Cognitive bias modification for individuals with opioid use disorder and chronic pain did not predict changes in clinical outcomes.

Objective: Attentional bias (AB), defined as the preferential focus on personally salient-compared to neutral-cues, has a hypothesized link to substance use disorders and chronic pain. While growing research demonstrates Cognitive Bias Modification (CBM) can alter ABs, evidence assessing the extent to which such alterations predict changes in clinical symptoms or behaviors (e.g., pain severity, craving) is lacking.

Method: 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 OUD (mOUD) with moderate pain for the past 3-months (MacLean et al., 2024; NCT04132609). We examined CBM effects vs. control on pain severity, interference, and catastrophizing, as well as opioid craving and withdrawal.

Results: CBM for opioid and pain cues did not correspond with changes in the primary clinical outcomes of opioid craving and pain intensity, p's ≥ .111. Additional analyses of other possible outcomes including pain interference, pain catastrophizing, and subjective opioid withdrawal were also not associated with CBM, p's ≥ .125.

Conclusions: 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 ABs, 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 the use of more engaging methodologies (e.g., gamification of CBM tasks, using gaze-contingent paradigms).