Peace of Mind, Peace Embodied: Mindfulness-Induced Increases in Pleasant Sensations Are Associated with Reduced Opioid Use Disorder Severity

Background and Purpose: Chronic pain affects 20-30% of American adults, causing considerable physical and emotional suffering while exacting an annual financial toll estimated at $100 billion. Compounding these concerns, the primary treatment of chronic pain involves opioid pharmacotherapy.  Widespread prescription of opioid analgesics for pain management has resulted in rapidly rising rates of opioid use disorder. Opioid use disorder among chronic pain patients is theorized to involve a process of hedonic dysregulation in which repeated exposure to opioids results in increased sensitivity to pain coupled with decreased sensitivity to natural pleasure – a cycle that promotes opioid dose escalation and disordered opioid use as a means of maintaining a dwindling sense of well-being. Novel behavioral treatments utilizing mindfulness may be efficacious means of treating such hedonic dysregulation. In that regard, Mindfulness-Oriented Recovery Enhancement (MORE) teaches chronic pain patients methods of mindfully reinterpreting bodily sensations to reduce pain along with methods of mindfully savoring pleasurable experiences to combat the hedonic dysregulation that often accompanies chronic pain. By virtue of their effects on hedonic regulation, these mindful coping strategies are hypothesized to reduce opioid use disorder symptom severity.

Methods: Data were collected from opioid treated chronic pain patients participating in a randomized control trial comparing 8-weeks of Mindfulness Oriented Recovery Enhancement (MORE; n=18) to an active Support Group (n=25). The malleability of bodily sensations in opioid-treated chronic pain patients was measured with a novel assessment tool, the digital sensation bodymap (DSB). The DSB was developed by overlaying 469 1 cm x 1 cm squares on the image of a body. At pre- and post-treatment assessments, participants were instructed to identify locations on the DSB where they currently felt pleasant and unpleasant sensations.

Results: A significant Group (MORE vs. Support Group) x Time (Pre-Post-Treatment) interaction was observed for pleasant sensation reports (F_1,41=5.31, p=.026, η2=.115),such that participants allocated to MORE reported significantly greater increases in pleasant sensation from pre- to post-treatment than those in the support group. However, no significant Group X Time interaction was observed for unpleasant sensations (F_1,41=0.17, p=.682, η2=.004). To extend these findings, pre-post treatment change scores were computed for pleasant sensation reports and opioid use disorder severity from pre- to post-treatment. Increases in pleasant sensations from pre- to post-treatment were significantly associated with decreased opioid use disorder symptom severity (r=.58, p=.004) over the course of treatment.

Conclusions: Findings from this study indicate that MORE amplifies pleasant sensations, a therapeutic process linked with reduced opioid use disorder symptom severity. Findings from this study have implications for both the measurement and treatment of chronic pain in opioid-treated individuals. First, these data suggest awareness of pleasant bodily sensations provides valuable clinical information neglected by traditional pain measurement strategies – information that may be particularly valuable for opioid-treated chronic pain patients given the hedonic dysregulation these patients often experience. Second, treatments that encourage awareness and appreciation of pleasant bodily sensations, such as MORE, may be particularly well suited to assist chronic pain patients receiving