University of Utah, Salt Lake City, Utah 84112, USA.
Psychother Psychosom. 2013;82(5):311-8. doi: 10.1159/000348868. Epub 2013 Aug 9.
Chronic pain involves hypervigilance for pain-related stimuli. Selective attention to pain-related stimuli, known as pain attentional bias (AB), can exacerbate chronic pain, prolong suffering, and undermine quality of life. The aim of this study was to determine if a multimodal mindfulness-oriented intervention could significantly reduce pain AB among chronic pain patients receiving opioid analgesics.
A total of 67 chronic pain patients were randomized to an 8-week Mindfulness-Oriented Recovery Enhancement (MORE) intervention or a social support group intervention and began treatment. A dot probe task was used to measure pain AB. Primary outcomes were pain AB scores for cues presented for 2,000 and 200 ms.
Prior to intervention, participants exhibited a significant bias towards pain-related cues presented for 2,000 ms, but no bias for cues presented for 200 ms. A statistically significant time × intervention condition interaction was observed for 2,000 ms pain AB, such that participants in MORE evidenced significantly reduced posttreatment pain AB relative to pretreatment levels, whereas no significant pre-post treatment changes in pain AB were observed for support group participants. Decreases in pain AB were associated with increased perceived control over pain and attenuated reactivity to distressing thoughts and emotions.
Study findings provide the first indication that a mindfulness-oriented intervention may reduce pain AB among adults suffering from chronic pain. Given the magnitude of chronic pain in postindustrial societies, coupled with the dramatic escalation in prescription opioid misuse, future studies should evaluate MORE as a nonpharmacological means of addressing factors linked with chronic pain.
慢性疼痛涉及对疼痛相关刺激的高度警觉。对疼痛相关刺激的选择性注意，即疼痛注意偏向（AB），会加重慢性疼痛，延长痛苦，并损害生活质量。本研究旨在确定一种多模式正念导向的干预是否可以显著减少接受阿片类镇痛药的慢性疼痛患者的疼痛 AB。
共有 67 名慢性疼痛患者被随机分配到 8 周的正念导向康复增强（MORE）干预或社会支持小组干预，并开始治疗。使用点探测任务来测量疼痛 AB。主要结果是呈现 2000 和 200 毫秒时的线索的疼痛 AB 分数。
在干预之前，参与者对呈现 2000 毫秒的疼痛相关线索表现出明显的偏向，但对呈现 200 毫秒的线索没有偏向。观察到 2000 毫秒疼痛 AB 的时间×干预条件的交互作用具有统计学意义，即 MORE 组的参与者在治疗后疼痛 AB 明显低于治疗前水平，而支持组的参与者则没有观察到疼痛 AB 的显著治疗前后变化。疼痛 AB 的减少与对疼痛的感知控制增加以及对痛苦的想法和情绪的反应性减弱有关。
研究结果首次表明，正念导向的干预可能会降低慢性疼痛患者的疼痛 AB。鉴于后工业化社会中慢性疼痛的严重程度，加上处方类阿片类药物滥用的急剧增加，未来的研究应评估 MORE 作为一种非药物手段，以解决与慢性疼痛相关的因素。
