Mindfulness physical therapy, pain management, rehabilitation

Pain, Opioids and Mindfulness

Garland and colleagues propose that reduced subjective reward and diminished reward-associated brain activity in response to natural rewards contribute to the etiology of opioid misuse and addiction among chronic pain patients.1 Mindfulness Oriented Recovery Enhancement engages mindfulness training to deliberately strengthen attention to natural rewards as a means to remediate these reward processing deficits.2 Participants are instructed to sustain attention on the pleasant sensory features of likeable objects and pleasurable events and the accompanying pleasant emotions. In a pilot study, this treatment was associated with significant increases in relevant brain responses to naturally rewarding stimuli, enhanced positive affective responses and reductions in opioid cravings from pre- to post-treatment.3

Instructing patients with persistent pain to engage in pleasant activities is a common practice in physical and occupational therapy. I integrate mindful awareness into this instruction by encouraging patients to pay attention to and mindfully savor the visual, auditory, olfactory, and/or tactile dimensions of the pleasant object or event and the agreeable mood or emotion that accompanies the experience. Quoting Rick Hanson, PhD, I remind patients to “Velcro the positive” and suggest they can promote healthy neuroplastic changes in brain through these activities.

1 Garland EL, Froeliger B, Zeidan F, et al. The downward spiral of chronic pain, prescription opioid misuse and addiction: cognitive, affective and neuropsychopharmacologic pathways. Neurosci Biobehav Rev. 2013;37(10 Pt 2):2597-607.

2 Garland EL. (2013) Mindfulness-Oriented Recovery Enhancement for Addiction, Stress and Pain. Washington, DC: NASW Press.

3 Garland EL, Froeliger B, Howard MO. Neurophysiological evidence for remediation of reward processing deficits in chronic pain and opioid misuse following treatment with Mindfulness-Oriented Enhancement: exploratory ERP findings from a pilot RCT. J Behav Med. 2105;38(2):327-36.