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Prescription opioid misusers exhibit blunted parasympathetic regulation during inhibitory control challenge

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Abstract

Rationale

Among opioid-treated chronic pain patients, response inhibition deficits in emotional contexts may contribute to opioid misuse.

Objectives

Using high-frequency heart rate variability (HF-HRV) to index-impaired response inhibition, we examined associations between opioid misuse and response inhibition in emotional and neutral contexts in a sample of opioid-treated chronic pain patients.

Method

Chronic pain patients taking opioid analgesics (N = 97) for ≥ 90 days completed an Emotional Go/NoGo task that presented an inhibitory control challenge in the context of neutral, opioid, negative affective, and positive affective background images while HF-HRV was computed. Opioid misuse and craving were assessed. Using a validated cut-point on the Current Opioid Misuse Measure, participants were classified as opioid misusers or non-misusers. Opioid misuse was examined as a predictor of behavioral and HF-HRV metrics of response inhibition.

Results

Negative affective and opioid images elicited more errors of commission (p = .002, η2partial = .16) and slowed reaction times (p = .045, η2partial = .09) compared to neutral and positive affective images, respectively. Though no between-group behavioral differences were observed on the task, opioid misusers exhibited significantly blunted phasic HF-HRV during the task relative to non-misusers (p = .027, η2partial = .11). HF-HRV during the task was significantly inversely associated with opioid craving. It was not clear whether these autonomic findings reflected a durable phenotypic difference between groups or between-group differences in opioid dosing and withdrawal.

Conclusion

Reduced parasympathetic regulation during inhibitory control challenge may indicate heightened opioid misuse risk among opioid-treated chronic pain patients.

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Acknowledgments

This study was supported by NIDA grant R03DA032517 awarded to E.L.G. E.L.G. was supported by NIDA grant R01DA042033 during the preparation of this manuscript.

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Authors and Affiliations

  1. University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA

    Eric L. Garland

  2. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Matthew O. Howard

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  1. Eric L. Garland
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  2. Matthew O. Howard
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Correspondence to Eric L. Garland.

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Garland, E.L., Howard, M.O. Prescription opioid misusers exhibit blunted parasympathetic regulation during inhibitory control challenge. Psychopharmacology 238, 765–774 (2021). https://doi.org/10.1007/s00213-020-05729-z

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