Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial
Eric L Garland, Yoshio Nakamura, Craig J. Bryan, Adam W. Hanley, Anna Parisi, Brett Froeliger, William R. Marchand, Gary W Donaldson
American Journal of Psychiatry January 10, 2024 DOI: 10.1176/appi.ajp.20230272 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 230 |
| Population | Past and current U.S. military personnel prescribed long-term opioid therapy for chronic pain |
| Interventions | Mindfulness-Oriented Recovery Enhancement (MORE) Supportive psychotherapy |
| Duration | 8-month follow-up |
| Measures | Brief Pain Inventory (BPI), Current Opioid Misuse Measure (COMM) |
| Topics | Meditation |
| Key findings | MORE led to greater reductions in pain interference, pain severity, and opioid dose (20.7% vs 3.9%) than supportive psychotherapy over 8 months, with no overall difference in opioid misuse. MORE also improved psychological outcomes like anhedonia, catastrophizing, craving, and positive affect. |
Abstract
OBJECTIVE. Evaluate the efficacy of Mindfulness-Oriented Recovery Enhancement (MORE) for past and current military personnel prescribed long-term opioid therapy (LTOT) for chronic pain. METHODS. In a clinical trial, 230 past and current U.S. military personnel prescribed LTOT were randomized (1:1) to MORE or supportive psychotherapy (in-person and then online via Zoom after onset of COVID-19). Primary outcomes were 1) chronic pain measured by the Brief Pain Inventory (BPI) and 2) aberrant drug-related behaviors measured by the Current Opioid Misuse Measure (COMM) through 8-month follow-up. Opioid dose was a key secondary outcome. Other outcomes included psychiatric symptoms, catastrophizing, positive affect, ecological momentary assessments of opioid craving, and opioid attentional bias. RESULTS. MORE was superior to supportive psychotherapy through 8-month follow-up in reducing pain-related functional interference (p=0.01), pain severity (p=0.048), and opioid dose (p=0.029). MORE reduced opioid dose by 20.7%, compared to 3.9% in supportive psychotherapy. Although there was no overall between-groups difference in opioid misuse (p=0.43), the in-person MORE cohorts outperformed supportive psychotherapy for reducing opioid misuse (p=0.047). MORE reduced anhedonia, pain catastrophizing, craving, and opioid attentional bias, while increasing positive affect to a greater extent than supportive psychotherapy. MORE also modulated therapeutic processes including mindful reinterpretation of pain sensations, nonreactivity, savoring, positive attention, and reappraisal. CONCLUSIONS. For past and current U.S. military personnel, MORE led to sustained decreases in chronic pain, opioid use, craving, and opioid cue-reactivity. MORE facilitates opioid dose reduction while preserving adequate pain control and preventing mood decrements, suggesting MORE’s utility for safe opioid tapering.