Mindfulness-Oriented Recovery Enhancement For Chronic Pain Patients Receiving Opi

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在短期内普遍有效，但长期成瘾的风险很大。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表现出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。阿片类药物渴望和对疼痛的高度敏感性预示着阿片类药物滥用行为的发生，是干预的关键目标。这些干预目标的基础是若干机制。痛觉过敏，被压力和负面情绪放大，可能导致阿片类药物的渴望和消费增加。此外，个体可能使用阿片类药物来自我治疗引起疼痛、与疼痛同时发生或由疼痛引起的负面影响、压力和自主神经觉醒。反过来，慢性疼痛患者的阿片类药物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偏差，这可以启动自动的、非自愿的药物寻求反应。此外，长期使用阿片类药物可能导致对自然奖励的处理受损，迫使使用者消耗更高剂量以实现享乐平衡。目前，很少有行为干预措施解决这些致病机制。为此，我们建议对一种新的双过程干预——正念导向恢复增强（MORE）进行一项试点随机对照试验（RCT），它将正念训练、认知重构和积极情绪诱导的互补方面结合在一起，形成一种综合治疗策略。PI设计并调整了MORE，以修改慢性疼痛和阿片类药物渴望之间反馈回路的注意偏差、情感失调和自主应激反应。在拟议的随机对照试验中，已接受处方阿片类药物治疗超过3个月的慢性疼痛诊断患者将被随机分配到8周的more或由治疗师领导的传统支持小组。评估将在治疗前、治疗中、治疗后以及3个月的随访中进行。基于理论和先前的研究，我们假设更多会减少疼痛、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团体条件的幸福感。我们假设这些临床结果的改善将由以下因素介导：减少对阿片类药物和疼痛相关刺激的注意偏差和心理生理线索反应；增强对自动反应的认知控制；自然奖励刺激的情感加工增加；减少压力和负面影响；增加了应对痛苦的能力和积极的心理过程。慢性疼痛患者的阿片类药物滥用和成瘾是一种新出现的公共卫生威胁，给社会带来巨大代价。本申请寻求SOAR拨款支持，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加强拟议试验的执行、力量和准确性。研究结果将指导r01资助的全面随机对照试验的开发和实施。

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