感比率（↑愉快/不愉快），从而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 心理干扰。我们的初步数据表明 MIM 和传统的正念呼吸都会增加愉悦感—— 蚂蚁感觉比率。我们不知道的是，MIM 和正念呼吸是否会对愉悦感产生不同的影响？ 站比率。了解哪种类型的正念指导最有效地增加愉悦感 tios 将使我们能够更好地纠正享乐缺陷，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.