Enhancing Natural Reward Responsiveness Among Opioid Users Predicts Chronic Pain Relief: EEG Analyses From a Trial of Mindfulness-Oriented Recovery Enhancement.

Objective: Although opioid-treated chronic pain patients evidence blunted responsiveness to natural rewards, focusing on naturally rewarding stimuli can produce analgesia in these patients. A prior randomized controlled trial (RCT) demonstrated that a social work intervention-Mindfulness-Oriented Recovery Enhancement (MORE)-enhanced natural reward processing as indicated by event-related brain potentials (ERPs). The aim of the present study was to perform a secondary data analysis on ERPs collected in this RCT to explore whether improvements in electrocortical response to natural reward predicted pain relief.

Method: The sample for this secondary analysis included opioid-treated chronic pain patients with complete ERP data ( = 29). Participants were randomized to 8 weeks of MORE or a support group control condition, and ERPs to images representing naturally rewarding stimuli were measured before and after 8 weeks of treatment. We explored associations between changes in brain reward response, chronic pain symptoms, and pain coping.

Results: Increases in ERP reward response were significantly associated with decreased pain severity from pretreatment to posttreatment (β = -.48, = .007) and improvements in pain catastrophizing (β = -.36, = .05) and diverting attention as a means of pain coping (β = .38, = .043). Increased ERP reward response predicted decreased pain interference by 3-month follow-up (β = -.37, = .048).

Conclusions: Chronic pain may be alleviated by enhancing brain response to natural rewards.