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.
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 15
- Anhedonia: Current and future treatments Psychiatry and Clinical Neurosciences Reports March 1, 2025
- Be more mindful: Targeting addictive responses by integrating mindfulness with cognitive bias modification or cue exposure interventions Neuroscience & Biobehavioral Reviews September 25, 2023
- Immediate Effects of Mindful Awareness in Body-Oriented Therapy as an Adjunct to Medication for Opioid Use Disorder. Mindfulness November 1, 2024
- How Bud Craig's Insights Reshape the Research on Pain and Mind-Body Therapies. Current Topics in Behavioral Neurosciences October 23, 2024
- Mindfulness-Oriented Recovery Enhancement for Cancer Pain Relief: Pilot Randomized Controlled Trial. Journal of Pain and Symptom Management January 3, 2026
and 10 more in the library
Cites 9
- Using Self-Report Assessment Methods to Explore Facets of Mindfulness Assessment January 27, 2006
- Mindfulness-induced endogenous theta stimulation occasions self-transcendence and inhibits addictive behavior. Science Advances October 14, 2022
- The Mindful Reappraisal of Pain Scale (MRPS): Validation of a New Measure of Psychological Mechanisms of Mindfulness-Based Analgesia. Mindfulness 2023
- Mindfulness-Oriented Recovery Enhancement for Addictive Behavior, Psychiatric Distress, and Chronic Pain: A Multilevel Meta-Analysis of Randomized Controlled Trials. Mindfulness September 15, 2022
- Mindfulness-Oriented Recovery Enhancement vs Supportive Group Therapy for Co-occurring Opioid Misuse and Chronic Pain in Primary Care JAMA Internal Medicine February 28, 2022
and 4 more in the library