Over 40% of U.S. military personnel report post-deployment chronic pain, and up to a third of military veterans are prescribed opioids for long-term pain management. Over a quarter of these veterans go on to engage in some form of opioid misuse, either taking more than their prescribed doses, using opioids to manage negative emotions, or taking non-prescribed drugs.
Therapists are always looking for ways to manage pain more safely and effectively, and mindfulness training may have a role to play in reducing chronic pain and opioid misuse.
Garland et al. [American Journal of Psychiatry] compared the efficacy of Mindfulness-Oriented Recovery Enhancement (MORE) and supportive psychotherapy in reducing self-reported pain and opioid misuse in past and present U.S. military personnel prescribed long-term opioids for chronic pain.
The researchers randomly assigned 230 past and present U.S. military personnel (average age = 58 years; average length of chronic pain = 19 years; 91% veterans; 83% male; 86% white) prescribed long-term opioid treatment for chronic pain to either MORE or supportive psychotherapy. Both treatments were delivered by the same licensed psychologists in 8 weekly two-hour group formats. While 63% of the participants received treatment in person, the onset of the COVID pandemic caused 39% to receive treatment on-line.
The MORE curriculum combines elements of mindfulness training, cognitive reappraisal, and savoring of positive experiences, and psychoeducation on chronic pain and opioid misuse. The mindfulness component included breath- and body-focused meditations. In addition to 15 minutes of daily guided home mindfulness, reappraisal and savoring practice, participants were to engage in 3 minutes of mindful awareness prior to taking doses of their medication.
The supportive therapy control used a non-directive client-centered approach that included discussion of thoughts and emotions around pain, opioid use, and emotional distress, but did not include skills training.
Participants were assessed at baseline, post-treatment, and 4-and 6-month follow-up on measures of pain, opioid use and misuse, and a variety of psychological variables. Participants also rated their opioid cravings three times daily throughout the six months of the study.
The results showed that the MORE group reduced average chronic pain severity, pain-related interference with daily activities, and daily opioid cravings to a significantly greater degree than controls. They also reduced their average daily opioid dosage (by 21%) significantly more than controls (by 4%). Both groups significantly reduced opioid misuse from baseline but did not differ from each other in that regard.
This trial suggests MORE for patients with chronic pain who are prescribed long-term opioid treatment attenuates self-reported pain outcomes. The study population of predominantly white, middle-aged males may restrict the degree to which these results may generalize to other populations. It is also not clear how switching from an in-person to on-line therapy format midway through the study might have affected the outcomes.
People with schizophrenic spectrum disorders (SSDs) often exhibit both positive (hallucinations, delusions) and negative (apathy, social withdrawal, lack of affect) symptoms. Negative symptoms respond poorly to current medications, and there is a need for novel treatments that can help minimize them.
Reference:
Garland, E. L., Nakamura, Y., Bryan, C. J., Hanley, A. W., Parisi, A., Froeliger, B., Marchand, W. R., & Donaldson, G. W. (2024). Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial. American Journal of Psychiatry.
Link to study
