Endogenous theta stimulation during meditation predicts reduced opioid dosing following treatment with Mindfulness-Oriented Recovery Enhancement

Justin Hudak,Adam W Hanley,Yoshio Nakamura,Eric L Garland,William R Marchand,Brandon Yabko

doi:10.1038/s41386-020-00831-4

Justin Hudak, Adam W Hanley + Show 4 more

Open Access

https://doi.org/10.1038/s41386-020-00831-4

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Abstract

Veterans experience chronic pain at greater rates than the rest of society and are more likely to receive long-term opioid therapy (LTOT), which, at high doses, is theorized to induce maladaptive neuroplastic changes that attenuate self-regulatory capacity and exacerbate opioid dose escalation. Mindfulness meditation has been shown to modulate frontal midline theta (FMT) and alpha oscillations that are linked with marked alterations in self-referential processing. These adaptive neural oscillatory changes may promote reduced opioid use and remediate the neural dysfunction occasioned by LTOT. In this study, we used electroencephalography (EEG) to assess the effects of a mindfulness-based, cognitive training intervention for opioid misuse, Mindfulness-Oriented Recovery Enhancement (MORE), on alpha and theta power and FMT coherence during meditation. We then examined whether these neural effects were associated with reduced opioid dosing and changes in self-referential processing. Before and after 8 weeks of MORE or a supportive psychotherapy control, veterans receiving LTOT (N = 62) practiced mindfulness meditation while EEG was recorded. Participants treated with MORE demonstrated significantly increased alpha and theta power (with larger theta power effect sizes) as well as increased FMT coherence relative to those in the control condition—neural changes that were associated with altered self-referential processing. Crucially, MORE significantly reduced opioid dose over time, and this dose reduction was partially statistically mediated by changes in frontal theta power. Study results suggest that mindfulness meditation practice may produce endogenous theta stimulation in the prefrontal cortex, thereby enhancing inhibitory control over opioid dose escalation behaviors.

Highlights

Veterans are more likely to experience pain than the general population [1], with 29% of Veterans reporting chronic pain [2]
Mindfulness-based interventions are emerging as efficacious treatment options for an array of psychiatric disorders [42], and meta-analytic evidence supports their efficacy for reducing pain and opioid dosing [43]
While a considerable body of research demonstrates that mindfulness modulates neurophysiological oscillations in alpha and theta frequency ranges [15, 16], few studies have directly examined the effects of mindfulness training on EEG power in clinical samples

Summary

Introduction

Veterans are more likely to experience pain than the general population [1], with 29% of Veterans reporting chronic pain [2]. To mitigate opioid-related harms, the Department of Veterans Affairs (VA) launched Opioid Safety Initiatives to decrease opioid prescribing and improve safety monitoring In response to these initiatives, use of complementary and integrative therapies like mindfulness-based interventions (MBIs) has significantly increased across the VA healthcare system [3]. As open monitoring reaches its zenith, practitioners often report marked alterations in self-referential processing in the form of ego dissolution, a softening of perceived body boundaries, and a blissful, phenomenological unity between self and world [8, 9]. Though such “nondual” self-transcendent states are often assumed to be inaccessible to only but the most advanced practitioners, recent psychometric research indicates that they occur even among novices [10,11,12]

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