A mindfulness-based intervention known as Mindfulness-Oriented Recovery Enhancement (MORE) appears to be more effective than psychotherapy at reducing opioid misuse, pain, and emotional distress in adults with chronic pain, according to a study published today in JAMA Internal Medicine. The benefits of the eight-week MORE therapy over supportive psychotherapy remained nine months after the therapy sessions ended.
“The MORE intervention’s broad-spectrum effects were noteworthy given that many participants in the sample presented with multiple chronic pain conditions, were taking high opioid doses, and had co-occurring psychiatric disorders,” wrote Eric Garland, Ph.D., of the University of Utah and colleagues.
Garland and colleagues enrolled 250 adults with chronic pain who reported misusing opioids (defined as a score of 9 or more on the Current Opioid Misuse Measure). The participants were randomly assigned to receive eight weekly two-hour sessions of MORE or supportive psychotherapy; both interventions were delivered in a group format by the same set of clinical social workers. Participants in the MORE group received sequential training on mindfulness (for example, meditation and breathing skills), reappraisal (reframing maladaptive thoughts to decrease negative emotions), and savoring (focusing on pleasurable events and sensations to amplify positive emotions). Those assigned to the supportive psychotherapy group participated in discussions about coping with pain, the adverse effects of opioids, and the use of opioids to alleviate negative emotions.
The participants’ pain levels, opioid use, and emotional distress (depression, anxiety, and/or stress) were assessed at baseline; after the eight sessions; and at three-, six-, and nine-month follow-ups. Participants were prompted to assess their levels of opioid cravings three times a day throughout the eight-week intervention and for one month following the intervention. At nine months, 38.0% in the MORE group and 35.5% in the supportive psychotherapy group were unavailable for follow-up—discontinuation rates that are similar to those observed in clinical trials of psychosocial treatments for opioid use disorder, the authors noted.
At the nine-month follow up, 45.0% of the participants who received MORE group therapy were no longer misusing opioids compared with 24.4% of those who received supportive psychotherapy. In addition, 35.5% of participants in the MORE group decreased their opioid dose by at least 50% compared with 15.9% of those in the supportive psychotherapy group. Participants in the MORE group also reported less severe pain symptoms, less pain interference, fewer opioid cravings, and less emotional distress than those in the supportive psychotherapy group.
“Unlike many interventions with effects that are greatest immediately after treatment but gradually diminish, MORE’s effect was sustained, likely a function of the intervention’s unique mechanisms of action,” Garland and colleagues wrote. The researchers noted that additional clinical trials are needed to compare MORE with other evidence-based interventions, such as cognitive-behavioral therapy and mindfulness-based stress reduction.
To read more on this topic, see the Psychiatric News article “Meditation, CBT May Ease Opioid-Treated Pain.”
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