Pain, hedonic regulation, and opioid misuse: Modulation of momentary experience by Mindfulness-Oriented Recovery Enhancement in opioid-treated chronic pain patients
Eric L Garland, Craig J. Bryan, Patrick H. Finan, Elizabeth Anne Thomas, Sarah E. Priddy, Michael R. Riquino, Matthew O. Howard
Drug and Alcohol Dependence March 29, 2017 DOI: 10.1016/j.drugalcdep.2016.07.033 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Secondary analysis of ecological momentary assessment data from a randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 55 |
| Population | Chronic pain patients at risk for opioid misuse |
| Intervention | Mindfulness-Oriented Recovery Enhancement (MORE) |
| Duration | 8 weeks of treatment |
| Topics | Meditation |
| Citations | 74 |
| Registration | NCT01505101 |
| Key findings | Patients receiving Mindfulness-Oriented Recovery Enhancement (MORE) reported greater improvements in momentary pain and positive affect than a support group control, and were more likely to exhibit positive affect regulation (OR=2.75). Improvements in positive affect, but not pain, were associated with reduced risk of opioid misuse by post-treatment. |
Abstract
Background: Given the risk of opioid misuse among chronic pain patients being treated with long-term opioid pharmacotherapy, non-pharmacological treatments are needed. Further, in light of hedonic deficits in this population, therapies that enhance positive affect may be useful. The purpose of this study was to examine effects of a Mindfulness-Oriented Recovery Enhancement (MORE) intervention on ecological momentary assessments (EMA) of pain and positive affective experience, and to determine if changes in pain, affect, and their interaction were associated with opioid misuse at post-treatment.
Methods: This study examined unpublished EMA data from a subset of participants (N=55) in a previously published RCT (NCT01505101) of MORE versus a support group (SG) control. Across 8 weeks of treatment, patients completed up to 224 EMA measures of pain and affect. Multilevel models and generalized estimating equations examined effects of treatment on momentary pain and positive affect, and generalized linear models examined associations between pain and affect and changes in opioid misuse by post-treatment.
Results: Patients in MORE reported significantly greater improvements in momentary pain (p=0.01) and positive affect (p=0.004) than patients in the SG. Further, over the entire course of treatment, patients in MORE were significantly more likely to exhibit positive affect regulation (OR=2.75) than patients in the SG. Finally, improvements in positive affect (but not pain) over the course of intervention were associated with reduced risk of misusing opioids by post-treatment (p=0.02).
Conclusion: MORE may be a useful non-pharmacological treatment for pain and hedonic deficits among chronic pain patients at risk for opioid misuse.
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
- Mindfulness-based programs for substance use disorders: a systematic review of manualized treatments Substance Abuse Treatment, Prevention, and Policy July 29, 2020
- Positive Psychological States in the Arc from Mindfulness to Self-Transcendence: Extensions of the Mindfulness-to-Meaning Theory and Applications to Addiction and Chronic Pain Treatment Current Opinion in Psychology January 14, 2019
- Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards. Psychological Medicine April 1, 2023
- Mindfulness-based interventions for opioid misuse: A systematic review of randomized controlled trials. Journal of Substance Use and Addiction Treatment July 30, 2026
- Mindfulness‐Oriented Recovery Enhancement: Implementing an evidence‐based intervention for chronic pain, opioid use, and opioid addiction in clinical settings British Journal of Clinical Pharmacology July 24, 2024
and 10 more in the library
Cites 10
- Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial Pain Medicine March 10, 2016
- Restructuring reward processing with Mindfulness-Oriented Recovery Enhancement: novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain. Annals of the New York Academy of Sciences April 1, 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
- Restructuring Hedonic Dysregulation in Chronic Pain and Prescription Opioid Misuse: Effects of Mindfulness-Oriented Recovery Enhancement on Responsiveness to Drug Cues and Natural Rewards Psychotherapy and Psychosomatics February 1, 2017
- Neurophysiological Evidence for Remediation of Reward Processing Deficits in Chronic Pain and Opioid Misuse Following Treatment with Mindfulness-Oriented Recovery Enhancement: Exploratory ERP Findings from a Pilot RCT Journal of Behavioral Medicine November 11, 2014
and 5 more in the library