Mindfulness-oriented recovery enhancement reduces opioid dose in primary care by strengthening autonomic regulation during meditation.
Eric L Garland, Justin Hudak, Adam W. Hanley, Yoshio Nakamura
American Psychologist September 1, 2020 DOI: 10.1037/amp0000638 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Secondary analysis of a randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 95 |
| Population | Chronic pain patients on long-term opioid therapy treated in primary care |
| Interventions | Mindfulness-Oriented Recovery Enhancement (MORE) support group |
| Duration | 8 weeks of intervention, 3-month follow-up |
| Measures | Timeline Followback, heart rate variability (HRV) |
| Topics | Meditation |
| Keywords | Autonomic nervous system Humans Analgesics, opioid Middle aged Primary health care Female Chronic pain |
| Key findings | Participants receiving MORE showed a 32% greater decrease in opioid dosing by 3-month follow-up than the support group, and MORE increased heart rate variability during meditation. The authors propose that meditation-induced changes in heart rate variability partially mediate opioid dose reduction, suggesting MORE may bolster self-regulation and self-control over opioid use. |
Abstract
The current opioid crisis was fueled by escalation of opioid dosing among patients with chronic pain. Yet, there are few evidence-based psychological interventions for opioid dose reduction among chronic pain patients treated with long-term opioid analgesics. Mindfulness-Oriented Recovery Enhancement (MORE), which was designed to target mechanisms underpinning chronic pain and opioid misuse, has shown promising results in 2 randomized clinical trials (RCTs) and could facilitate opioid sparing and tapering by bolstering self-regulation. Here we tested this hypothesis with secondary analyses of data from a Stage 2 RCT. Chronic pain patients (N = 95) on long-term opioid therapy were randomized to 8 weeks of MORE or a support group (SG) control delivered in primary care. Opioid dose was assessed with the Timeline Followback through 3-month follow-up. Heart rate variability (HRV) during mindfulness meditation was quantified as an indicator of self-regulatory capacity. Participants in MORE evidenced a greater decrease in opioid dosing (a 32% decrease) by follow-up than did the SG, F(2, 129.77) = 5.35, p = .006, d = 1.07. MORE was associated with a significantly greater increase in HRV during meditation than was the SG. Meditation-induced change in HRV partially mediated the effect of MORE on opioid dose reduction (p = .034). MORE may boost self-regulatory strength via mindfulness and thereby facilitate self-control over opioid use, leading to opioid dose reduction in people with chronic pain. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cited by 14
- Endogenous theta stimulation during meditation predicts reduced opioid dosing following treatment with Mindfulness-Oriented Recovery Enhancement. Neuropsychopharmacology September 12, 2020
- Telehealth Mindfulness-Oriented Recovery Enhancement vs Usual Care in Individuals With Opioid Use Disorder and Pain: A Randomized Clinical Trial. JAMA Psychiatry April 1, 2024
- Mindfulness-induced endogenous theta stimulation occasions self-transcendence and inhibits addictive behavior. Science Advances October 14, 2022
- Low-dose ketamine infusion to facilitate opioid tapering in chronic non-cancer pain with opioid-use disorder: a historical cohort study. Regional Anesthesia & Pain Medicine May 6, 2025
- Mindfulness-induced self-transcendence promotes universal love with consequent effects on opioid misuse. Behaviour Research and Therapy April 1, 2024
and 9 more in the library
Cites 17
- Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology 2000
- Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness Frontiers in Human Neuroscience 2012
- Long-term mindfulness training is associated with reliable differences in resting respiration rate Scientific Reports June 7, 2016
- Restructuring Reward Mechanisms in Nicotine Addiction: A Pilot fMRI Study of Mindfulness‐Oriented Recovery Enhancement for Cigarette Smokers Evidence-based Complementary and Alternative Medicine 2017
- Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial. Journal of Consulting and Clinical Psychology October 1, 2019
and 12 more in the library