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