The Society for Social Work and Research

2014 Annual Conference

January 15-19, 2014 I Grand Hyatt San Antonio I San Antonio, TX

Randomized Controlled Trial of Mindfulness-Oriented Recovery Enhancement for Chronic Pain and Prescription Opioid Misuse: Clinical Outcomes and Mechanisms

Saturday, January 18, 2014: 9:00 AM
Marriott Riverwalk, River Terrace, Upper Parking Level, Elevator Level P2 (San Antonio, TX)
* noted as presenting author
Eric L. Garland, PhD, LCSW, Associate Professor, University of Utah, Salt Lake City, UT
Matthew O. Howard, PHD, Frank A. Daniels, Jr., Distinguished Professor of Human Service Policy Information, University of North Carolina at Chapel Hill, Chapel Hill, NC

Opioid analgesic pharmacotherapy is a common treatment for chronic pain. Yet, for a subset of patients, chronic opioid use and the use of opioids to self-medicate negative emotions that co-occur with chronic pain may confer risk for opioid misuse and addiction. Prescription opioid misuse among persons with chronic pain is a prevalent threat to public health that has increased more than threefold over the past 20 years. This NIH-funded randomized controlled trial sought to determine whether an integrative, multimodal intervention, Mindfulness-Oriented Recovery Enhancement (MORE), could reduce chronic pain and opioid misuse. We hypothesized that MORE would reduce pain severity, pain-related functional impairment, opioid craving, and opioid misuse to a significantly greater extent than a conventional support group (SG).


Chronic pain patients (N = 115) were randomized to either a MSW-led MORE group (n = 57) or a SG (n = 58). The MORE intervention sessions involved mindfulness training, cognitive restructuring, and techniques for positive emotion regulation (i.e., finding meaning in adversity, savoring pleasant events). Standardized measures of pain severity, pain-related functional interference, opioid craving, and opioid misuse were collected pre- and post-intervention, as well as at 3-month follow-up. To explore therapeutic mechanisms, measures of reinterpretation of pain sensations, nonreactivity, positive reappraisal, and heart rate variability (HRV) to pain-, opioid-, and pleasure-related visual stimuli were monitored pre- and post-treatment.


The MORE group demonstrated significantly greater decreases in pain severity (p = .04), functional interference (p < .001), and opioid craving (p = .005) than the SG; effects on pain severity and interference persisted for 3 months. Compared to the SG, a greater proportion of individuals in the MORE group who met criteria for opioid misuse at pre-treatment no longer met opioid misuse criteria at post-treatment (p = .05). Increases in reinterpretation of pain sensations, nonreactivity, and positive reappraisal were associated with decreases in pain severity, functional interference, and opioid craving/misuse, respectively. HRV responses were associated with reduced opioid craving and misuse.


By virtue of its effects on cognitive, affective, and psychophysiological mechanisms, MORE appears to ameliorate chronic pain and opioid-related problems. Importantly, significant intervention effects on chronic pain may persist up to 3 months after completing treatment. Thus, MORE appears to be a promising means of enhancing therapeutic outcomes among vulnerable persons suffering from chronic pain and addictive behaviors.