Psychosocial intervention and the reward system in pain and opioid misuse: new opportunities and directions.

Abstract

Clinicians and scientists have begun to recognize that chronic pain and its treatment with opioid analgesics may occasion <i>hedonic dysregulation</i>—a blunting of physiological and positive emotional responses to rewarding objects and events in the social environment. Conversely, pain relief can be rewarding [83,84]. Yet, this relation is not unidirectional; experimental manipulations and clinical observational studies demonstrate the analgesic effects of positive affect and reward [32,86]. Although positive emotions and rewarding experiences can produce analgesia, how might they be intentionally cultivated for their therapeutic value? To answer this research question, this topical review proposes a mechanistic model (Figure 1) for optimizing psychosocial interventions by leveraging positive affective/reward-related mechanisms as means of addressing chronic pain and opioid misuse.