正念导向的康复增强通过镇痛和积极的心理机制降低阿片类药物滥用风险：一项随机对照试验。
Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial.
机构信息
Center on Mindfulness and Integrative Health Intervention Development and College of Social Work, University of Utah.
Center on Mindfulness and Integrative Health Intervention Development and Department of Anesthesiology, University of Utah.
出版信息
J Consult Clin Psychol. 2019 Oct;87(10):927-940. doi: 10.1037/ccp0000390.
OBJECTIVE
Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health.
METHOD
Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up.
RESULTS
Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p < .001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p = .048), which in turn predicted decreases in opioid misuse risk by follow-up (p = .02).
CONCLUSIONS
Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
目的
尽管当前阿片类药物处方危机迫在眉睫，但很少有心理疗法针对长期接受阿片类药物镇痛的慢性疼痛患者进行评估。目前的心理疼痛治疗主要侧重于改善负面情感过程，但基础科学表明，阿片类药物滥用的风险与积极情感的缺乏有关。调节积极心理过程的干预措施可能会为接受阿片类药物治疗的慢性疼痛患者带来治疗益处。本研究的目的是对正念导向的康复增强（MORE）的一项 2 期随机对照试验的近端结果数据进行理论驱动的机制分析，这是一种旨在促进积极心理健康的综合干预措施。
方法
接受阿片类药物治疗的慢性疼痛患者（N = 95；年龄 = 56.8 ± 11.7；66%女性）被随机分配接受 8 周的治疗师主导的 MORE 或支持小组（SG）干预。一个由积极情绪、生活意义和自我超越措施组成的潜在积极心理健康变量被视为 MORE 对治疗后疼痛严重程度变化和 3 个月随访时阿片类药物滥用风险的影响的中介。
结果
与 SG 参与者相比，MORE 参与者报告的疼痛严重程度在治疗后（p =.03）和 3 个月随访时（p =.03）显著降低，阿片类药物滥用风险显著降低（p <.001），积极心理健康显著增加（p <.001）。积极心理健康的增加中介了 MORE 对治疗后疼痛严重程度的影响（p =.048），而疼痛严重程度的降低又预测了随访时阿片类药物滥用风险的降低（p =.02）。
结论
通过 MORE 和其他心理干预措施针对积极心理机制，可能会降低接受长期阿片类药物治疗的慢性疼痛患者的阿片类药物滥用风险。
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