title: Deficits in autonomic indices of emotion regulation and reward processing associated with prescription opioid use and misuse.
abstract: Prescription opioid misuse and high-dose opioid use may result in allostatic dysregulation of hedonic brain circuitry, leading to reduced emotion regulation capacity. In particular, opioid misuse may blunt the ability to experience and upregulate positive affect from natural rewards.
  
  
  
  The purpose of this study was to examine associations between opioid use/misuse and autonomic indices of emotion regulation capability in a sample of chronic pain patients receiving prescription opioid pharmacotherapy.
  
  
  
  Chronic pain patients taking long-term opioid analgesics (N = 40) completed an emotion regulation task while heart rate variability (HRV) was recorded, and also completed self-report measures of opioid misuse, craving, pain severity, and emotional distress. Based on a validated cut-point on the Current Opioid Misuse Measure, participants were grouped as opioid misusers or non-misusers. Opioid misuse status and morphine equivalent daily dose (MEDD) were examined as predictors of HRV and self-reports of emotion regulation.
  
  
  
  Opioid misusers exhibited significantly less HRV during positive and negative emotion regulation, and significantly less positive effect, than non-misusers, after controlling for confounders including pain severity and emotional distress. MEDD was inversely associated with positive emotion regulation efficacy.
  
  
  
  Findings implicate the presence of reward processing deficits among chronic pain patients with opioid-misusing behaviors, and opioid dosage was associated with deficient emotion regulation, suggesting the presence of compromised top-down cognitive control over bottom-up hedonic processes. Emotion regulation among opioid misusers may represent an important treatment target.
authors.affiliation: University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA. eric.garland@socwk.utah.edu.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Garland
authors.affiliation: University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Bryan
authors.affiliation: University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Medical University of South Carolina, Charleston, CS, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Froeliger
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Howard
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000494:pharmacology / Q000627:therapeutic use*; D001341:Autonomic Nervous System / Q000187:drug effects* / Q000503:physiopathology; D059350:Chronic Pain / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D004644:Emotions / Q000187:drug effects / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000494:pharmacology / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000503:physiopathology* / Q000523:psychology; D012201:Reward; D057566:Self Report
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Allostatic; Chronic pain; Emotion regulation; Heart rate variability; Opioid misuse; Reward