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

Abstract

Dysregulated processing of natural rewards may be a central pathogenic process in the etiology and maintenance of prescription opioid misuse and addiction among chronic pain patients. This study examined whether a Mindfulness-Oriented Recovery Enhancement (MORE) intervention could augment natural reward processing through training in savoring as indicated by event-related brain potentials (ERPs). Participants were chronic pain patients at risk for opioid misuse who were randomized to 8 weeks of MORE (n = 11) or a support group control condition (n = 18). ERPs to images representing naturally rewarding stimuli (e.g., beautiful landscapes, intimate couples) and neutral images were measured before and after 8 weeks of treatment. Analyses focused on the late positive potential (LPP)—an ERP response in the 400–1,000 ms time window thought to index allocation of attention to emotional information. Treatment with MORE was associated with significant increases in LPP response to natural reward stimuli relative to neutral stimuli which were correlated with enhanced positive affective cue-responses and reductions in opioid craving from pre- to post-treatment. Findings suggest that cognitive training regimens centered on strengthening attention to natural rewards may remediate reward processing deficits underpinning addictive behavior.

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Acknowledgments

This work was supported by Grant Numbers DA032517 and DA037005 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. We wish to thank Zhenghui Yu and Elizabeth McCoy for their assistance in ERP data processing. We also wish to thank two anonymous reviewers for their insightful suggestions with regard to the analysis and interpretation of ERP findings.

Conflict of interest

E.L.G., B.F., and M.O.H. declare that they have no conflict of interest.

Human and animal rights and Informed Consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Correspondence to Eric L. Garland.

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Garland, E.L., Froeliger, B. & Howard, M.O. 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 (2015). https://doi.org/10.1007/s10865-014-9607-0

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Keywords

  • Mindfulness
  • Chronic pain
  • Opioid misuse
  • Reward
  • ERP
  • Positive emotion
  • Allostasis
  • LPP
  • Savoring