Mindfulness-Oriented Recovery Enhancement Reduces Pain Attentional Bias in Chronic Pain Patients

Abstract

Background: Chronic pain involves hypervigilance for pain-related stimuli. Selective attention to pain-related stimuli, known as pain attentional bias (AB), can exacerbate chronic pain, prolong suffering, and undermine quality of life. The aim of this study was to determine if a multimodal mindfulness-oriented intervention could significantly reduce pain AB among chronic pain patients receiving opioid analgesics. Methods: A total of 67 chronic pain patients were randomized to an 8-week Mindfulness-Oriented Recovery Enhancement (MORE) intervention or a social support group intervention and began treatment. A dot probe task was used to measure pain AB. Primary outcomes were pain AB scores for cues presented for 2,000 and 200 ms. Results: Prior to intervention, participants exhibited a significant bias towards pain-related cues presented for 2,000 ms, but no bias for cues presented for 200 ms. A statistically significant time × intervention condition interaction was observed for 2,000 ms pain AB, such that participants in MORE evidenced significantly reduced posttreatment pain AB relative to pretreatment levels, whereas no significant pre-post treatment changes in pain AB were observed for support group participants. Decreases in pain AB were associated with increased perceived control over pain and attenuated reactivity to distressing thoughts and emotions. Conclusion: Study findings provide the first indication that a mindfulness-oriented intervention may reduce pain AB among adults suffering from chronic pain. Given the magnitude of chronic pain in postindustrial societies, coupled with the dramatic escalation in prescription opioid misuse, future studies should evaluate MORE as a nonpharmacological means of addressing factors linked with chronic pain.

The Role of Positive Affect in Pain and Its Treatment

“…A recent adaptation of an intervention originally developed to treat addiction, Mindfulness-Oriented Recovery Enhancement (MORE)(101), unites complementary aspects of mindfulness training, cognitive reappraisal, and positive psychological principles into an integrative treatment strategy designed to disrupt the cycle of somatic distress and maladaptive cognitive-affective states common to chronic pain. MORE aims to directly stimulate PA by promoting savoring of natural rewards.…”

“…MORE aims to directly stimulate PA by promoting savoring of natural rewards. Evidence from an early stage RCT involving chronic pain patients suggests that MORE may be efficacious for diminishing pain attentional bias and enhancing perceived control over pain (101). Recent findings from this preliminary trial suggest that MORE decreases pain severity and functional impairment (102), and reduces desire for opioid analgesics by enhancing autonomic responsiveness to positive emotional stimuli (102).…”

Frequency of Ophthalmic Complications on 140 Cases of Type II Diabetes Mellitus, Babol, Iran

“…Mindfulness interventions are reportedly associated with reduced attention bias, especially in response to negative stimuli (57,58). However, instability on negative events is not enough to promote well-being.…”

Treating chronic pain: the need for non-opioid options

“…Furthermore, MORE significantly decreased opioid craving and the risk of opioid misuse by at post-treatment. Subsequent analyses of neurocognitive data from the trial revealed several of MORE's potential mechanisms of action; MORE reduced hypervigilance toward pain-related information (pain attentional bias) [65], decreased subjective opioid cue reactivity [66] and enhanced autonomic nervous system responses to images representing natural rewards (e.g., photos of a sunset, romantic couples, smiling babies, etc.,) [66].…”