Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis.

Importance: Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients. Objective: To evaluate the association of MBTs with pain and opioid dose reduction in a diverse adult population with clinical pain. Data Sources: For this systematic review and meta-analysis, the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases were searched for English-language randomized clinical trials and systematic reviews from date of inception to March 2018. Search logic included (pain OR analgesia OR opioids) AND mind-body therapies. The gray literature, ClinicalTrials.gov, and relevant bibliographies were also searched. Study Selection: Randomized clinical trials that evaluated the use of MBTs for symptom management in adults also prescribed opioids for clinical pain. Data Extraction and Synthesis: Independent reviewers screened citations, extracted data, and assessed risk of bias. Meta-analyses were conducted using standardized mean differences in pain and opioid dose to obtain aggregate estimates of effect size with 95% CIs. Main Outcomes and Measures: The primary outcome was pain intensity. The secondary outcomes were opioid dose, opioid misuse, opioid craving, disability, or function. Results: Of 4212 citations reviewed, 60 reports with 6404 participants were included in the meta-analysis. Overall, MBTs were associated with pain reduction (Cohen d = -0.51; 95% CI, -0.76 to -0.26) and reduced opioid dose (Cohen d = -0.26; 95% CI, -0.44 to -0.08). Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and cognitive behavioral therapy (n = 7) interventions. Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d = -0.70), hypnosis (Cohen d = -0.54), suggestion (Cohen d = -0.68), and cognitive behavioral therapy (Cohen d = -0.43) but not for other MBTs. Although most meditation (n = 4 [80%]), cognitive-behavioral therapy (n = 4 [57%]), and hypnosis (n = 12 [63%]) studies found improved opioid-related outcomes, fewer studies of suggestion, guided imagery, and relaxation reported such improvements. Most MBT studies used active or placebo controls and were judged to be at low risk of bias. Conclusions and Relevance: The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse. Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes.

Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement.

Addiction neuroscience models posit that recurrent drug use increases reactivity to drug-related cues and blunts responsiveness to natural rewards, propelling a cycle of hedonic dysregulation that drives addictive behavior. Here, we assessed whether a cognitive intervention for addiction, Mindfulness-Oriented Recovery Enhancement (MORE), could restructure reward responsiveness from valuation of drug-related reward back to valuation of natural reward. Before and after 8 weeks of MORE or a support group control, prescription opioid users (N = 135) viewed opioid and natural reward cues while an electroencephalogram biomarker of target engagement was assessed. MORE was associated with decreased opioid cue-reactivity and enhanced capacity to regulate responses to opioid and natural reward cues. Increased positive affective responses to natural reward cues were associated with decreased craving and mediated MORE's therapeutic effects on opioid misuse. This series of randomized experiments provide the first neurophysiological evidence that an integrative behavioral treatment can remediate hedonic dysregulation among chronic opioid users.

Adherence to Practice of Mindfulness in Novice Meditators: Practices Chosen, Amount of Time Practiced, and Long-Term Effects Following a Mindfulness-Based Intervention.

In this study, we objectively tracked the duration, frequency, and the preferred practices chosen by novice mindfulness practitioners following a mindfulness meditation (MM) intervention. A sample of 55 mildly stressed participants, aged 50 to 80 years old, underwent an individual 6-week MM intervention and had their guided meditation home practice electronically recorded during the intervention and the 8-week post-intervention period. Participants' psychological well-being was assessed through self-report measures of mindfulness, quality of life, and symptoms of depression and stress. Results evidenced a high adherence to practice, with an average of ~23 minutes per day during the intervention and ~16 minutes per day in the follow-up period. Body scan, sitting meditation, and breathing space were the most popular meditation practices among participants. Our results showed significant alterations in self-reported measures over time, suggesting improvements in stress and overall quality of life. Changes in the self-report measures did not correlate with MM practice time, which suggests that other psychological phenomena, including quality of meditation practice, influence these outcomes.

Influence of emotional states on inhibitory gating: animals models to clinical neurophysiology.

Integrating research efforts using a cross-domain approach could redefine traditional constructs used in behavioral and clinical neuroscience by demonstrating that behavior and mental processes arise not from functional isolation but from integration. Our research group has been examining the interface between cognitive and emotional processes by studying inhibitory gating. Inhibitory gating can be measured via changes in behavior or neural signal processing. Sensorimotor gating of the startle response is a well-used measure. To study how emotion and cognition interact during startle modulation in the animal model, we examined ultrasonic vocalization (USV) emissions during acoustic startle and prepulse inhibition. We found high rates of USV emission during the sensorimotor gating paradigm and revealed links between prepulse inhibition (PPI) and USV emission that could reflect emotional and cognitive influences. Measuring inhibitory gating as P50 event-related potential suppression has also revealed possible connections between emotional states and cognitive processes. We have examined the single unit responses during the traditional gating paradigm and found that acute and chronic stress can alter gating of neural signals in regions such as amygdala, striatum and medial prefrontal cortex. Our findings point to the need for more cross-domain research on how shifting states of emotion can impact basic mechanisms of information processing. Results could inform clinical work with the development of tools that depend upon cross-domain communication, and enable a better understanding and evaluation of psychological impairment.

MEMORY FOR POETRY: MORE THAN MEANING?

The assumption has become that memory for words' sound patterns, or form, is rapidly lost in comparison to content. Memory for form is also assumed to be verbatim rather than schematic. Oral story-telling traditions suggest otherwise. The present experiment investigated if form can be remembered schematically in spoken poetry, a context in which form is important. We also explored if sleep could help preserve memory for form. We tested whether alliterative sound patterns could cue memory for poetry lines both immediately and after a delay of 12 hours that did or did not include sleep. Twelve alliterative poetry lines were modified into same alliteration, different alliteration, and no alliteration paraphrases. We predicted that memory for original poetry lines would be less accurate after 12 hours, same alliteration paraphrases would be falsely recognized as originals more often after 12 hours, and that the no-sleep group would make more errors. Different alliteration and no alliteration paraphrases were not expected to share this effect due to schematically different sound patterns. Our data support these hypotheses and provide evidence that memory for form is schematic in nature, retained in contexts in which form matters, and that sleep may help preserve memory for sound patterns.