Trait Mindfulness is Associated with Enhanced Autonomic Regulation of Opioid Cue Reactivity

Objectives The primary objective of this study was to examine whether trait mindfulness could buffer opioid craving among people with chronic pain by enhancing autonomic regulation of opioid cue reactivity. Methods Chronic pain patients on long-term opioid therapy ( N = 95) completed an opioid dot-probe task while heart rate was recorded. This task served as a means of eliciting opioid cue reactivity. Analyses examined relations among trait mindfulness, high-frequency heart rate variability (HF-HRV), cue-elicited opioid craving, and subsequent changes in opioid dosing over a 2-month period. Trait mindfulness was assessed using the Five Facet Mindfulness Questionnaire (FFMQ) and opioid dosing was assessed using the Timeline Followback (TLFB) questionnaire triangulated with electronic health records. Results FFMQ trait mindfulness was significantly positively associated with phasic high-frequency HRV (HF-HRV) during the dot-probe task ( r = .23, p = .03) and inversely associated with cue-elicited opioid craving ( r = − .24, p = .026). Phasic HF-HRV mediated the association between trait mindfulness and reduced cue-elicited craving, and predicted decreases in future opioid dosing. Conclusions This study provides evidence that trait mindfulness may serve as a protective factor against craving and opioid dose escalation among people with chronic pain via enhanced autonomic regulation of opioid cue reactivity.