Garland Eric L, Bryan Craig J, Finan Patrick H, Thomas Elizabeth A, Priddy Sarah E, Riquino Michael R, Howard Matthew O
University of Utah, United States.
University of Utah, United States.
Drug Alcohol Depend. 2017 Apr 1;173 Suppl 1:S65-S72. doi: 10.1016/j.drugalcdep.2016.07.033.
Given the risk of opioid misuse among chronic pain patients being treated with long-term opioid pharmacotherapy, non-pharmacological treatments are needed. Further, in light of hedonic deficits in this population, therapies that enhance positive affect may be useful. The purpose of this study was to examine effects of a Mindfulness-Oriented Recovery Enhancement (MORE) intervention on ecological momentary assessments (EMA) of pain and positive affective experience, and to determine if changes in pain, affect, and their interaction were associated with opioid misuse at post-treatment.
This study examined unpublished EMA data from a subset of participants (N=55) in a previously published RCT (NCT01505101) of MORE versus a support group (SG) control. Across 8 weeks of treatment, patients completed up to 224 EMA measures of pain and affect. Multilevel models and generalized estimating equations examined effects of treatment on momentary pain and positive affect, and generalized linear models examined associations between pain and affect and changes in opioid misuse by post-treatment.
Patients in MORE reported significantly greater improvements in momentary pain (p=0.01) and positive affect (p=0.004) than patients in the SG. Further, over the entire course of treatment, patients in MORE were significantly more likely to exhibit positive affect regulation (OR=2.75) than patients in the SG. Finally, improvements in positive affect (but not pain) over the course of intervention were associated with reduced risk of misusing opioids by post-treatment (p=0.02).
MORE may be a useful non-pharmacological treatment for pain and hedonic deficits among chronic pain patients at risk for opioid misuse.
鉴于接受长期阿片类药物药物治疗的慢性疼痛患者存在阿片类药物滥用风险，需要非药物治疗。此外，鉴于该人群存在享乐缺陷，增强积极情绪的疗法可能会有所帮助。本研究的目的是检验以正念为导向的康复增强（MORE）干预对疼痛和积极情感体验的生态瞬时评估（EMA）的影响，并确定治疗后疼痛、情感及其相互作用的变化是否与阿片类药物滥用有关。
本研究检查了来自先前发表的一项随机对照试验（RCT，NCT01505101）中一个子集参与者（N = 55）未发表的EMA数据，该试验比较了MORE与支持组（SG）对照。在8周的治疗过程中，患者完成了多达224次关于疼痛和情感的EMA测量。多层次模型和广义估计方程检验了治疗对瞬时疼痛和积极情感的影响，广义线性模型检验了疼痛与情感之间的关联以及治疗后阿片类药物滥用的变化。
与SG组患者相比，MORE组患者在瞬时疼痛（p = 0.01）和积极情感（p = 0.004）方面的改善显著更大。此外，在整个治疗过程中，MORE组患者比SG组患者更有可能表现出积极的情感调节（OR = 2.75）。最后，干预过程中积极情感（而非疼痛）的改善与治疗后阿片类药物滥用风险降低相关（p = 0.02）。
对于有阿片类药物滥用风险的慢性疼痛患者，MORE可能是一种有用的疼痛和享乐缺陷非药物治疗方法。
