Psychosocial intervention and the reward system in pain and opioid misuse: new opportunities and directions.

Clinicians and scientists have begun to recognize that chronic pain and its treatment with opioid analgesics may occasion —a blunting of physiological and positive emotional responses to rewarding objects and events in the social environment. Conversely, pain relief can be rewarding [83,84]. Yet, this relation is not unidirectional; experimental manipulations and clinical observational studies demonstrate the analgesic effects of positive affect and reward [32,86]. Although positive emotions and rewarding experiences can produce analgesia, how might they be intentionally cultivated for their therapeutic value? To answer this research question, this topical review proposes a mechanistic model (Figure 1) for optimizing psychosocial interventions by leveraging positive affective/reward-related mechanisms as means of addressing chronic pain and opioid misuse.