Autonomic indices of negative emotion regulation predict treatment response in opioid-treated chronic low back pain

Difficulties engaging in emotion regulation strategies, such as cognitive reappraisal, may contribute to heightened pain severity, functional interference and poorer treatment response among adults with chronic low back pain (CLBP) receiving long-term opioid therapy (LTOT). This study used high-frequency heart rate variability (HF-HRV) as a physiological index of negative emotion regulation capacity to examine its influence on psychological treatment outcomes in opioid-treated CLBP. Participants (N = 68) were adults with opioid-treated CLBP enrolled in the Salt Lake City site of a multisite randomized clinical trial comparing mindfulness-based therapy (MBT) and cognitive behavioral therapy (CBT) adjunctive to usual care. At baseline, participants completed an emotion regulation task involving passive viewing and cognitive reappraisal of negative affective stimuli while HF-HRV was recorded. They also completed the Brief Pain Inventory (BPI) to assess pain severity and functional interference. Participants were then randomized to 8 weeks of MBT (n = 41) or CBT (n = 27) and completed BPI assessments at 3-, 6-, 9-, and 12-month follow-ups. Linear mixed-effects models revealed that lower baseline reappraisal capacity, as indicated by blunted phasic HF-HRV during the emotional regulation task, significantly predicted higher pain severity and interference following treatment with MBT or CBT through 12-month follow-up. Findings suggest that attenuated ability to regulate autonomic responses during reappraisal of negative emotional stimuli may contribute to more refractory pain outcomes as long as a year later among individuals engaged in evidence-based psychological treatments. Enhancing emotion regulation strategies, like cognitive reappraisal, may strengthen autonomic functioning and improve pain-related outcomes. PERSPECTIVE: This study found that lower baseline cognitive reappraisal efficacy, indexed by blunted HF-HRV during an emotion regulation task, predicted worse response to psychological treatment for adults with opioid-treated CLBP. These findings point to the potential importance of cognitive reappraisal as a therapeutic target in chronic pain interventions.