Mindfulness-Oriented Recovery Enhancement Leads to Decreased Pain and Negative Affect Among Chronic Pain Patients: A Session-By-Session Analysis

Objectives: Opioid misuse among chronic pain patients has garnered national attention in the last several decades due to its deleterious effects on public health. Uncontrolled pain and dysregulated negative emotions are two key risk factors for opioid misuse. Thus, targeted interventions are needed to help patients manage pain and negative affect as means of preventing opioid misuse. Mindfulness-Oriented Recovery Enhancement (MORE) is an integrated behavioral intervention that addresses the underlying mechanisms that precipitate and maintain opioid misuse among individuals with chronic pain. In this secondary data analysis, we sought to examine the impact of MORE versus a support group (SG) on changes in pain and negative affect across eight treatment sessions. To our knowledge, this study represents one of the first attempts to model session-by-session changes in symptoms during a multi-week mindfulness intervention. We hypothesized that participants in MORE would report greater decreases in pain negative affect following each intervention session compared to those in the SG control condition.

Methods: Session data were obtained from randomized controlled trials of MORE including a total of 229 chronic pain patients prescribed long-term opioid therapy (>90 days). At the beginning and end of each of the eight group intervention sessions, participants completed a self-report measure of pain and negative affect on a scale from one (not at all) to five (extremely). We used linear mixed models to examine the impact of MORE versus a SG on the change in pain and negative affect throughout the eight weeks of the intervention.

Results: We observed a significant main effect of treatment condition favoring MORE for pain relief across all sessions, F(1, 476.11) = 4.29, p = .04, as well as a significant main effect of time, F(1, 445.52) = 5.03, p = .03, indicating that pain decreased over time. However, the treatment X time interaction was not significant, F(1, 445.52) = .89, p = .35), indicating that the pain relieving effects of MORE manifested in the very first session and were maintained over time. With regard to changes in negative affect, we again found a significant main effect of treatment condition favoring MORE, F(1, 458.86) = 4.40, p = .036, and also a main effect of time, F(1, 502.58) = 11.53, p = .001. However, the treatment X time interaction was not significant, F(502.58) = 1.23, p = .27. Thus, as with physical pain, the effect of MORE on reducing negative affect was apparent in the first intervention session and was maintained over time.

Discussion: Our findings demonstrate that MORE reduces pain and negative affect among opioid-treated individuals. Contrary to models suggesting that the clinical benefits of mindfulness accrue over time through a training effect, our findings suggest that the clinical impact of mindfulness interventions may be immediate and then sustained over time. Altogether, this study and others support the integration of MORE into social work settings. Social workers are well suited for supporting chronic pain patients given their role as providers of integrated healthcare treatment.