Mindfulness-Oriented Recovery Enhancement For Chronic Pain Patients Receiving Opi

阿片类药物通常用来缓解慢性疼痛症状。尽管通常在短期内有效- 从长远来看，阿片类药物治疗有很大的长期成瘾风险。多达18%的患者成为 对处方的阿片类止痛药上瘾，近四分之一的慢性疼痛患者显示出阿片类药物的迹象 滥用，这可能预示着从阿片类药物使用到成瘾的转变。阿片类药物渴求和敏感度升高 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。一个数字 这些干预目标的基础是一系列机制。因压力和负面情绪而放大的痛觉过敏， 可能会导致对阿片类药物的渴望和消费增加。此外，个人可能会使用阿片类药物来自我 治疗引起疼痛、与疼痛同时发生和由疼痛引起的负面情绪、压力和自主神经兴奋。在……里面 反过来，慢性疼痛患者中阿片类药物的使用可能是由隐性神经认知操作推动的，例如 注意力偏向于阿片类药物和疼痛相关的兴奋，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会损害自然回报的处理， 强迫使用者摄入更高剂量的食物以达到享乐平衡。目前，很少有行为 干预措施解决了这些致病机制。为此，我们建议进行一项随机试点 一种新的双过程干预、正念导向的康复增强的对照试验(RCT) (更多)，它结合了正念训练、认知重建和积极方面的互补方面 情绪诱导成为综合治疗策略。PI已经设计和调整了更多以修改 注意偏向、情感失调和反馈环路背后的自主神经应激反应 在慢性疼痛和阿片类药物渴求之间。在拟议的RCT中，被诊断为慢性疼痛的患者 接受处方阿片类药物治疗3个月以上的患者将被随机分配到8周 更像是一个由治疗师领导的传统支持小组。评估将在前、中、后进行 治疗，以及3个月的随访。根据理论和以前的研究，我们假设 更多将减少疼痛，阿片类药物渴望和阿片类药物滥用行为，同时增加幸福感相对于 支持团队条件。我们假设这些临床结果的改善将通过以下方式实现： 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；增加对自然奖励刺激的情感处理； 减少压力和消极情绪；增加疼痛应对和积极的心理过程。阿片类药物 慢性疼痛患者的滥用和成瘾是一种新的公共健康威胁，其代价是巨大的 向社会致敬。此应用程序寻求Soar授权支持，以增强 通过允许更大的研究样本和更复杂的生物行为评估来建议试验 方法论。研究结果将指导制定和实施一项全面的、由R01资助的RCT。

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.