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Neurophysiological evidence for remediation of reward processing deficits in chronic pain and opioid misuse following treatment with Mindfulness-Oriented Recovery Enhancement: exploratory ERP findings from a pilot RCT
Open accessAbstract
Dysregulated processing of natural rewards may be a central pathogenic process in the etiology and maintenance of prescription opioid misuse and addiction among chronic pain patients. This study examined whether a Mindfulness-Oriented Recovery Enhancement (MORE) intervention could augment natural reward processing through training in savoring as indicated by event-related brain potentials (ERPs). Participants were chronic pain patients at risk for opioid misuse who were randomized to 8 weeks of MORE (n = 11) or a support group control condition (n = 18). ERPs to images representing naturally rewarding stimuli (e.g., beautiful landscapes, intimate couples) and neutral images were measured before and after 8 weeks of treatment. Analyses focused on the late positive potential (LPP)--an ERP response in the 400-1,000 ms time window thought to index allocation of attention to emotional information. Treatment with MORE was associated with significant increases in LPP response to natural reward stimuli relative to neutral stimuli which were correlated with enhanced positive affective cue-responses and reductions in opioid craving from pre- to post-treatment. Findings suggest that cognitive training regimens centered on strengthening attention to natural rewards may remediate reward processing deficits underpinning addictive behavior.
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“Contrary to their hypotheses, MORE did not significantly increase self-reported mindfulness, nor did it result in significant decrements in craving, but significantly reduced symptoms associated with chronic pain and prescription opioid misuse.”
From Mindfulness-Based Interventions for the Treatment of Substance and Behavioral Addictions: A Systematic Review (2018) · cites this paper as [57]
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“In mechanistic analyses from a RCT of MORE as a treatment for prescription opioid misuse among chronic pain patients, MORE produced significant increases in cardiac-autonomic and electrocortical responses to natural reward stimuli that were, in turn, associated with decreases in opioid craving [30, 31]”
From Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research (2018) · cites this paper as [31]
In the citing paper
“electrocortical indices of natural reward processing (i.e., late positive potential (LPP).47”
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“MORE’s effects on increasing autonomic and electroencephalographic responses to natural reward stimuli were associated with reductions in drug craving,46,47”
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- Garland, E. L. (2013). Mindfulness-Oriented Recovery Enhancement for addiction, stress, and pain. Washington, DC: NASW Press.
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Metadata
- Authors
- Garland, E. L., Froeliger, B., & Howard, M. O.
- Affiliations
- University of Utah (US)
- Medical University of South Carolina (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Garland, Eric L.
- Venue
- Journal of Behavioral Medicine
- Published
- 2014-11-11
- Volume
- 38
- Issue
- 2
- Pages
- 327-336
- ISSN
- 0160-7715 (ISSN-L)
- 1573-3521
- PMC
- PMC4355224
- OpenAlex
- W2064349719
- Cited by
- 136
- References
- 59
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 7 · 2023: 7 · 2022: 5 · 2021: 7 · 2020: 50 · 2019: 16 · 2018: 11 · 2017: 6 · 2016: 9 · 2015: 7 · 2014: 1
- FWCI
- 7.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- Fahs-Beck Fund for Research and Experimentation
- National Institutes of Health
- National Institute on Drug Abuse (DA 032517, R03DA032517, R01DA042033, R34DA037005, DA037005)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- Mindfulness-Oriented Recovery Enhancement, chronic pain, prescription opioid misuse, opioid use disorder, savoring, late positive potential, event-related potentials, positive affect, opioid craving, mindfulness-based interventions
- MeSH terms
- Analgesics, Opioid, Evoked Potentials, Visual, Female, Humans, Individuality, Male, Middle Aged, Opioid-Related Disorders, Pilot Projects, Reward, Chronic Pain, Mindfulness
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