Deficits in autonomic indices of emotion regulation and reward processing associated with prescription opioid use and misuse
- 757 Downloads
Prescription opioid misuse and high-dose opioid use may result in allostatic dysregulation of hedonic brain circuitry, leading to reduced emotion regulation capacity. In particular, opioid misuse may blunt the ability to experience and upregulate positive affect from natural rewards.
The purpose of this study was to examine associations between opioid use/misuse and autonomic indices of emotion regulation capability in a sample of chronic pain patients receiving prescription opioid pharmacotherapy.
Chronic pain patients taking long-term opioid analgesics (N = 40) completed an emotion regulation task while heart rate variability (HRV) was recorded, and also completed self-report measures of opioid misuse, craving, pain severity, and emotional distress. Based on a validated cut-point on the Current Opioid Misuse Measure, participants were grouped as opioid misusers or non-misusers. Opioid misuse status and morphine equivalent daily dose (MEDD) were examined as predictors of HRV and self-reports of emotion regulation.
Opioid misusers exhibited significantly less HRV during positive and negative emotion regulation, and significantly less positive effect, than non-misusers, after controlling for confounders including pain severity and emotional distress. MEDD was inversely associated with positive emotion regulation efficacy.
Findings implicate the presence of reward processing deficits among chronic pain patients with opioid-misusing behaviors, and opioid dosage was associated with deficient emotion regulation, suggesting the presence of compromised top-down cognitive control over bottom-up hedonic processes. Emotion regulation among opioid misusers may represent an important treatment target.
KeywordsOpioid misuse Chronic pain Emotion regulation Heart rate variability Allostatic Reward
This work was supported by grant numbers R34DA037005 and R01DA042033 from the National Institutes of Health awarded to E.L.G. and a grant from the Fahs Beck Fund for Research and Experimentation, also awarded to E.L.G.
Compliance with ethical standards
All procedures complied with standards propounded in the Helsinki Declaration of 1975.
Conflict of interest
The authors declare that they have no conflicts of interest.
- Burns JW (2006) The role of attentional strategies in moderating links between acute pain induction and subsequent psychological stress: evidence for symptom-specific reactivity among patients with chronic pain versus healthy nonpatients. Emotion 6:180–192. doi: 10.1037/1528-35126.96.36.199 CrossRefPubMedGoogle Scholar
- Cleeland CS (1994) Brief pain inventory–short form (BPI–SF). Houston, TXGoogle Scholar
- Di Simplicio M, Costoloni G, Western D, et al. (2011) Decreased heart rate variability during emotion regulation in subjects at risk for psychopathology. Psychol Med 1–9. doi: 10.1017/S0033291711002479
- Edwards RR, Dolman AJ, Michna E, et al. (2016) Changes in pain sensitivity and pain modulation during oral opioid treatment: the impact of negative affect. Pain Med pnw010. doi: 10.1093/pm/pnw010
- Garland EL, Froeliger B, Howard MO (2014b) Neurophysiological evidence for remediation of reward processing deficits in chronic pain and opioid misuse following treatment with mindfulness-oriented recovery enhancement: exploratory ERP findings from a pilot RCT. J Behav Med 38:327–336. doi: 10.1007/s10865-014-9607-0 CrossRefPubMedPubMedCentralGoogle Scholar
- Garland EL, Froeliger B, Zeidan F et al (2013) The downward spiral of chronic pain, prescription opioid misuse, and addiction: cognitive, affective, and neuropsychopharmacologic pathways. Neurosci Biobehav Rev 37:2597–2607. doi: 10.1016/j.neubiorev.2013.08.006 CrossRefPubMedPubMedCentralGoogle Scholar
- Garland EL, Hanley AW, Thomas EA, et al. (2014c) Low dispositional mindfulness predicts self-medication of negative emotion with prescription opioids.Google Scholar
- Lang P, Bradley M, Cuthbert B (1997) International affective picture system (IAPS): technical manual and affective ratingsGoogle Scholar
- Martins SS, Fenton MC, Keyes KM et al (2012) Mood and anxiety disorders and their association with non-medical prescription opioid use and prescription opioid-use disorder: longitudinal evidence from the National Epidemiologic study on alcohol and related conditions. Psychol Med 42:1261–1272CrossRefPubMedGoogle Scholar
- Udo T, Weinberger AH, Grilo CM, et al. (2013) Heightened vagal activity during high-calorie food presentation in obese compared with non-obese individuals—results of a pilot studyGoogle Scholar
- Wasan AD, Michna E, Edwards RR et al (2015) Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. Anesthesiology 123:861–872. doi: 10.1097/ALN.0000000000000768 CrossRefPubMedPubMedCentralGoogle Scholar