A Virtual Reality Meditative Intervention Modulates Pain and the Pain Neuromatrix in Patients with Opioid Use Disorder.
Mohammed M Faraj, Nina M Lipanski, Austin Morales, Elimelech Goldberg, Martin H Bluth, Hilary A Marusak, Mark K Greenwald
Pain medicine (Malden, Mass.) November 26, 2021 DOI: 10.1093/pm/pnab162 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Prospective, non-blinded, single-arm Peer reviewed |
|---|---|
| Sample size | 15 |
| Population | Patients undergoing methadone maintenance treatment for opioid use disorder |
| Duration | 12-week intervention, sessions twice weekly; pre- and post-intervention fMRI; cortisol and CRP measured at baseline and weeks 4, 8, and 12 |
| Topics | Meditation Addiction |
| Keywords | Cortisol Craving Methadone Pain neuromatrix Postcentral gyrus FMRI |
| Key points | A virtual reality-based meditative intervention decreased pain, craving, anxiety, and depression after sessions, reduced saliva cortisol, and altered pain-related brain activation and connectivity. |
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.