Cognitive Bias Modification for Individuals With Opioid Use Disorder and Chronic Pain Did Not Predict Changes in...

Attentional bias, defined as the preferential focus on personally salient--compared with neutral--cues, has a hypothesized link to substance use disorders and chronic pain. Although growing research demonstrates that cognitive bias modification (CBM) can alter attentional biases, evidence is lacking to assess the extent to which such alterations predict changes in clinical symptoms or behaviors (e.g., pain severity, craving).

We conducted a secondary analysis of a clinical trial examining the feasibility, acceptability, and preliminary effectiveness of a 4-week CBM adjunct for veterans (N = 28) receiving medication treatment for opioid use disorder (mOUD) with moderate pain for the past 3 months. We examined CBM effects versus control on pain severity, interference, and catastrophizing, as well as opioid craving and withdrawal.

CBM for opioid and pain cues did not correspond with changes in the primary clinical outcomes of opioid craving and pain intensity (ps > .111). Additional analyses of other possible outcomes, including pain interference, pain catastrophizing, and subjective opioid withdrawal, were also not associated with CBM (ps > .125).

Results from this pilot study did not show changes in pain severity or opioid craving corresponding to CBM for opioid and pain. Findings should be considered preliminary given our small sample size; however, findings indicate a distinction between attentional biases, their modification, and clinically salient outcomes. Future research should examine CBM in larger, more diverse samples and assess the impacts of addiction severity, substance type, naturalistic settings, and more engaging methodologies (e.g., gamification of CBM tasks, using gaze-contingent paradigms).