Large-scale studies of non-pharmacologic treatments such as mindfulness for individuals with both chronic pain and opioid use disorder (OUD) have been lacking. This randomized controlled study examined the effects of Mindfulness-Oriented Recovery Enhancement* (MORE; n=129) on pain and opioid use outcomes among individuals with “opioid misuse”** who were receiving opioid treatment for pain. A control group received group supportive psychotherapy (n=121). Participants were followed for 9 months.
- Most participants were white (87%), had mean duration of chronic pain of >14 years, and had a daily mean morphine-equivalent (MME) opioid dose of 101 mg.
- Attrition was similar to other studies; 37% of participants had discontinued by 9 months.
- Compared with the control group, individuals randomized to MORE had lower odds of “opioid misuse” (odds ratio, 2.06), less pain severity (between-group effect, 0.49), less pain-related functional interference (between-group effect, 1.07), and greater reduction in total daily MME (between-group effect, 0.15 log mg).
* A manualized, group therapy intervention using a combination of mindfulness training, cognitive behavioral therapy, and principles from positive psychology.
** Defined as having a score higher than the validated cutoff (≥9 points) for “opioid misuse” on the Current Opioid Misuse Measure.
Comments: MORE shows promise as a non-pharmacologic treatment for individuals with both chronic pain and unhealthy opioid use, although this study was limited in the diversity of its participants and had high attrition. Studies like this demonstrate that non-pharmacologic treatments can be effective, but they require time and resources that may not be available in all settings.
Melissa B. Weimer, DO, MCR
Reference: Garland EL, Hanley AW, Nakamura Y, et al. Mindfulness-oriented recovery enhancement vs supportive group therapy for co-occurring opioid misuse and chronic pain in primary care: a randomized clinical trial. JAMA Intern Med. 2022;182(4):407–417.