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.

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

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Small Research Grants (R03)
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Special Emphasis Panel (ZRG1-IFCN-L (50))
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Aklin, Will
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Florida State University
Schools of Social Work
United States
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Li, Michael J; Black, David S; Garland, Eric L (2016) The Applied Mindfulness Process Scale (AMPS): A process measure for evaluating mindfulness-based interventions. Pers Individ Dif 93:6-15
Garland, Eric L; Brown, Samantha M; Howard, Matthew O (2016) Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med 39:128-38
Finan, Patrick H; Garland, Eric L (2015) The role of positive affect in pain and its treatment. Clin J Pain 31:177-87
Garland, Eric L; Froeliger, Brett; Howard, Matthew O (2015) Neurophysiological evidence for remediation of reward processing deficits in chronic pain and opioid misuse following treatment with Mindfulness-Oriented Recovery Enhancement: exploratory ERP findings from a pilot RCT. J Behav Med 38:327-36
Garland, Eric L; Froeliger, Brett; Howard, Matthew O (2015) Allostatic dysregulation of natural reward processing in prescription opioid misuse: autonomic and attentional evidence. Biol Psychol 105:124-9
Hanley, Adam W; Garland, Eric L (2014) Dispositional Mindfulness Co-varies with Self-Reported Positive Reappraisal. Pers Individ Dif 66:146-152
Garland, Eric L; Howard, Matthew O (2014) Opioid attentional bias and cue-elicited craving predict future risk of prescription opioid misuse among chronic pain patients. Drug Alcohol Depend 144:283-7
Garland, Eric L; Manusov, Eron G; Froeliger, Brett et al. (2014) Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial. J Consult Clin Psychol 82:448-59
Hanley, Adam; Garland, Eric L; Black, David S (2014) Use of mindful reappraisal coping among meditation practitioners. J Clin Psychol 70:294-301
Garland, Eric L; Thomas, Elizabeth; Howard, Matthew O (2014) Mindfulness-oriented recovery enhancement ameliorates the impact of pain on self-reported psychological and physical function among opioid-using chronic pain patients. J Pain Symptom Manage 48:1091-9

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