Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards.

Eric L Garland,Gary W Donaldson,Spencer T Fix,Yoshio Nakamura,Justin P Hudak,Brett Froeliger,Edward M Bernat,Adam W Hanley,William R Marchand

doi:10.1017/s0033291721003834

Abstract

Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Yet, there are no known efficacious treatments for anhedonia and reward deficits associated with chronic opioid use. Mindfulness-Oriented Recovery Enhancement (MORE), a novel behavioral intervention combining training in mindfulness with savoring of natural rewards, may hold promise for treating anhedonia in LTOT. Veterans receiving LTOT (N = 63) for chronic pain were randomized to 8 weeks of MORE or a supportive group (SG) psychotherapy control. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. We then examined whether these neurophysiological effects were associated with reductions in subjective anhedonia by 4-month follow-up. Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. The effect of MORE on reducing anhedonia was statistically mediated by increases in LPP response during savoring. MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder.

Highlights

Patients with chronic non-cancer pain are commonly treated with long-term opioid therapy (LTOT; ⩾90 days of opioid use) (Chou et al, 2009) despite risks including opioid misuse and opioid use disorder (OUD) (Chou et al, 2015)
Anhedonia, a reduced capacity to pursue, experience, and/or learn from pleasure (Rømer Thomsen, Whybrow, & Kringelbach, 2015), is a core feature of chronic pain that is magnified by opioid misuse (Garland, Trøstheim, Eikemo, Ernst, & Leknes, 2020; Trøstheim et al, 2020)
A significant Treatment × Time interaction was observed, F1,61 = 4.80, p = 0.03, ηp2artial = 0.07, indicating that regardless of strategy, Mindfulness-Oriented Recovery Enhancement (MORE) was associated with significantly greater increases in late positive potential (LPP) response to natural reward cues across the LPP than the supportive group (SG), regardless of strategy (Fig. 2)

Summary

Introduction

Patients with chronic non-cancer pain are commonly treated with long-term opioid therapy (LTOT; ⩾90 days of opioid use) (Chou et al, 2009) despite risks including opioid misuse and opioid use disorder (OUD) (Chou et al, 2015). Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder

Methods

Results

Conclusion