How Do Opioid-Using Chronic Pain Patients Experience Change during an 8-Week Mindfulness-Oriented Intervention? a Phenomenological Study

Background and Purpose: Opioid analgesic medications are the frontline treatment for chronic pain conditions; however, these medications often provide inadequate relief from chronic pain. Furthermore, extended use of these medications contributes significantly to a rising epidemic of prescription opioid addiction. In light of this public health crisis, considerable effort has been made to discover complementary and alternative therapies to aid in reduction of chronic pain and opioid misuse. Mindfulness-Oriented Recovery Enhancement (MORE) has emerged as an especially promising intervention. To date, evidence of adaptive emotional and behavioral changes associated with MORE have been examined almost exclusively through quantitative analyses. And although quantitative data provide robust statistical evidence of MORE’s effectiveness, qualitative analyses of MORE may capture meaningful information about chronic pain patients’ subjective experiences of change that quantitative data cannot illuminate. Hence, the present study was designed to serve as a phenomenological investigation of how opioid-using chronic pain patients experience change over the course of an 8-week MORE intervention.

Methods: Adults on long-term prescription opioid analgesic medications for chronic pain (N=44) participated in several group cohorts of a MORE intervention each of which consisted of 8 weekly sessions. Sessions were approximately 2 hours in duration and were facilitated by a licensed clinical social worker. Group sessions were recorded and transcribed verbatim, then analyzed using a phenomenological, grounded theory approach and the method of constant comparison. Thematic coding was guided by principles of grounded theory and an inductive approach to qualitative analysis, and the Mindfulness-to-Meaning theory (Garland et al., 2015) served as the theoretical framework with which the data were interpreted.

Results: Emergent themes included increased self-awareness and enhanced capacity to manage physical pain, stress, and emotional suffering, as well as an increased sense of social support and connectedness. Qualitative data provide anecdotal evidence in support of the Mindfulness-to-Meaning theory, suggesting that the change process precipitated by MORE occurs in an upward spiral of improved emotion regulation and enhanced eudaimonic meaning.   

Conclusions & Implications: Findings reveal the lived-experience of individuals participating in MORE, and suggest that participants perceive MORE to be an effective treatment for chronic pain and opioid misuse. The phenomenology of change elucidated by group participants offers valuable insight into the mechanisms of action in recovery from addiction, stress and pain. Qualitative data may inform social intervention research, and social workers may benefit from training in mindfulness-oriented interventions to provide better care for vulnerable populations at risk for opioid misuse.