Therapeutic Efficacy of Rhemercise: A Novel Mindfulness Technique in Patients With Opioid Use Disorder

Maju Mathew Koola, MD^c; Sajoy P. Varghese, MD^g; Deepam Kundal, MD^a; Rajnish Raj, MD^b; Rohit Garg, MD^b; Alex R. Zachariah, MD^d; Stephen Daniel Paul, BA^d; Michael Y. Bai^e; Ori David Florentin, BA^f

Prim Care Companion CNS Disord 2022;24(1):21m03064

ABSTRACT

Objective: Rhemercise is a novel mindfulness technique used to prevent relapse in opioid use disorder (OUD). Rhemercise is a quantifiable and intentional slow-breathing technique that could increase subjective well-being, which helps to prevent relapse in OUD by reducing craving, negative affect, and visceral reactivity. The objective of this study was to assess the efficacy of rhemercise as an adjunctive therapy in patients with OUD undergoing detoxification.

Methods: This was a hospital-based, open-label, prospective, and exploratory study conducted between June 2018 and June 2019 that included 126 male inpatients admitted for detoxification of OUD. Patients with OUD diagnosed according to ICD-10 criteria who were aged 18–65 years were included in the study. Patients with other psychiatric disorders were excluded. Participants were divided into 2 groups: group A (n = 63) comprised patients receiving treatment as usual + rhemercise, and group B (n = 63) received treatment as usual only. Assessment tools included the Clinical Opiate Withdrawal Scale, Brief Pain Inventory, and Subjective Well-Being Inventory.

Results: Various domains of the Subjective Well-Being Inventory (general well-being–positive affect [P = .02], confidence in coping [P = .007], inadequate mental mastery [P = .002]) improved significantly among OUD patients who received rhemercise treatment compared to treatment as usual.

Conclusion: Rhemercise promoted general well-being and positive affect and decreased the opioid withdrawal symptoms, thereby potentially reducing the overall risk for relapse. Future studies are warranted with rhemercise to validate these promising findings.

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References (30)

Volkow ND, Baler RD. Addiction science: uncovering neurobiological complexity. Neuropharmacology. 2014;76(Pt B(0 0):235–249. PubMed CrossRef
Kraft TL, Pressman SD. Grin and bear it: the influence of manipulated facial expression on the stress response. Psychol Sci. 2012;23(11):1372–1378. PubMed CrossRef
Gallup AC, Eldakar OT. The thermoregulatory theory of yawning: what we know from over 5 years of research. Front Neurosci. 2013;6:188. PubMed
Varghese S, Varghese S, Chackochan A, et al. 652. novel complementary and alternative mindfulness-based intervention: therapeutic approach to manage substance use disorders and posttraumatic stress disorder. Biol Psychiatry. 2017;81(10):S264. CrossRef
Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003;35(2):253–259. PubMed CrossRef
Poquet N, Lin C. The Brief Pain Inventory (BPI). J Physiother. 2016;62(1):52. PubMed CrossRef
World Health Organization. Regional Office for South-East, A. Assessment of Subjective Well-Being, the Subjective Well-Being Inventory (SUBI). New Delhi: WHO Regional Office for South-East Asia; 1992.
Varghese SP, Koola MM, Eiger RI, et al. Opioid use remits, depression remains. Curr Psychiatr. 2014;13(18):45–50. PubMed
Chang WH, Lee IH, Chi MH, et al. Prefrontal cortex modulates the correlations between brain-derived neurotrophic factor level, serotonin, and the autonomic nervous system. Sci Rep. 2018;8(1):2558. PubMed CrossRef
Heberlein A, Dürsteler-MacFarland KM, Lenz B, et al. Serum levels of BDNF are associated with craving in opiate-dependent patients. J Psychopharmacol. 2011;25(11):1480–1484. PubMed CrossRef
Karege F, Schwald M, Cisse M. Postnatal developmental profile of brain-derived neurotrophic factor in rat brain and platelets. Neurosci Lett. 2002;328(3):261–264. PubMed CrossRef
Schmidt HD, Sangrey GR, Darnell SB, et al. Increased brain-derived neurotrophic factor (BDNF) expression in the ventral tegmental area during cocaine abstinence is associated with increased histone acetylation at BDNF exon I-containing promoters. J Neurochem. 2012;120(2):202–209. PubMed CrossRef
Trivedi MS, Deth R. Redox-based epigenetic status in drug addiction: a potential contributor to gene priming and a mechanistic rationale for metabolic intervention. Front Neurosci. 2015;8:444. PubMed
Koola MM, Qualls C, Kelly DL, et al. Prevalence of childhood physical and sexual abuse in veterans with psychiatric diagnoses. J Nerv Ment Dis. 2013;201(4):348–352. PubMed CrossRef
Kreek MJ, Ragunath J, Plevy S, et al. ACTH, cortisol and beta-endorphin response to metyrapone testing during chronic methadone maintenance treatment in humans. Neuropeptides. 1984;5(1–3):277–278. PubMed CrossRef
Varghese SP, Montalvo-Ortiz JL, Csernansky JG, et al. Early life stress as a risk factor for substance use disorders: clinical and neurobiological substrates. Indian J Psychol Med. 2015;37(1):36–41. PubMed CrossRef
Upadhyay Dhungel K, Malhotra V, Sarkar D, et al. Effect of alternate nostril breathing exercise on cardiorespiratory functions. Nepal Med Coll J. 2008;10(1):25–27. PubMed
Garland EL, Manusov EG, Froeliger B, et al. Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial. J Consult Clin Psychol. 2014;82(3):448–459. PubMed CrossRef
Zachariah AR. Let’s Move Mindfully. Illinois: Compassion Now Network for All International; 2017.
Garland EL, Boettiger CA, Gaylord S, et al. Mindfulness is inversely associated with alcohol attentional bias among recovering alcohol-dependent adults. Cognit Ther Res. 2012;36(5):441–450. PubMed CrossRef
Garland EL, Roberts-Lewis A, Kelley K, et al. Cognitive and affective mechanisms linking trait mindfulness to craving among individuals in addiction recovery. Subst Use Misuse. 2014;49(5):525–535. PubMed CrossRef
Joseph CN, Porta C, Casucci G, et al. Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension. 2005;46(4):714–718. PubMed CrossRef
Pal GK, Velkumary S, Madanmohan. Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers. Indian J Med Res. 2004;120(2):115–121. PubMed
Li M, Chen K, Mo Z. Use of qigong therapy in the detoxification of heroin addicts. Altern Ther Health Med. 2002;8(1):50–54, 56–59. PubMed
Gard T, Hölzel BK, Sack AT, et al. Pain attenuation through mindfulness is associated with decreased cognitive control and increased sensory processing in the brain. Cereb Cortex. 2012;22(11):2692–2702. PubMed CrossRef
Zeidan F, Martucci KT, Kraft RA, et al. Brain mechanisms supporting the modulation of pain by mindfulness meditation. J Neurosci. 2011;31(14):5540–5548. PubMed CrossRef
Garland EL. Pain processing in the human nervous system: a selective review of nociceptive and biobehavioral pathways. Prim Care. 2012;39(3):561–571. PubMed CrossRef
Dietze P, Stoové M, Miller P, et al. The self-reported personal wellbeing of a sample of Australian injecting drug users. Addiction. 2010;105(12):2141–2148. PubMed CrossRef
Garland EL, Bryan CJ, Finan PH, et al. Pain, hedonic regulation, and opioid misuse: modulation of momentary experience by mindfulness-oriented recovery enhancement in opioid-treated chronic pain patients. Drug Alcohol Depend. 2017;173(suppl 1):S65–S72. PubMed CrossRef
Keune PM, Forintos DP. Mindfulness meditation: a preliminary study on meditation practice during everyday life activities and its association with well-being. J Psychological Topics. 2010;19(2):373–386.