A Virtual Reality Meditative Intervention Modulates Pain and the Pain Neuromatrix in Patients with Opioid Use Disorder

Abstract

Objective Standard-of-care for opioid use disorder (OUD) includes medication and counseling. However, there is an unmet need for complementary approaches to treat OUD patients coping with pain; furthermore, few studies have probed neurobiological features of pain or its management during OUD treatment. This preliminary study examines neurobiological and behavioral effects of a virtual reality-based meditative intervention in patients undergoing methadone maintenance treatment (MMT). Design Prospective, non-blinded, single-arm, 12-week intervention with standardized assessments. Setting Academic research laboratory affiliated with an on-site MMT clinic. Methods Fifteen (11 female) MMT patients completed a virtual reality, therapist-guided meditative intervention that included breathing and relaxation exercises; sessions were scheduled twice weekly. Assessments included functional magnetic resonance imaging (fMRI) of pain neuromatrix activation and connectivity (pre- and post-intervention), saliva cortisol and C-reactive protein (CRP) at baseline and weeks 4, 8 and 12; and self-reported pain and affective symptoms before and after each intervention session. Results After each intervention session (relative to pre-session), ratings of pain, opioid craving, anxiety and depression (but not anger) decreased. Saliva cortisol (but not CRP) levels decreased from pre- to post-session. From pre- to post-intervention fMRI assessments, pain task-related left postcentral gyrus (PCG) activation decreased. At baseline, PCG showed positive connectivity with other regions of the pain neuromatrix, but this pattern changed post-intervention. Conclusions These preliminary findings demonstrate feasibility, therapeutic promise, and brain basis of a meditative intervention for OUD patients undergoing MMT.

Application of Virtual Reality Technology in Clinical Practice, Teaching, and Research in Complementary and Alternative Medicine

“…Regarding pain management, clinical studies have validated the effectiveness of VR as a facilitator of meditation practice in patients with acute pain [ 62 ], chronic pain [ 60 ], and opioid tolerance or opioid use disorder [ 61 , 62 ]. Further neurobiological research studies found that scores for pain, opioid craving, anxiety, and depression decreased after each intervention session (relative to before the session) [ 61 ]. In addition, salivary cortisol (but not CRP) levels were found to decrease from pre- to postsession [ 61 ].…”

“…Further neurobiological research studies found that scores for pain, opioid craving, anxiety, and depression decreased after each intervention session (relative to before the session) [ 61 ]. In addition, salivary cortisol (but not CRP) levels were found to decrease from pre- to postsession [ 61 ]. Based on pre- to postintervention fMRI assessments, painful task-related left postcentral gyrus (PCG) activation was found to decrease [ 61 ].…”

“…In addition, salivary cortisol (but not CRP) levels were found to decrease from pre- to postsession [ 61 ]. Based on pre- to postintervention fMRI assessments, painful task-related left postcentral gyrus (PCG) activation was found to decrease [ 61 ]. At baseline, the PCG showed positive connectivity with other regions of the pain neuromatrix, but this pattern changed postintervention [ 61 ].…”

“…Based on pre- to postintervention fMRI assessments, painful task-related left postcentral gyrus (PCG) activation was found to decrease [ 61 ]. At baseline, the PCG showed positive connectivity with other regions of the pain neuromatrix, but this pattern changed postintervention [ 61 ]. The results of this feasibility study suggest that a VR-based meditation intervention is a promising approach for reducing pain scores and modulating pain neuromatrix activity and connectivity among patients with opioid use disorder [ 61 ].…”

“…VR technology may facilitate meditation practice by immersing users in a distraction-free and calming virtual environment [60]. Today, VR and meditation therapy have been applied to a range of disorders and conditions, including pain [60][61][62], depression [63], anxiety disorders [3,63,64], sleep disorders [65], posttraumatic stress disorder [66], and pressure [60].…”