Mindfulness intervention reduces pain, opioid misuse

A mindfulness-based intervention was associated with significant reductions in chronic pain and opioid misuse compared with supportive psychotherapy, according to a recent study in JAMA Internal Medicine.

Eric Garland, PhD, LCSW, Distinguished Endowed Chair in research at the University of Utah’s College of Social Work, told Healio that he was surprised by “how powerful and long-lasting” the Mindfulness-Oriented Recovery Enhancement (MORE) intervention was in treating adults with chronic pain and opioid misuse.

Garland and colleagues randomly assigned 129 adults to participate in MORE and 121 to receive supportive psychotherapy from Jan. 4, 2016, to Jan. 16, 2020. The interventions were delivered through 2-hour group sessions once a week in primary care settings for 8 weeks.

At baseline, the mean duration of participants’ pain was 14.7 years, and the mean morphine-equivalent opioid dose was 101 mg. About 81% of participants completed the minimum intervention dose, which the researchers defined as four sessions.

At 9 months, MORE reduced opioid misuse in 45% of treated individuals, “more than doubling the effect of standard supportive psychotherapy and exceeding the effect size of other known therapies for opioid misuse among people with chronic pain,” Garland said.

Participants in the MORE group also reported feeling less severe pain (between-group effect = 0.49; 95% CI, 0.17-0.81) and more often achieved clinically important reductions in pain severity compared with those who received supportive psychotherapy (50% vs. 29.3%), according to the researchers.

The pain reduction effects of MORE were “greater than that observed for the current gold-standard psychological treatment for chronic pain, cognitive-behavioral therapy,” Garland said.

In addition, a greater proportion of participants in the MORE group decreased their daily opioid dose by at least 50% (35.5% vs. 15.9%), and experienced greater reductions in emotional distress (between-group effect = 2.79 points; 95% CI, 0.41-5.18) compared with the supportive psychotherapy group. There was also a significant decrease in reports of opioid craving in the MORE group vs. the supportive psychotherapy group.

“When patients need to continue to take opioids for pain management, MORE can help reduce opioid-related risks,” Garland said. “MORE is also a highly effective treatment that can simultaneously address addictive behavior, emotional distress and chronic pain.”

The trial discontinuation rate increased during the final year of the study, which coincided with the onset of the COVID-19 pandemic, limiting the findings to a smaller pool of participants, according to the researchers. Overall, 4% of participants completed the 9-month follow-up visits in the final year vs. 74% of participants in the year before.

Future clinical trials should study how to best implement MORE as part of standard medical care and an insurance-reimbursable service, Garland said.

References:

• Garland EL, et al. JAMA Intern Med. 2022;doi:10.1001/jamainternmed.2022.0033.
• Mindfulness-oriented recovery enhancement. https://drericgarland.com/about-m-o-r-e/. Accessed March 8, 2022.