Improve Emotional Response Inhibition in Patients with Chronic Pain and Opioid Use with Mindfulness
By John M. de Castro, Ph.D.
“mindfulness meditation could represent a viable alternative to opioid-based therapy for chronic pain, and may be useful in helping patients taper their use of high doses of opioid-acting agents.” – Hymie Anisman
We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.
There is an accumulating volume of research findings to demonstrate that mindfulness practices, in general, are effective in treating pain. In today’s Research News article “Effects of Mindfulness-Oriented Recovery Enhancement Versus Social Support on Negative Affective Interference During Inhibitory Control Among Opioid-Treated Chronic Pain Patients: A Pilot Mechanistic Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735955/), Garland and colleagues examine the mechanisms by which mindfulness reduces perceived pain.
They recruited adult patients with non-cancer related chronic pain who were taking daily opioids. They were randomly assigned to receive 8-weeks of a Mindfulness-Oriented Recovery Enhancement (MORE) program or to an 8-week support groups meeting. Mindfulness-Oriented Recovery Enhancement (MORE) involves mindful breathing and body scan meditations, cognitive reappraisal to decrease negative emotions and craving, and savoring to augment natural reward processing and positive emotion. The patients were measured before and after treatment and 3 months later for pain severity and the mindfulness facet of nonreactivity. The patients also performed a go – no-go task. They viewed either neutral or pain related images in which was embedded either the letter “M” or “W”. They were asked to press a key a quickly as possible when the letter “M” was present.
They found that in comparison to baseline and the support group, after the mindfulness treatment there was a significant reduction in pain severity and increase in nonreactivity and improvement in go – no-go task accuracy. These changes were maintained 3 months after the completion of th treatment. In addition, they found that the higher the levels of nonreactivity and the greater the amount of meditation practice, the fewer errors occurred in the go – no-go task with pain-related images. In other words, the greater the improvement in response inhibition to emotional stimuli. Finally, they found that the greater the reductions in go – no-go task errors with pain related images, the greater the reduction in pain severity.
The results are complicated and so are the conclusions. Nevertheless, the results suggest that mindfulness training reduces pain severity and increases the mindfulness facet of nonreactivity. This suggests that the mindfulness training improves the patient’s ability to not react to pain stimuli and thereby reduce the perceived severity of the pain. This increase in nonreactivity would also explain why the patients didn’t react to pain related distractors in the go – no-go task and thereby improve their accuracy.
These results suggest that Mindfulness-Oriented Recovery Enhancement (MORE) enhances the chronic pain patient’s ability to inhibit emotional responses in the presence of pain related stimuli. This ability in turn reduces perceived pain. It remains to be seen if these improvements make it easier for the patients to wean off of opiates.
So, improve emotional response inhibition in patients with chronic pain and opioid use with mindfulness.
“Meditation teaches patients how to react to the pain. People are less inclined to have the ‘Ouch’ reaction, then they are able to control the emotional reaction to pain.” – Fadel Zeidan
CMCS – Center for Mindfulness and Contemplative Studies
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Garland, E. L., Bryan, M. A., Priddy, S. E., Riquino, M. R., Froeliger, B., & Howard, M. O. (2019). Effects of Mindfulness-Oriented Recovery Enhancement Versus Social Support on Negative Affective Interference During Inhibitory Control Among Opioid-Treated Chronic Pain Patients: A Pilot Mechanistic Study. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 53(10), 865–876. doi:10.1093/abm/kay096
Among opioid-treated chronic pain patients, deficient response inhibition in the context of emotional distress may contribute to maladaptive pain coping and prescription opioid misuse. Interventions that aim to bolster cognitive control and reduce emotional reactivity (e.g., mindfulness) may remediate response inhibition deficits, with consequent clinical benefits.
To test the hypothesis that a mindfulness-based intervention, Mindfulness-Oriented Recovery Enhancement (MORE), can reduce the impact of clinically relevant, negative affective interference on response inhibition function in an opioid-treated chronic pain sample.
We examined data from a controlled trial comparing adults with chronic pain and long-term prescription opioid use randomized to either MORE (n = 27) treatment or to an active support group comparison condition (n = 30). Participants completed an Emotional Go/NoGo Task at pre- and post-treatment, which measured response inhibition in neutral and clinically relevant, negative affective contexts (i.e., exposure to pain-related visual stimuli).
Repeated-measures analysis of variance indicated that compared with the support group, participants in MORE evidenced significantly greater reductions from pre- to post-treatment in errors of commission on trials with pain-related distractors relative to trials with neutral distractors, group × time × condition F(1,55) = 4.14, p = .047, η2partial = .07. Mindfulness practice minutes and increased nonreactivity significantly predicted greater emotional response inhibition. A significant inverse association was observed between improvements in emotional response inhibition and treatment-related reductions in pain severity by 3-month follow-up.
Study results provide preliminary evidence that MORE enhances inhibitory control function in the context of negative emotional interference.