Ecological Momentary Assessment of the Effects of Mindfulness-Oriented Recovery Enhancement on Momentary Pain Experience Among Chronic Pain Patients: Results from a RCT

Background and Purpose:  Pain is a subjective phenomenon that can be modified through cognitive processes, affective states, and behavioral patterns.  Understanding these complex, biopsychosocial interactions has been impeded by reliance on retrospective and global self-reports, which make it difficult to elucidate the temporal dynamics of pain and well-being. Ecological Momentary Assessment (EMA) is a method of data collection that overcomes many of the biases that arise with retrospective measures by gathering data through real-time reports of momentary experiences in the context of everyday life.  EMA may allow for more accurate observation of phenomena in real-world contexts and facilitate a more nuanced analysis of interrelationships between variables over time. In this study we used EMA to assess the therapeutic impact of Mindfulness-Oriented Recovery Enhancement (MORE), a novel social work intervention for chronic pain patients who are prescribed long-term opioid analgesic medications. We hypothesized that MORE would result in significantly lower levels of EMA measures of momentary pain relative to a conventional support group (SG), and that higher levels of therapeutic skill practice would predict decreases in pain. Given MORE’s focus on enhancing positive emotions through mindful savoring, we also hypothesized that MORE would moderate the association between mood and pain by strengthening the relationship between momentary positive emotions and reductions in pain level. 

Methods:  Chronic pain patients (N = 115) were randomized to 8 weeks of either a MSW-led MORE group (n = 57) or a SG (n = 58). As part of an ecological momentary assessment (EMA) protocol, participants completed daily symptom diaries up to four times a day to report their level of pain and their mood state in the moment. Repeated-measures mixed models were computed to test our primary hypotheses that MORE would result in significantly lower levels of momentary pain over the 8 weeks of treatment than the SG. Mixed models accounted for the variability associated with the nesting of multiple observations (i.e., four times/day for 8 weeks; Level 1) within participants (Level 2). Therapeutic skill practice was entered into a second model as a predictor of momentary pain. A third model evaluated treatment group (MORE vs. SG) as a moderator of the association of momentary pain and mood.

Results:  A significant Group X Time interaction on momentary pain experience was observed (p=.03), such that MORE led to significantly greater decreases in moment-by-moment pain levels than the SG over the course of treatment. Higher levels of therapeutic skill practice (e.g., mindfulness) significantly predicted greater decreases in pain (p< 05). In support of our moderational hypothesis, we found that MORE significantly moderated the association between mood state and pain (p<.001), such that MORE strengthened the relationship between higher positive mood and lower levels of pain over time.

Conclusions and Implications:  Findings indicate that MORE may be an efficacious means of providing moment-by-moment pain relief. EMA methods may improve the validity and reliability of research findings by overcoming retrospective biases and providing a more accurate picture of the impact of interventions on day-to-day, “real world” experience.