PMID- 37310337 OWN - NLM STAT- MEDLINE DCOM- 20230615 LR - 20230621 IS - 1469-8978 (Electronic) IS - 0033-2917 (Print) IS - 0033-2917 (Linking) VI - 53 IP - 5 DP - 2023 Apr TI - Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards. PG - 2085-2094 LID - 10.1017/S0033291721003834 [doi] AB - BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. FAU - Garland, Eric L AU - Garland EL AD - Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA. AD - College of Social Work, University of Utah, Salt Lake City, UT, USA. AD - Veterans Health Care Administration VISN 19 Whole Health Flagship site located at the VA Salt Lake City Health Care System, Salt Lake City, UT, USA. FAU - Fix, Spencer T AU - Fix ST AD - Department of Psychology, University of Maryland. FAU - Hudak, Justin P AU - Hudak JP AD - Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA. AD - College of Social Work, University of Utah, Salt Lake City, UT, USA. FAU - Bernat, Edward M AU - Bernat EM AD - Department of Psychology, University of Maryland. FAU - Nakamura, Yoshio AU - Nakamura Y AD - Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA. AD - Department of Anesthesiology, Division of Pain Medicine, Pain Research Center, University of Utah School of Medicine. FAU - Hanley, Adam W AU - Hanley AW AD - Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA. AD - College of Social Work, University of Utah, Salt Lake City, UT, USA. FAU - Donaldson, Gary W AU - Donaldson GW AD - Department of Anesthesiology, Division of Pain Medicine, Pain Research Center, University of Utah School of Medicine. FAU - Marchand, William R AU - Marchand WR AD - Veterans Health Care Administration VISN 19 Whole Health Flagship site located at the VA Salt Lake City Health Care System, Salt Lake City, UT, USA. AD - Department of Psychiatry, University of Utah School of Medicine. FAU - Froeliger, Brett AU - Froeliger B AD - Department of Psychiatry and Psychology, University of Missouri. LA - eng GR - R61AT009296/AT/NCCIH NIH HHS/United States GR - R01 DA042033/DA/NIDA NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20211014 PL - England TA - Psychol Med JT - Psychological medicine JID - 1254142 RN - 0 (Analgesics, Opioid) SB - IM MH - Humans MH - Analgesics, Opioid/pharmacology MH - Anhedonia MH - *Chronic Pain/drug therapy MH - *Mindfulness MH - *Opioid-Related Disorders/drug therapy MH - Reward PMC - PMC10106294 OTO - NOTNLM OT - Analgesia OT - hedonic dysregulation OT - meditation OT - opioid use disorder OT - reward processing OT - savoring COIS- Eric Garland, Ph.D., LCSW is the Director of the Center on Mindfulness and Integrative Health Intervention Development. The Center provides Mindfulness-Oriented Recovery Enhancement (MORE), mindfulness-based therapy, and cognitive behavioral therapy in the context of research trials for no cost to research participants; however, Dr Garland has received honoraria and payment for delivering seminars, lectures, and teaching engagements (related to training clinicians in mindfulness) sponsored by institutions of higher education, government agencies, academic teaching hospitals, and medical centers. Dr Garland also receives royalties from the sale of books related to MORE, and is a consultant of and licensor to BehaVR, LLC. The remaining authors have nothing to disclose. EDAT- 2023/06/13 13:12 MHDA- 2023/06/15 06:42 PMCR- 2023/04/16 CRDT- 2023/06/13 10:24 PHST- 2023/06/15 06:42 [medline] PHST- 2023/06/13 13:12 [pubmed] PHST- 2023/06/13 10:24 [entrez] PHST- 2023/04/16 00:00 [pmc-release] AID - S0033291721003834 [pii] AID - 10.1017/S0033291721003834 [doi] PST - ppublish SO - Psychol Med. 2023 Apr;53(5):2085-2094. doi: 10.1017/S0033291721003834. Epub 2021 Oct 14.