22827 - Targeting Chronic Pain and Prescription Opioid Misuse with Mindfulness [ ]

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22827 - Targeting Chronic Pain and Prescription Opioid Misuse with Mindfulness

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Targeting Chronic Pain and Prescription Opioid Misuse with Mindfulness-Oriented Recovery Enhancement (MORE): Results from a Randomized Controlled Trial
Speaker: Eric Garland, PhD, LCSW
Format: Audio & Slides

INTRODUCTION: Prescription opioid misuse among persons with chronic pain is a prevalent threat to public health that has increased more than threefold over the past 20 years. This NIH-funded randomized controlled trial sought to determine whether an integrative, multimodal intervention, Mindfulness-Oriented Recovery Enhancement (MORE), could reduce chronic pain and opioid misuse. We hypothesized that MORE would reduce pain severity, functional impairment, opioid craving, and opioid misuse to a significantly greater extent than a support group (SG).

METHODS: Chronic pain patients (N = 115) were randomized to either a MSW-led MORE group (n = 57) or a SG (n = 58). MORE intervention sessions involved training in mindfulness, cognitive reappraisal, and positive emotion regulation. Pain severity, functional interference, opioid craving, and opioid misuse were assessed pre- and post-intervention, as well as at 3-month follow-up. To explore therapeutic mechanisms, measures of reinterpretation of pain sensations, nonreactivity, reappraisal, and neurocognition were monitored pre- and post-treatment.

RESULTS: MORE participants reported significantly greater reductions in pain severity (p = .038) and interference (p = .003) than SG participants, which were maintained by 3-month follow-up and mediated by increased nonreactivity and reinterpretation of pain sensations. Compared with those in the SG, participants in MORE also evidenced significantly less desire for opioids (p = .027), and were significantly more likely to no longer meet criteria for opioid use disorder following treatment (p = .05). Clinical outcomes were linked to changes in attentional bias, cue-elicited heart rate variability, and cognitive control mechanisms.

DISCUSSION: By targeting key cognitive, affective, and psychophysiological processes, MORE appears to be a promising means of enhancing therapeutic outcomes among vulnerable persons suffering from chronic pain and opioid misuse.