Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: Results from an early-stage randomized controlled trial.

Abstract

Objective Opioid pharmacotherapy is now the leading treatment for chronic pain, a problem that affects nearly one-third of the United States population. Given the dramatic rise in prescription opioid misuse and opioid-related mortality, novel behavioral interventions are needed. The purpose of this study was to conduct an early stage randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), a multimodal intervention designed to simultaneously target mechanisms underpinning chronic pain and opioid misuse. Method Chronic pain patients (N=115; mean age = 48±14; 68% female) were randomized to 8 weeks of MORE or a Support Group (SG). Outcomes were measured at pre- and post-treatment, and at 3-month follow-up. The Brief Pain Inventory assessed changes in pain severity and interference. Changes in opioid use disorder status were measured by the Current Opioid Misuse Measure. Desire for opioids, stress, nonreactivity, reinterpretation of pain sensations, and reappraisal were also evaluated. Results MORE participants reported significantly greater reductions in pain severity (p = .038) and interference (p = .003) than SG participants, which were maintained by 3-month follow-up and mediated by increased nonreactivity and reinterpretation of pain sensations. Compared with SG participants, participants in MORE evidenced significantly less stress arousal (p = .034) and desire for opioids (p = .027), and were significantly more likely to no longer meet criteria for opioid use disorder immediately following treatment (p = .05); however, these effects were not sustained at follow-up. Conclusions Findings demonstrate preliminary feasibility and efficacy of MORE as a treatment for co-occurring prescription opioid misuse and chronic pain.

Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

“…27 This study extends the existing knowledge by evaluating effects of an MM intervention and reporting on the details of home MM practice among individuals with opioid-treated CLBP. The findings 37 of reduced pain severity and decreased pain sensitivity to nociceptive thermal stimuli in the MM group, as compared to the waitlist control group, during the 26-week study, are promising and consistent with those of an RCT by Garland et al 23 Adherence to and high satisfaction with the MM intervention among the current study's severely disabled, opioidtreated patients support its feasibility and are encouraging, especially because one of the common reported barriers to Values expressed with a plus/minus sign are the mean -standard deviation. Better pain control (n = 8) ''I wanted another tool to deal with pain.''…”

“…29 However, evidence on MM's efficacy for chronic pain is limited and mixed, and MM and CBT interventions have not been sufficiently studied in patients with chronic pain requiring a long-term opioid therapy. 18,19,23,27,28,[30][31][32][33][34][35] A recent randomized controlled trial (RCT) (n = 115) found that a ''mindfulnessoriented recovery enhancement'' intervention, combining MM and CBT, led to decreases in pain severity and opioid desire ratings in adults with opioid-treated chronic pain; however, opioid dose was not quantified in this study. 23 Although MM and CBT have been shown as feasible and acceptable interventions for many chronic health conditions, 18,19,27 including depression, anxiety, and maladaptive stress or pain coping (problems commonly co-occurring with and affecting treatment outcomes in chronic pain 11,27,36 ), the Agency for Healthcare Research and Quality calls for systematic reporting on feasibility and safety of MM-based modalities.…”

“…[14][15][16][17] It can result in unique skills for chronic pain management, such as acceptance, complementing those acquired through CBT, a part of ''usual care'' for chronic pain, [18][19][20][21][22] and potentially enhancing its benefits. [21][22][23][24][25][26] MM is perceived as safe and effective for pain reduction and has established empirical support for reducing symptoms of anxiety, depression, and stress-all problems commonly co-occurring with and affecting outcomes in chronic pain. 27,28 Research has indicated that MM practice can influence function of the brain areas associated with pain, attention, and emotional response, implicating them as potential mechanisms of action.…”

Living with chronic neuropathic pain after spinal cord injury: an interpretative phenomenological analysis of community experience

“…Mindfulness may be useful for those wishing to reduce or avoid medication use, such as participants in this study, due to its ability to shift the focus to experience and reduce the desire for pain medication as a means to solve a problem [63]. Further research has found benefits of mindfulness in terms of physical and psychological well-being [64], and interpersonal relationships [65].…”

Treating chronic pain: the need for non-opioid options

“…Recently, MORE was tested as an intervention for cooccurring chronic pain and prescription opioid misuse in a randomized controlled trial [64]. In this trial, 115 patients who had taken prescription opioids for >3 months for chronic pain were randomly assigned to receive either 8 weeks of MORE or 8 weeks of a social support group (the control condition in this study).…”