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Rudolph KE, Williams NT, Diaz I, Forrest S, Hoffman KL, Samples H, Olfson M, Doan L, Cerda M, Ross RK. Pain Management Treatments and Opioid Use Disorder Risk in Medicaid Patients. Am J Prev Med 2024:S0749-3797(24)00248-4. [PMID: 39025248 DOI: 10.1016/j.amepre.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION People with chronic pain are at increased risk of opioid misuse. Less is known about the unique risk conferred by each pain management treatment, as treatments are typically implemented together, confounding their independent effects. This study estimated the extent to which pain management treatments were associated with risk of opioid use disorder (OUD) for those with chronic pain, controlling for baseline demographic and clinical confounding variables and holding other pain management treatments at their observed levels. METHODS Data were analyzed in 2024 from 2 chronic pain subgroups within a cohort of non-pregnant Medicaid patients aged 35-64 years, 2016-2019, from 25 states: those with (1) chronic pain and physical disability (CPPD) (N=6,133) or (2) chronic pain without disability (CP) (N=67,438). Nine pain management treatments were considered: prescription opioid (1) dose and (2) duration; (3) number of opioid prescribers; opioid co-prescription with (4) benzo- diazepines, (5) muscle relaxants, and (6) gabapentinoids; (7) nonopioid pain prescription, (8) physical therapy, and (9) other pain treatment modality. The outcome was OUD risk. RESULTS Having opioids co-prescribed with gabapentin or benzodiazepine was statistically significantly associated with a 37-45% increased OUD risk for the CP subgroup. Opioid dose and duration also were significantly associated with increased OUD risk in this subgroup. Physical therapy was significantly associated with an 18% decreased risk of OUD in the CP subgroup. DISCUSSION Coprescription of opioids with either gabapentin or benzodiazepines may substantially increase OUD risk. More positively, physical therapy may be a relatively accessible and safe pain management strategy.
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Affiliation(s)
- Kara E Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
| | - Nicholas T Williams
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Ivan Diaz
- Division of Biostatistics, New York University Grossman School of Medicine, New York, New York
| | - Sarah Forrest
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Katherine L Hoffman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Hillary Samples
- Rutgers Institute for Health, Rutgers University, New Brunswick, New Jersey
| | - Mark Olfson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Lisa Doan
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University Grossman School of Medicine, New York, New York
| | - Magdalena Cerda
- Division of Epidemiology, New York University Grossman School of Medicine, New York, New York
| | - Rachael K Ross
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Cooperman NA, Shen J, Gordon AJ, Garland EL. Commentary With Study Protocol: Implementation and Effectiveness of Mindfulness-Oriented Recovery Enhancement (MORE) as an Adjunct to Methadone Treatment for Opioid Use Disorder (IMPOWR-MORE). SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241261890. [PMID: 38907675 DOI: 10.1177/29767342241261890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
Traditional methadone treatment (MT) for opioid use disorder (OUD) fails to systematically address the physical pain, emotion dysregulation, and reward processing deficits that co-occur with OUD, and novel interventions that address these issues are needed to improve MT outcomes. Mindfulness-Oriented Recovery Enhancement (MORE) remediates the hedonic dysregulation in brain reward systems that is associated with OUD. Our pilot and phase 2 randomized controlled trials of MORE were the first to demonstrate MORE's feasibility, acceptability, and efficacy as delivered in MT clinics; MORE significantly reduced drug use (eg, benzodiazepines, barbiturates, cocaine, marijuana, opioids, and other drugs), craving, depression, anxiety, and pain among people with OUD. However, uptake of novel, efficacious interventions like MORE may be slow in MT because time and resources are often limited. Therefore, to best address potential implementation issues and to optimize future MORE implementation and dissemination, in this study, we will utilize a Type 2, Hybrid Implementation-Effectiveness study design. We will not only evaluate MORE's effectiveness but also assess barriers and facilitators to integrating MORE into MT. MT clinicians will receive training in (1) a higher intensity MORE implementation strategy consisting of training in the full MORE treatment manual or (2) a minimal intensity implementation strategy consisting of a simple, scripted mindfulness practice (SMP) extracted from the MORE treatment manual with minimal training. We aim to: (1) using a Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, examine barriers and facilitators to implementation of MORE and SMP in MT, and evaluate strategies for optimizing training, fidelity, and engagement, (2) optimize existing MORE and SMP training and implementation toolkits, including adaptable resources that can accelerate the translation of evidence into practice, and (3) compared to usual MT, evaluate the relative effectiveness of MORE plus MT or SMP plus MT (N = 450).
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Affiliation(s)
- Nina A Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Jincheng Shen
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City, UT, USA
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Li LY, Meng X, Hu WT, Geng JS, Cheng TH, Luo JC, Hu MY, Li HY, Wang Y, Wang YY. A meta-analysis of the association between mindfulness and motivation. Front Public Health 2023; 11:1159902. [PMID: 37614448 PMCID: PMC10442577 DOI: 10.3389/fpubh.2023.1159902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Mindfulness reflects attention to the present moment in a non-judgmental way and has been linked to individual autonomy and motivation, but conclusions are inconsistent. The purpose of this review was to summarize previous studies to explore the relationship between mindfulness and motivation and its intervention effects. Methods Literature searches were conducted in five electronic databases. Both correlational studies assessing the association between motivation and mindfulness and experimental studies to verify the effect of intervention were included. Results Six papers with seven intervention studies and twenty-three papers with twenty-seven correlational studies met the inclusion criteria. Meta-analysis showed that mindfulness was positively correlated with intrinsic motivation (r = 0.28, p < 0.0001) and total motivation (r = 0.37, p < 0.0001) but had no significant correlation with extrinsic motivation (r = 0.01, p = 0.93) or amotivation (r = -0.17, p = 0.14). Effect-size estimates suggested that mindfulness intervention was beneficial to motivation promotion, but the effect was at a low level (g = 0.12). Conclusion We found consistent support for mindfulness practice relating to motivation promotion, especially on intrinsic motivation development. However, there was still a portion of heterogeneity that could not be explained and needed to be identified in future studies.
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Affiliation(s)
- Li-ying Li
- School of Psychology, Weifang Medical University, Weifang, China
| | - Xue Meng
- School of Psychology, Weifang Medical University, Weifang, China
| | - Wen-ting Hu
- School of Psychology, Weifang Medical University, Weifang, China
| | - Jia-sen Geng
- School of Psychology, Weifang Medical University, Weifang, China
| | - Tian-hua Cheng
- School of Psychology, Weifang Medical University, Weifang, China
| | - Jia-cheng Luo
- School of Psychology, Weifang Medical University, Weifang, China
| | - Ming-yu Hu
- School of Psychology, Weifang Medical University, Weifang, China
| | - Hai-yue Li
- School of Psychology, Weifang Medical University, Weifang, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yan-yu Wang
- School of Psychology, Weifang Medical University, Weifang, China
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Chammas F, Januel D, Bouaziz N. Inpatient suicide in psychiatric settings: Evaluation of current prevention measures. Front Psychiatry 2022; 13:997974. [PMID: 36386981 PMCID: PMC9650354 DOI: 10.3389/fpsyt.2022.997974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 12/01/2022] Open
Abstract
The risk of suicide in psychiatric hospitals is 50 times higher than in the general population, despite patient safety being a priority for any hospital. However, to date, due to the complexity of assessing suicide risk, there has been no consensus on the suicide prevention measures that should be in place in hospitals. The aim of this work is: To provide an overview of the progress that has been made in the field of inpatient suicide prevention in recent years; discuss the problems that remain; and suggest potential future developments. As new clinical dimensions (notably anhedonia, psychological pain and hopelessness) develop, they should become new therapeutic targets. Team training (like the Gatekeeper Training Program) and the latest advances in suicide risk assessment (such as the Collaborative Assessment and Management of Suicidality) should be implemented in psychiatric wards. Suicide prevention plans (e.g., ASSIP, SAFE-T, etc.) represent easy-to-administer, low-cost interventions. The Mental Health Environment of Care Checklist has been proven effective to reduce suicide risk at hospitals. Furthermore, the types of psychotherapy recommended to reduce suicide risk are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). There are several pharmacological treatments for suicide risk, such as lithium and clozapine, which have been shown to be effective in the long term, as well as ketamine and esketamine, which are more effective in the short term. Following some encouraging recent results, buprenorphine may also be proposed to patients with a suicide risk. Triple chronotherapy rapidly improves depressive symptoms over 9 weeks. Regarding brain stimulation techniques, rTMS has proven to be effective in alleviating multiple dimensions of suicidality.
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Affiliation(s)
- Francesca Chammas
- Centre de Recherche Clinique, EPS Ville-Evrard, Neuilly-sur-Marne, France
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Parisi A, Hanley AW, Garland EL. Mindfulness-Oriented Recovery Enhancement reduces opioid craving, pain, and negative affect among chronic pain patients on long-term opioid therapy: An analysis of within- and between-person state effects. Behav Res Ther 2022; 152:104066. [DOI: 10.1016/j.brat.2022.104066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/16/2022]
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Carlton CN, Antezana L, Garcia KM, Sullivan-Toole H, Richey JA. Mindfulness-Based Stress Reduction Specifically Improves Social Anhedonia Among Adults with Chronic Stress. AFFECTIVE SCIENCE 2021; 3:145-159. [PMID: 36046096 PMCID: PMC9382999 DOI: 10.1007/s42761-021-00085-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/02/2021] [Indexed: 10/19/2022]
Abstract
This randomized controlled trial examined the effects of mindfulness on anhedonic symptoms in a sample of adults reporting high levels of chronic stress. Meditation-naïve adults (N = 68, Mage = 32, 62% female) were randomized to either an 8-week group-based MBSR intervention (N = 35), or a waitlist control group (N = 33). We hypothesized that changes in mindfulness would mediate the relationship between condition and changes in anhedonic symptoms. Additionally, the present study aimed to determine if other theoretically linked mechanisms (i.e., stress, negative affect [NA], depression) were involved in producing changes in anhedonic symptoms. Results provided evidence for full mediation of the effect of MBSR on social anhedonia through its essential mechanism of ΔMindfulness. These results highlight specificity of anhedonic symptoms targeted by MBSR, with social anhedonia symptoms being modified by changes in mindfulness whereas other anhedonic domains were not. The specificity of effects to the social anhedonia domain may be in part due to the group-based nature of MBSR. Additionally, although associative relationships were present for stress, depression, NA, and anhedonic symptoms, no mediational relationships emerged. Results presented here should be evaluated in light of study limitations, such as the reliance on self-report measures as well as a lack of information regarding cultural or geographic diversity.
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Affiliation(s)
- Corinne N. Carlton
- grid.438526.e0000 0001 0694 4940Department of Psychology, Virginia Tech, 109 Williams Hall, Blacksburg, VA 24061 USA
| | - Ligia Antezana
- grid.438526.e0000 0001 0694 4940Department of Psychology, Virginia Tech, 109 Williams Hall, Blacksburg, VA 24061 USA
| | - Katelyn M. Garcia
- grid.438526.e0000 0001 0694 4940Department of Psychology, Virginia Tech, 109 Williams Hall, Blacksburg, VA 24061 USA
| | - Holly Sullivan-Toole
- grid.438526.e0000 0001 0694 4940Department of Psychology, Virginia Tech, 109 Williams Hall, Blacksburg, VA 24061 USA ,grid.264727.20000 0001 2248 3398Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 191221 USA
| | - John A. Richey
- grid.438526.e0000 0001 0694 4940Department of Psychology, Virginia Tech, 109 Williams Hall, Blacksburg, VA 24061 USA
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Rizvi SJ, Gandhi W, Salomons T. Reward processing as a common diathesis for chronic pain and depression. Neurosci Biobehav Rev 2021; 127:749-760. [PMID: 33951413 DOI: 10.1016/j.neubiorev.2021.04.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/14/2020] [Accepted: 04/27/2021] [Indexed: 12/25/2022]
Abstract
Pain disorders and psychiatric illness are strongly comorbid, particularly in the context of Major Depressive Disorder (MDD). While these disorders account for a significant amount of global disability, the mechanisms of their overlap remain unclear. Understanding these mechanisms is of vital importance to developing prevention strategies and interventions that target both disorders. Of note, brain reward processing may be relevant to explaining how the comorbidity arises, given pain disorders and MDD can result in maladaptive reward responsivity that limits reward learning, appetitive approach behaviours and consummatory response. In this review, we discuss this research and explore the possibility of reward processing deficits as a common diathesis to explain the manifestation of pain disorders and MDD. Specifically, we hypothesize that contextual physical or psychological events (e.g. surgery, divorce) in the presence of a reward impairment diathesis worsens symptoms and results in a negative feedback loop that increases the chronicity and probability of developing the other disorder. We also highlight the implications for treatment and provide a framework for future research.
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Affiliation(s)
- Sakina J Rizvi
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Wiebke Gandhi
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Tim Salomons
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
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8
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Day MA, Ehde DM, Burns J, Ward LC, Friedly JL, Thorn BE, Ciol MA, Mendoza E, Chan JF, Battalio S, Borckardt J, Jensen MP. A randomized trial to examine the mechanisms of cognitive, behavioral and mindfulness-based psychosocial treatments for chronic pain: Study protocol. Contemp Clin Trials 2020; 93:106000. [PMID: 32302791 PMCID: PMC7195020 DOI: 10.1016/j.cct.2020.106000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/27/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Abstract
This randomized trial will evaluate the mechanisms of three chronic pain treatments: cognitive therapy (CT), mindfulness meditation (MM), and activation skills (AS). We will determine the extent to which late-treatment improvement in primary outcome (pain interference) is predicted by early-treatment changes in cognitive content, cognitive process, and/or activity level. The shared versus specific role of these mechanisms across the three treatments will be evaluated during treatment (Primary Aim), and immediately post-treatment to examine relapse mechanisms (Secondary Aim). We will enroll 300 individuals with chronic pain (with low back pain as a primary or secondary condition), with 240 projected to complete the study. Participants will be randomly assigned to eight, 1.5 h telehealth group sessions of CT, MM, or AS. Mechanisms and outcomes will be assessed twice daily during 2-week baseline, 4-week treatment period, and 4-week post-treatment epoch via random cue-elicited ecological momentary assessment (EMA); activity level will be monitored during these time epochs via daily monitoring with ActiGraph technology. The primary outcome will be measured by the PROMIS 5-item Pain Interference scale. Structural equation modeling (SEM) will be used to test the primary aims. This study is pre-registered on clinicaltrials.gov (Identifier: NCT03687762). This study will determine the temporal sequence of lagged mediation effects to evaluate rates of change in outcome as a function of change in mediators. The findings will provide an empirical basis for enhancing and streamlining psychosocial chronic pain interventions. Further, results will guide future efforts towards optimizing maintenance of gains to effectively reduce relapse risk.
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Affiliation(s)
- M A Day
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia.
| | - D M Ehde
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - J Burns
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - L C Ward
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - J L Friedly
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - B E Thorn
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - M A Ciol
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - E Mendoza
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - J F Chan
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - S Battalio
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - J Borckardt
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
| | - M P Jensen
- The University of Queensland, 330 McElwain Building, Brisbane 4072, Queensland, Australia
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Kiluk BD, Yip SW, DeVito EE, Carroll KM, Sofuoglu M. Anhedonia as a key clinical feature in the maintenance and treatment of opioid use disorder. Clin Psychol Sci 2019; 7:1190-1206. [PMID: 32042509 PMCID: PMC7009780 DOI: 10.1177/2167702619855659] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is a critical need for research on clinical features that may influence response to treatment for opioid use disorder (OUD). Given its neurobiology and relevance to opioid use, anhedonia may be one such promising clinical feature. We identified and reviewed 11 studies that measured anhedonia in humans with OUD to characterize the current state of evidence and highlight potential implications for treatment. The majority of studies were cross-sectional, indicating higher anhedonia scores in opioid-dependent samples compared to healthy controls. Rates of participants with clinically significant anhedonia ranged from 21% to 48%. Anhedonia scores were correlated with opioid craving and use, however there are significant knowledge gaps regarding its time course and impact on treatment adherence and outcomes. Repeated assessment of anhedonia early in treatment for OUD is recommended, as it may be a unique predictor of dropout or non-response, and a potential target for behavioral and/or pharmacological intervention.
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Zeidan F, Salomons T, Farris SR, Emerson NM, Adler–Neal A, Jung Y, Coghill RC. Neural mechanisms supporting the relationship between dispositional mindfulness and pain. Pain 2018; 159:2477-2485. [PMID: 30015711 PMCID: PMC6237620 DOI: 10.1097/j.pain.0000000000001344] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Interindividual differences in pain sensitivity vary as a function of interactions between sensory, cognitive-affective, and dispositional factors. Trait mindfulness, characterized as the innate capacity to nonreactively sustain attention to the present moment, is a psychological construct that is associated with lower clinical pain outcomes. Yet, the neural mechanisms supporting dispositional mindfulness are unknown. In an exploratory data analysis obtained during a study comparing mindfulness to placebo analgesia, we sought to determine whether dispositional mindfulness is associated with lower pain sensitivity. We also aimed to identify the brain mechanisms supporting the postulated inverse relationship between trait mindfulness and pain in response to noxious stimulation. We hypothesized that trait mindfulness would be associated with lower pain and greater deactivation of the default mode network. Seventy-six meditation-naive and healthy volunteers completed the Freiburg Mindfulness Inventory and were administered innocuous (35°C) and noxious stimulation (49°C) during perfusion-based functional magnetic resonance imaging. Higher Freiburg Mindfulness Inventory ratings were associated with lower pain intensity (P = 0.005) and pain unpleasantness ratings (P = 0.005). Whole brain analyses revealed that higher dispositional mindfulness was associated with greater deactivation of a brain region extending from the precuneus to posterior cingulate cortex during noxious heat. These novel findings demonstrate that mindful individuals feel less pain and evoke greater deactivation of brain regions supporting the engagement sensory, cognitive, and affective appraisals. We propose that mindfulness and the posterior cingulate cortex should be considered as important mechanistic targets for pain therapies.
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Affiliation(s)
- Fadel Zeidan
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston–Salem, NC, 27157
| | - Tim Salomons
- School of Psychology and Clinical Language Sciences, University of Reading, Whiteknights PO Box 217,United Kingdom
| | - Suzan R. Farris
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston–Salem, NC, 27157
| | | | - Adrienne Adler–Neal
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston–Salem, NC, 27157
| | - Youngkyoo Jung
- Department of Radiology, Wake Forest School of Medicine, Winston–Salem, NC, 27157
| | - Robert C. Coghill
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston–Salem, NC, 27157
- Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, 45229
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11
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Priddy SE, Hanley AW, Riquino MR, Platt KA, Baker AK, Garland EL. Dispositional mindfulness and prescription opioid misuse among chronic pain patients: Craving and attention to positive information as mediating mechanisms. Drug Alcohol Depend 2018; 188:86-93. [PMID: 29754031 DOI: 10.1016/j.drugalcdep.2018.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/26/2018] [Accepted: 03/29/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Opioid-treated chronic pain patients may be at risk for prescription opioid misuse due to heightened opioid craving coupled with deficits in attention to naturally rewarding, positive stimuli. Conversely, dispositional mindfulness, which is associated with reduced craving and increased responsiveness to natural rewards, may serve as a protective factor and buffer opioid misuse risk. The current investigation aimed to examine the association between mindfulness and opioid misuse, and to test opioid craving and attention to positive information as mediators of this relationship. METHODS This cross-sectional analysis examined data obtained from a sample of civilian opioid-treated chronic pain patients in the Southeastern U.S. (Sample 1: N = 115), as well as civilian (Sample 2: N = 141) and military samples in the Intermountain West (Sample 3: N = 44). Pearson correlations and path analyses were employed to test relations among participant self-reports on the Current Opioid Misuse Measure (COMM), the Five Facet Mindfulness Questionnaire (FFMQ), two measures of opioid craving, and the Attention to Positive and Negative Information Scale (APNIS). RESULTS Across all three samples, dispositional mindfulness was significantly inversely associated with opioid misuse (N = 300, r = -0.36, p < .001). Reduced opioid craving and increased attention to positive information mediated the association between dispositional mindfulness and opioid misuse. DISCUSSION Dispositional mindfulness may buffer opioid misuse risk by attenuating opioid craving and enhancing attention to naturally rewarding stimuli.
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Affiliation(s)
- Sarah E Priddy
- Center on Mindfulness and Integrative Health Intervention Development, 395 South, 1500 East, University of Utah, Salt Lake City, UT 84112, United States; College of Social Work, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States
| | - Adam W Hanley
- Center on Mindfulness and Integrative Health Intervention Development, 395 South, 1500 East, University of Utah, Salt Lake City, UT 84112, United States; College of Social Work, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States
| | - Michael R Riquino
- Center on Mindfulness and Integrative Health Intervention Development, 395 South, 1500 East, University of Utah, Salt Lake City, UT 84112, United States; College of Social Work, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States
| | - Keith A Platt
- Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431, United States
| | - Anne K Baker
- Center on Mindfulness and Integrative Health Intervention Development, 395 South, 1500 East, University of Utah, Salt Lake City, UT 84112, United States; College of Social Work, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, 395 South, 1500 East, University of Utah, Salt Lake City, UT 84112, United States; College of Social Work, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States; Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr., Salt Lake City, UT 84103, United States.
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12
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Ducasse D, Loas G, Dassa D, Gramaglia C, Zeppegno P, Guillaume S, Olié E, Courtet P. Anhedonia is associated with suicidal ideation independently of depression: A meta-analysis. Depress Anxiety 2018; 35:382-392. [PMID: 29232491 DOI: 10.1002/da.22709] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/27/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Anhedonia is considered a suicide risk factor in patients with major affective disorders. Here, we wanted to quantify the association between anhedonia and current suicidal ideation according to the absence/presence of between-group differences for depressive scores and psychiatric disorders. METHODS We performed a meta-analysis of data on studies retrieved from Medline, Web of Science, and PsycINFO from 1965 to 2016 using, among others, the terms (suicid* or depression) and anhedonia. RESULTS We identified 15 observational case-control studies that investigated the anhedonia differences in individuals with and without current (i.e., within the past week, independently of the lifetime suicidality status) suicidal ideation (defined as thoughts of killing oneself). Overall, 657 subjects with and 6,690 subjects without current suicidal ideation could be compared. Anhedonia level was higher in the group with current suicidal ideation than in the group without, with a medium effect size (standardized mean difference = 0.57, z = 5.43, P < 0.001, 95% confidence interval, CI = 0.37-0.79). The association between anhedonia and current suicidal ideation remained significant when controlling for depression and psychiatric disorders. The anhedonia scales used in the selected studies did not allow investigating consummatory and motivational anhedonia separately. CONCLUSION Our major finding is the robust association between anhedonia and current suicidal ideation, independently of depression. This is highly relevant for the clinicians' daily practice and might help improving suicidal risk detection and the development of new therapeutic strategies for suicide prevention.
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Affiliation(s)
- Déborah Ducasse
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France.,Fondamental Foundation, Créteil, France
| | - Gwenolé Loas
- Department of Psychiatry & Laboratory of Psychiatric Research (ULB 266), Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Déborah Dassa
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Carla Gramaglia
- Psychiatry Institute, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Novara, Italy
| | - Patrizia Zeppegno
- Psychiatry Institute, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Novara, Italy.,SCDU Psichiatria, AOU Maggiore della Carità, Novara, Novara, Italy
| | - Sébastien Guillaume
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France.,Fondamental Foundation, Créteil, France.,University of Montpellier, Montpellier, France
| | - Emilie Olié
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France.,Fondamental Foundation, Créteil, France.,University of Montpellier, Montpellier, France
| | - Philippe Courtet
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France.,Fondamental Foundation, Créteil, France.,University of Montpellier, Montpellier, France
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Abdolghaderi M, Kafi SM, Saberi A, Ariaporan S. Effectiveness of Mindfulness-Based Cognitive Therapy on Hope and Pain Beliefs of Patients With Chronic Low Back Pain. CASPIAN JOURNAL OF NEUROLOGICAL SCIENCES 2018. [DOI: 10.29252/nirp.cjns.4.12.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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