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

A virtual reality-based meditative intervention for patients undergoing methadone maintenance treatment for opioid use disorder reduced self-reported pain, opioid craving, anxiety, and depression after each session, though anger did not change. Saliva cortisol levels also decreased after sessions, while C-reactive protein did not. Brain scans taken before and after the 12-week intervention showed decreased activation in the left postcentral gyrus during a pain task, and connectivity within the pain neuromatrix changed from baseline. These preliminary findings suggest the intervention is feasible and may have therapeutic benefits, supported by observable brain changes.

Study at a glance

Abstract

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). Prospective, non-blinded, single-arm, 12-week intervention with standardized assessments. Academic research laboratory affiliated with an on-site MMT clinic. Fifteen (11 female) MMT patients completed a virtual reality, therapist-guided meditative intervention that included breathing and relaxation exercisessessions 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. 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. These preliminary findings demonstrate feasibility, therapeutic promise, and brain basis of a meditative intervention for OUD patients undergoing MMT.