Neurophysiological Deficits During Reappraisal of Negative Emotional Stimuli in Opioid Misuse

Abstract

Background: Opioid misuse is hypothesized to compromise the ability to regulate negative emotions, as manifested through visceral and peripheral physiological signals. However, neurophysiological impairment of top-down cognitive emotion regulation in opioid misuse has not previously been shown.

Methods: Patients with chronic pain who had been taking opioids for 90 days or longer (N = 149; female, n = 98) underwent a negative emotion regulation task with electroencephalography. Participants were instructed to view or reappraise negative images presented for 3 seconds. Using a validated cutoff score on the Current Opioid Misuse Measure, participants were classified as exhibiting aberrant drug-related behavior consistent with opioid misuse (MISUSE+) or as being low risk for opioid misuse (MISUSE-). Participants reported their craving in response to negative emotions over the past week.

Results: We observed a group × condition interaction (p = .003) such that the MISUSE- group decreased the late positive potential of the electroencephalography during reappraisal, whereas the MISUSE+ group showed increased late positive potential during reappraisal. This deficit in negative emotion regulation remained significant after controlling for an array of potential confounding variables, including opioid dose, pain, and depression. Heightened late positive potential during reappraisal was associated with more severe opioid craving.

Conclusions: Opioid misuse may occasion top-down deficits in emotional regulation that begin as early as 400 ms after presentation of negative stimuli. It remains unknown whether emotion dysregulation is the cause, correlate, or consequence of opioid misuse. Nonetheless, targeting emotion dysregulation in opioid misuse with reappraisal-focused interventions may represent an important treatment approach.

Keywords: Chronic pain; Craving; Emotion regulation; Opioid misuse; Opioid use disorder; Reappraisal.

Figure 1.

Grand average event-related potential during viewing and reappraisal of negative emotional stimuli for patients with chronic pain who misuse opioids (MISUSE+, n=91, in red) and patients at low risk for opioid misuse (MISUSE-, n=58, in blue).

Figure 2.

Plot depicting the interaction between experimental condition (view versus reappraisal) and opioid craving in response to negative emotions in the past week measured by a visual analogue scale (VAS) on the late positive potential (LPP) amplitude in response to negative emotional stimuli. The LPP was significantly higher during the reappraise condition than during the view condition (b=0.63, s.e.= 0.20, p=.002) when the craving score was one standard deviation above the mean When the craving score was one standard deviation below the mean, LPP values were not significantly different during the reappraise condition and the view condition (b=−0.13, s.e.=0.20, p=.53).