Mindfulness-Oriented Recovery Enhancement Ameliorates the Impact of Pain on Psychological and Physical Function Among Opioid-Using Chronic Pain Patients

Purpose. Chronic pain impacts one-third of the US population, and its effects are debilitating for individuals and costly to the medical system. Though opioids are commonly prescribed to address chronic pain, they confer risk for misuse and addiction, and may not fully restore life function – particularly with regard to psychosocial factors. Due to the multiplicity of impacts that chronic pain may have on daily functioning and healthy aging, broad-spectrum behavioral interventions are needed. One such promising intervention is Mindfulness-Oriented Recovery Enhancement (MORE; Garland, 2013), a manualized therapy which unites mindfulness training, third-wave cognitive-behavioral therapy, and principles of positive psychology into an integrative treatment approach. The purpose of this study was to conduct follow-up and mediational analyses from a RCT to assess effects of MORE on various biopsychosocial aspects of pain-related impairment. We hypothesized that chronic pain patients randomly assigned to MORE would exhibit significantly greater reductions in pain-related functional impairments than participants assigned to a conventional support group (SG).

Method. Chronic pain patients (N=115; mean age = 48±14; 68% female) were randomly assigned to either 8 weeks of MORE or to a SG. Pain-related functional impairments were measured with the Brief Pain Inventory at pre- and post-treatment, and at a 3-month follow-up. Treatment effects were analyzed with multivariate intention-to-treat models. Nonreactivity to distressing thoughts and emotions, reinterpretation of pain sensations as innocuous sensory information, and positive reappraisal coping were examined as potential treatment mediators in path analyses.

Results. MORE participants reported significantly greater reductions in functional impairment than SG participants at post-treatment across all domains, including: general activity (p = .01, D = .56), mood (p = .02, D = .35), walking ability (p = .003, D = .59), normal work (p = .01, D = .55), relationships (p = .005, D = .70), sleep (p < .001, D = .80), and enjoyment of life (p = .007, D = .56). These effects were largely maintained by the 3-month follow-up and increased for most variables (mood D = 1.07; work D = 1.04, relationships D = 1.17, enjoyment D = 1.01); however effects on general activity level and walking ability were no longer significant, indicating differential long-term effects between physiological and psychological functioning. Nonreactivity, reinterpretation of pain sensations, and reappraisal distinctly mediated the effect of MORE on various domains of functional interference.

Implications for Practice. Given the high prevalence of chronic pain in an aging US population and the escalating incidence of prescription opioid misuse, there is a growing need for new interventions that can address multiple domains of pain-related impairment. Moreover, due to treatment advances, many patients with cancer and other serious illnesses are living longer with high levels of pain-related dysfunction and attendant psychological distress; long-term opioid pharmacotherapy is often used to manage such symptoms, which may increase risk for opioid-related complications. Findings from this analysis suggest that MORE may be a useful non-pharmacologic intervention for reducing the adverse effects of chronic pain on biopsychosocial functioning and enhancing quality of life in the face of adversity.