National Public Radio recently covered a story on Mindfulness-Oriented Recovery Enhancement (MORE) as an intervention for chronic pain and prescription opioid-related problems. The story details new discoveries about the biobehavioral mechanisms of this novel therapy, as well as how mindfulness can be used to improve well-being in individuals suffering from chronic pain.
The NPR story can be found here.
My colleagues and I just published a new paper in the Journal of General Internal Medicine demonstrating that mindfulness training and hypnotic suggestion significantly reduced acute pain experienced by hospital inpatients. After participating in a single, 15-minute session of one of these mind-body therapies, patients reported an immediate decrease in pain levels similar to what one might expect from an opioid painkiller.
This study is the first to compare the effects of mindfulness and hypnosis on acute pain in the hospital setting.
The yearlong study’s 244 participants were patients at the University of Utah Hospital in Salt Lake City who reported experiencing unmanageable pain as the result of illness, disease, or surgical procedures. Willing patients were randomly assigned to receive a brief, scripted session in one of three interventions: mindfulness, hypnotic suggestion or pain coping education. Hospital social workers who completed basic training in each scripted method provided the interventions to patients.
While all three types of intervention reduced patients’ anxiety and increased their feelings of relaxation, patients who participated in the hypnotic suggestion intervention experienced a 29% reduction in pain, and patients who participated in the mindfulness intervention experienced a 23% reduction in pain, compared to a 9% reduction experienced by those who participated in the pain coping intervention. Patients receiving the two mind-body therapies also reported a significant decrease in their perceived need for opioid medication.
About a third of the study participants receiving one of the two mind-body therapies achieved close to a 30% reduction in pain intensity. This clinically significant level of pain relief is roughly equivalent to the pain relief produced by five milligrams of oxycodone.
My previous research has indicated that an 8-week long course of Mindfulness-Oriented Recovery Enhancement can be an effective way to reduce chronic pain symptoms and decrease prescription opioid misuse. This new study added a new dimension to my work by revealing the promise of brief mind-body therapies for acute pain patients.
It was really exciting and quite amazing to see such dramatic results from a single mind-body session. Given our nation’s current opioid epidemic, the implications of this study are potentially huge. These brief mind-body therapies could be cost-effectively and feasibly integrated into standard medical care as useful adjuncts to pain management.
My interdisciplinary team at Center for Mindfulness and Integrative Health Intervention Development plan to continue to investigate mind-body therapies as non-opioid means of alleviating pain by conducting a national replication study in a sample of thousands of patients in multiple hospitals around the country.
Because of its public health relevance, so far the study has been covered by more than 40 television stations around the country. Here is a brief clip about the study.
The University of Utah has launched a new center dedicated to providing a transformative influence on healthcare by unifying research on mindfulness and other integrative behavioral health interventions.
Eric Garland, Associate Dean for Research at the U’s College of Social Work, will serve as Director of the new Center on Mindfulness and Integrative Health Intervention Development (C-MIIND). The Center, which will assume oversight of more than $17 million in federal research grants, will be housed in the College of Social Work.
“The center will advance a vision of a new model of healthcare, in which behavioral health experts work in tandem with medical providers to address the physical, psychological and social needs of people suffering from an array of health conditions,” said Garland, whose research focuses on using mindfulness to help individuals who experience chronic pain.
The center will bring together researchers and clinicians from across main campus and University of Utah Health, including faculty in social work, psychiatry, primary care, anesthesiology, neuroscience, oncology, psychology, and health, who are pioneering integrative interventions aimed at improving physical and mental well-being. C-MIIND will strive to attract top faculty and provide research opportunities for undergraduate, graduate and post-doctoral fellows interested in studying mindfulness and integrative behavioral health.
A focus of the center also will be to train post-graduates and health care providers in innovative therapies to be used in primary care clinics, hospitals, community mental health centers and addiction treatment facilities.
News coverage of the Center launch can be found here.
An NPR interview with Dr. Garland about the Center can be found here.
Recently, I was awarded a R01 grant from the National Institute on Drug Abuse to conduct a full-scale clinical trial of Mindfulness-Oriented Recovery Enhancement (MORE) as an intervention to reduce chronic pain and prescription opioid misuse in primary care. This five-year study will compare the efficacy of MORE to supportive therapy for 260 chronic pain patients receiving long-term opioid therapy who are at risk for opioid misuse.
Opioids may be medically necessary for some individuals experiencing prolonged and intractable pain, and most patients take medicine as prescribed. Unfortunately, opioids rarely completely alleviate chronic pain, and when taken in high doses or for long periods of time, can lead to serious side effects, including death by overdose, as well as risk for opioid misuse, which affects about 1 in 4 opioid-treated patients. Misusing opioids by taking higher doses than prescribed or by taking opioids to self-medicate negative emotions can alter the brain’s capacity for hedonic regulation, making it difficult to cope with pain (e.g., causing hyperalgesia – an increased sensitivity of the nervous system to pain) and experience pleasure in life (e.g., reducing sensitivity of the brain to natural reward). As such, non-opioid pain treatments that target hedonic dysregulation may be especially helpful for reducing chronic pain and prevent opioid misuse.
Multiple studies suggest that MORE improves hedonic regulation in the brain, resulting in decreased pain and an increased ability to savor natural, healthy pleasure. People who participate in MORE show heightened brain and body responses to healthy pleasures, and report feeling more positive emotions by using of mindfulness as a tool to enhance savoring. These therapeutic effects of MORE on savoring may be critically important, because findings from several studies show that increasing sensitivity to natural reward through savoring may lead to decreased craving for drugs – a completely novel finding for the field of addiction science (Garland, 2016). Our NIDA-funded R01 will provide a rigorous test of whether MORE improves chronic pain and opioid misuse by targeting hedonic dysregulation.
In our NIDA-funded R01, patients are receiving MORE at community medical clinics throughout Salt Lake City. Providing MORE in the naturalistic setting where most chronic pain patients seek medical care will make the therapy accessible to the people who need it the most. Ultimately, my hope is that this project will advance a new form of integrative healthcare, in which doctors and nurses work alongside social workers and other behavioral health professionals to help patients reclaim a meaningful life from pain.
I was recently interviewed by Michael Juberg for the Mind and Life Institute, the world’s premier multi-disciplinary organization for the study of contemplative science. Michael and I had a wide ranging discussion that covered the span from philosophy to science to alleviating human suffering. He asked me some seriously thought-provoking questions that made me reflect back on the roots of my career and where it is all headed in the future. At the end of the interview, I offered a bit of advice for folks aspiring to become scientists in this field. The interview was really well done and I’m pleased to share it with you here.
Chronic pain is often treated with extended use of opioid analgesics, yet these drugs can alter the brain in ways that may make it difficult to cope with pain and may reduce the experience pleasure in life. Mindfulness-based interventions appear to be a promising means of addressing these issues, but research is needed to understand how such interventions change the brain to reduce suffering.
To that end, in September, 2016, I was recently awarded a five-year phased innovation grant from the National Institutes of Health’s (NIH) National Center for Complementary and Integrative Health entitled Effects of Mindfulness-Oriented Intervention on Endogenous Opioid Mechanisms of Hedonic Regulation in Chronic Pain (R61AT009296). The objective of the project is to study the effects of an innovative mindfulness-based intervention on brain mechanisms linked with pain and pleasure.
In the first two-year phase of the study ($800,000), I (Principal Investigator), along with my Co-Principal Investigator Jon-Kar Zubieta (Co-Principal Investigator), chair of the University of Utah’s Department of Psychiatry, will use positron emission tomography (PET) neuroimaging to assess the effects of Mindfulness-Oriented Recovery Enhancement (MORE) on restoring brain levels of endorphins in patients with chronic back pain who are being treated with prescription opioids.
This study represents the first use of PET in the history of science to quantify the effects of a mindfulness-based therapy on levels of endogenous opioids in the brain.
We will also use functional magnetic resonance imaging (fMRI) methods to assess how mindfulness training through MORE may increase people’s capacity to savor natural pleasure from positive and meaningful events in everyday life – a capacity that becomes diminished over time through the deleterious effects of chronic pain and prolonged opioid use on the brain. We will use a fMRI paradigm developed by my Co-Investigator Brett Froeliger, Assistant Professor of Neuroscience at the Medical University of South Carolina.
This study aims to test whether MORE might reverse this insensitivity to natural reward by targeting the endogenous opioid system and brain reward functions.
Following a successful first phase of the project, a three-year second phase ($2.2 million) will investigate whether patients with a particular genetic makeup that affects the expression of opioid receptors in the brain might benefit more from the mindfulness-based treatment. The second phase of the project will also assess the dose of mindfulness skill practice as a predictor of changes in endogenous opioid function and clinical correlates.
Based on the results of previous research, we hypothesize that mindfulness meditation training through MORE will restore proper function to the brain’s opioid receptors. We will be able to measure how MORE changes the brain’s ability to regulate pain and respond to natural rewards, as well as deepen our understanding of exactly how these changes in neural mechanisms happen.
Overall, this project will unite expertise in mindfulness-based interventions with expertise in neurogenetics and the use of PET and fMRI to probe the neurobiological mechanisms of pain and emotional experience. By elucidating a key mechanism of meditation-based therapies, this program of translational research will further the emerging field of social work neuroscience and enable us to rapidly optimize MORE to increase the effectiveness of the intervention as it is rolled out in clinical practice.
I was recently awarded $3.4 million in research funding from the Department of Defense Congressionally Directed Medical Research Program for a five-year clinical trial award entitled “Targeting Chronic Pain and Co-Occurring Disorders in the Community with Mindfulness-Oriented Recovery Enhancement.” To help me to carry out this pragmatic, large-scale randomized controlled trial, I will be supported by an interdisciplinary team of expert co-investigators from the University of Utah, including Jon-Kar Zubieta, Craig Bryan, Yoshio Nakamura, Gary Donaldson, and Bill Marchand.
The co-occurrence of chronic pain, psychological distress, and misuse of prescription opioids undermines the mission of the U.S. Military and inflicts suffering upon Veterans and their families. Approximately one-half of service members have chronic pain following deployment, and nearly one-fifth engage in opioid misusing behaviors like unauthorized dose escalation and use of opioids to self-medicate stress and anxiety. The state of Utah (where the proposed study will be conducted) has one of the highest incidences of nonmedical use of opioids in the U.S. and a rapidly increasing rate of prescription opioid-related deaths. Indeed, an estimated 21% of Utah adults were prescribed opioids during the past year, of which approximately one-in-five report taking more than prescribed. Given that military personnel and Veterans have higher rates of pain-related conditions than the general population, their risk for opioid-related problems is significantly enhanced.
New scientific findings indicate that because stress worsens pain and increases habit responses in the brain, individuals who cope with stress and pain through opioids are likely to have the most serious and difficult-to-treat opioid-related problems. The recent wars in Iraq and Afghanistan have been marked by repeated deployments involving serious combat-related and occupational stress. Unfortunately, there are no evidence-based treatments that simultaneously address pain, opioid misuse, and psychological distress. To fill this gap, this research proposal aims to conduct a pragmatic trial of a novel integrative medicine approach combining Mindfulness-Oriented Recovery Enhancement (MORE) with conventional opioid pain management for service members and Veterans. MORE aims to strengthen self-control over habit behaviors, increase flexible thinking under conditions of stress, and promote the sense of reward and meaning in the face of adversity.
This research project will help active duty service members and Veterans with chronic pain and stress who are at-risk for opioid misuse, and will also inform the treatment of civilians with similar issues. Should MORE prove to be effective in a community-based context, it could be easily transported into military installations and Veterans Administration Medical Centers in the U.S. and around the world, as well as in communities where no major military medical center is present. In these settings, MORE could be offered as a form of standard integrative health care provided to service members and Veterans.
A secondary objective of the proposed project is to utilize lab-based assessments and mobile technology to understand how MORE works to create therapeutic change, and to predict whether and when service members and Veterans are at risk for relapsing back to opioid misuse. To accomplish this objective, lab-based assessments will evaluate physiological reactivity to cues associated with past episodes of pain and opioid use, and a smartphone-based assessment will be used to evaluate opioid craving, pain, and negative mood in “the real world.” Because changes in heart rate and other physiological factors may indicate the extent to which a person’s brain has been triggered by opioid craving, this application of mind-body assessments to predict opioid misuse risk and treatment outcomes could facilitate early risk detection.
The final objective of the project is to understand for whom MORE works best, to help ensure more efficient healthcare resource allocation to the service members and Veterans who need it most. The proposed project will enable health care providers to more effectively deliver low-cost treatment to prevent progression toward opioid addiction, thereby averting costly inpatient stays, discharge from active duty military service, and social, legal, and occupational problems among Veterans. Ultimately, the proposed research could significantly enhance the psychological and physical health of military personnel and Veterans by addressing the need for new integrative medicine treatment options with findings from the leading edge of science.
It is my pleasure to announce that the very first review paper summarizing the theoretical rationale and empirical evidence for Mindfulness-Oriented Recovery Enhancement (MORE) has been accepted for publication in the prestigious journal Annals of the New York Academy of Sciences. In this paper, I review data from multiple clinical studies on the biobehavioral mechanisms of MORE, and articulate a hedonic regulatory model of the intervention – proposing that restructuring reward processing is the final common pathway through which MORE ameliorates addiction, stress, and pain. I map this novel theoretical model onto an earlier conceptual framework of the neural circuitry underlying mindfulness-centered regulation of addiction (Garland, Froeliger, & Howard, 2014) and then describe new neuroimaging and psychophysiological data in support of the model. The paper abstract is as follows:
“Though valuation processes are fundamental to survival of the human species, hedonic dysregulation is at the root of an array of clinical disorders including addiction, stress, and chronic pain, as evidenced by the allostatic shift in the relative salience of natural reward to drug reward observed among persons with severe substance use disorders. To address this crucial clinical issue, novel interventions are needed to restore hedonic regulatory processes gone awry in persons exhibiting addictive behaviors. This article describes theoretical rationale and empirical evidence for the effects of one such new intervention, Mindfulness-Oriented Recovery Enhancement (MORE), on top-down and bottom-up mechanisms implicated in cognitive control and hedonic regulation. MORE is innovative and distinct from extant mindfulness-based interventions in that in unites traditional mindfulness meditation with reappraisal and savoring strategies designed to reverse the downward shift in salience of natural reward relative to drug reward, representing a crucial tipping point to disrupt the progression of addiction – something that no other behavioral intervention has been designed to do. Though additional studies are needed, clinical and biobehavioral data from several completed and ongoing trials suggest that MORE may exert salutary effects on addictive behaviors and the neurobiological processes that underpin them.”
I recently learned that my research on Mindfulness-Oriented Recovery Enhancement (MORE) was highlighted on the National Institute on Drug Abuse website. The NIDA news story, entitled “Mindfulness training may reduce deficits in natural reward processing during chronic pain or drug addiction” details a study I conducted with my colleagues Brett Froeliger (Neuroscience, Medical University of South Carolina) and Matthew Howard (Social Work, University of North Carolina at Chapel Hill) that was published in April in the Journal of Behavioral Medicine. According to the excellent summary of this research on the NIDA website,
“Drug-dependent people show decreased behavioral and brain reactivity to natural rewards compared to non-drug users. As a result, drug-dependent users increasingly focus their attention on obtaining the drug instead of attending to natural rewards. Recent research shows that a cognitive-based intervention may help restore natural reward processing in opioid-dependent participants.
In this study, chronic pain patients at risk for opioid misuse were randomized to either eight weeks of a Mindfulness-Oriented 
Recovery Enhancement (MORE) intervention or to an eight-week support group (control). Participants in the MORE intervention used mindfulness meditation to focus on all sensory features of a pleasant experience or object (for example, a beautiful nature scene like a sunset), while reflecting on any positive emotions arising in response to the pleasant event. The support group discussed topics and emotions related to chronic pain and opioid use/misuse. Following these interventions, all participants were shown images representing natural rewards (such as endearing animals, appealing foods, landscapes) or neutral images (furniture, neutral facial expressions, or household items). Researchers measured late positive potential (LPP) brain activity, which reflects attention to emotionally salient information, while participants viewed these images. In comparison to the control group, participants completing the MORE intervention showed greater LPP responses to natural reward images relative to neutral images and greater the LPP responses predicted reduced opioid cravings as reported by the participants.”
These results suggest that teaching people who misuse opioids to mindfully attend to positive aspects of their life may increase the perceived value of natural rewards – processes that may be diminished in those facing chronic pain or addiction – which may in turn help them to control opioid cravings.”
It is thrilling to see that this line of research is making a positive impact on the scientific community, and of course, the ultimate aim of this work is to alleviate human suffering.
An article I published with my colleagues Brett Froeliger from MUSC and Matthew Howard from UNC Chapel Hill in the journal Frontiers in Psychiatry entitled “Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface” was designated in the 93rd percentile of 3,480,147 articles tracked by Altmetric. The Altmetric score is a measure of the quality and quantity of online attention that this article has received. The paper details the model depicted below.
In this review paper, we describe how mindfulness-based interventions (MBIs) may target neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. Empirical evidence is presented suggesting that MBIs ameliorate addiction by enhancing cognitive regulation of a number of key processes, including: clarifying cognitive appraisal and modulating negative emotions to reduce perseverative cognition and emotional arousal; enhancing metacognitive awareness to regulate drug-use action schema and decrease addiction attentional bias; promoting extinction learning to uncouple drug-use triggers from conditioned appetitive responses; reducing cue-reactivity and increasing cognitive control over craving; attenuating physiological stress reactivity through parasympathetic activation; and increasing savoring to restore natural reward processing. Treatment and research implications of our neurocognitive framework are presented. We conclude by offering a temporally sequenced description of neurocognitive processes targeted by MBIs through a hypothetical case study. Our neurocognitive framework has implications for the optimization of addiction treatment with MBIs.
A new and important research study from my lab was recently accepted for publication in the respected Journal of Behavioral Medicine. This paper, which I wrote with my colleagues Brett Froeliger, Ph.D., and Matthew Howard, Ph.D., describes neurophysiological findings from a pilot randomized controlled trial (RCT) of Mindfulness-Oriented Recovery Enhancement (MORE) for chronic pain patients who had been prescribed long-term opioids for pain management. To my knowledge, this exploratory study is the first in the scientific literature to demonstrate that a mindfulness-based intervention can increase electroencephalographic (EEG) responses to natural, healthy pleasures in life.
In this study, individuals suffering from various chronic pain conditions were randomly assigned to participate in MORE or a social support group led by a therapist. Participants in the MORE group received 8 weeks of instruction in applying mindfulness-oriented techniques to alleviate pain and craving while strengthening positive emotions and the sense of reward and meaning in life. This latter aspect of MORE may be critically important. A large body of research suggests that as chronic pain and addiction progresses, people may become less physiologically responsive to natural pleasure. As their brains become less sensitive to naturally-rewarding experiences, they get less enjoyment out of life. In the absence of positive feelings, they suffer worse from emotional and physical pain, and ultimately may feel compelled to take drugs (such as opioids) to achieve a normal sense of well-being.
To enhance the sense of reward in life, participants were taught a mindful savoring practice, which involved focusing attention intensely on the sensory features (e.g., sight, sound, smell, or touch) of a pleasant experience or object (e.g., a beautiful nature scene like a sunset or the feeling of connection with a loved one) while noticing, appreciating, and absorbing any positive emotions arising in response to the pleasant event. For example, in one meditation session, participants were taught to mindfully focus on the colors, textures, and scents of a bouquet of fresh flowers, and to absorb and appreciate the emotions of contentment and joy arising from this savoring practice. Participants were asked to practice savoring in everyday life as part of a weekly homework assignment (along with a daily practice of mindful breathing meditation).
Although people tend to savor beauty naturally, we hoped that training in MORE could enhance savoring, and thereby increase the sensitivity of the brain to naturally-rewarding experiences. As an indicator of this enhanced savoring ability, we hypothesized that MORE would increase brain responses to images representing such positive experiences. To measure this in the lab, we used a computer to present participants with a series of positive photos representing naturally-rewarding objects and events (e.g., smiling babies, beautiful nature scenes, intimate couples in love) and a series of neutral photos (e.g., kitchen items, household objects, neutral faces) presented for 6 seconds each. During this task, we measured EEG brain activity at the scalp (the parietal site Pz) that were time-locked to the onset of the image. We were particularly interested in the component of the EEG known as the late positive potential (LPP), a brain response that tends to occur between 400 – 1000 ms after an emotional image is displayed. The LPP is known to be enhanced to positive images relative to neutral images in healthy individuals, whereas opiate addicts show reduced EEG brain responses to positive images (Lubman et al., 2008; 2009). In addition to measuring brain activity, we also asked participants to rate how positive they felt after viewing each photograph, and how much they desired or craved opioids in general.
In line with our hypothesis, we found that relative to the control group, MORE significantly increased the LPP brain activity to positive images relative to neutral images. In other words, participants showed enhanced brain responses while viewing naturally-rewarding stimuli following treatment with MORE. In addition, patients who exhibited the largest increases in LPP brain response to positive images experienced the greatest increases in positive emotions while viewing those images. Also, individuals who experienced the biggest increases in brain response to positive images experienced the greatest reduction in craving for opioids. These findings are important because they suggest 1) that MORE may help people to become more sensitive to naturally-rewarding objects and events, and 2) as people learn to experience greater pleasure from healthy and meaningful experiences in life, they may feel less of a need to take addictive drugs.
My colleagues and I recently advanced a neurocognitive model that suggests that MORE may alter the function of the mesocorticolimbic dopamine system, and in particular, target activity in the ventral striatum, a brain structure involved in experiencing both natural pleasure and pleasure associated with drug use. Numerous studies have shown that the ventral striatum functions abnormally in people suffering from addiction. MORE may restore normal function in this brain area, although studies using functional magnetic resonance imaging (fMRI) are needed to test this hypothesis.
Taken together, results from this new study, in combination with my previously published findings on cardiac-autonomic responses to positive stimuli, suggest that MORE may ameliorate deficits in natural reward processing among chronic patients taking long-term opioids by strengthening their ability to pay attention to healthy objects and events. Restoration of the ability to extract a sense of reward, fulfillment, and meaning out of everyday pleasures may be crucial to the ability to self-generate positive emotions and to resilience itself (Garland, Fredrickson, et al., 2010). More rigorous and larger-scale research is needed to test my hypothesis that focusing one’s attentional lens to more richly process the pleasurable, interesting, and meaningful experiences in life may make the painful and dissatisfying ones insignificant by comparison.
With the advance online publication of “Mindfulness-Oriented Recovery Enhancement for Chronic Pain and Prescription Opioid Misuse: Results from an Early Stage Randomized Controlled Trial” in the Journal of Consulting and Clinical Psychology on February 3rd, over 10 news stories have covered this work. For example, the study was covered by the University of Utah news department in the story “Mind Over Matter: Beating Pain and Painkillers”, by Medical Daily in “Pain Management: M.O.R.E. Therapy uses Mental Interventions to Combat Chronic Pain, Opioid Painkillers Misuse”, by Science World Report in “New Pain Treatment Aims to Reduce Prescription Opioids” and by Healthline in “A Mindful Way to Beat Chronic Pain.” It is my sincere hope that this news coverage will ultimately help more people suffering from chronic pain to find the relief and comfort they are seeking.
Results from my NIH-funded clinical trial of Mindfulness-Oriented Recovery Enhancement (MORE) as a treatment for chronic pain and prescription opioid misuse were recently accepted for publication in the prestigious, top-tier Journal of Consulting and Clinical Psychology. Study findings demonstrated that MORE significantly reduced chronic pain, pain-related impairment, and stress while decreasing craving and opioid misuse among a sample of 115 people who had taken prescription opioid painkillers for more than three months. The effects of MORE on reducing pain severity and pain-related impairment were maintained for 3 months after the end of treatment, and MORE reduced disordered opioid use by 63%. These positive outcomes were linked with the development of mindfulness skills that are specifically strengthened by MORE, like the ability to “step back” and objectively observe negative thoughts and feelings in a non-reactive manner, the ability to reinterpret pain sensations as harmless sensory information, and the ability to reappraise adverse life events as opportunities for personal growth and meaning. In addition, participation in MORE weakened the link between desire for opioids and opioid misuse, suggesting that people who learned to use mindfulness to deal with craving were less likely to take inappropriate doses of opioids or to use opioids to self-medicate stress and negative emotions.
In some circumstances, opioids may be medically necessary for individuals experiencing prolonged and intractable pain, and most patients take medicine as prescribed. Nonetheless, opioids rarely completely alleviate chronic pain, and may lead to serious side effects, including death by overdose, as well as risk for developing opioid-related problems and addiction. As such, new interventions are needed to target chronic pain and prevent opioid misuse. Study findings indicate that MORE is a promising treatment for this growing problem. Over the next few years, additional social, psychological, and neuroscientific studies will reveal the many pathways by which MORE produces its therapeutic effects.
My colleagues and I recently had a new paper accepted for publication in the highly esteemed, international journal Neuroscience and Biobehavioral Reviews. This paper draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to opioid misuse and addiction among chronic pain patients taking prescription opioids for pain relief. In brief, we theorize that addictive use of opioids is the outcome of a cycle initiated by chronic pain and negative emotions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. We conclude the paper by introducing Mindfulness-Oriented Recovery Enhancement (MORE) as a potentially effective approach to disrupting the downward spiral. This is a particularly exciting publication for our research team, because it lays the theoretical groundwork for developing new and innovative efforts to help people recover from chronic pain and opioid addiction.
