Opioids and Mindfulness

Mindfulness-Oriented Recovery Enhancement vs Supportive Group Therapy for Co-occurring Opioid Misuse and Chronic Pain in Primary Care: A Randomized Clinical Trial | Complementary and Alternative Medicine | JAMA Internal Medicine | JAMA Network

Long-term opioid therapy (LTOT; ≥90 days of opioid use) for the treatment of chronic pain is common in primary care settings, despite risks including opioid misuse and opioid use disorder (OUD). Approximately 25% of individuals receiving LTOT misuse opioids, which is defined as aberrant drug-related behaviours (e.g., use of opioids to alleviate negative emotions) inconsistent with prescription directions. Escalation from chronic pain to opioid misuse and OUD is thought to be propelled by effects of prolonged opioid use on stress and reward circuitry in the brain. These neurobiological changes increase sensitization to emotional distress and pain and decrease sensitivity to pleasure derived from natural rewards, promoting opioid dose escalation as a means of preserving a dwindling sense of well-being. Because of these complex pathogenic mechanisms as well as a dearth of studies in this area, successful treatment of opioid misuse among people receiving LTOT has proven elusive.

This study published in JAMA, posed the question – “Does a mindfulness-based intervention reduce comorbid chronic pain and opioid misuse in the primary care setting more than supportive psychotherapy?”

The study included 250 adults with chronic pain receiving long-term opioid therapy who were misusing opioid medications.

They randomised these patients into two groups over 8 weeks and they received 2 hours of training in each of the following treatment approaches

  1. Mindfulness based program – MORE (comprising training in mindfulness, reappraisal, and savouring positive experiences)
  2. Psychotherapy based program – supportive group psychotherapy (control condition).

They found that the Mindfulness based program intervention led to sustained improvements in opioid misuse and chronic pain symptoms and reductions in opioid dosing, emotional distress, and opioid craving compared with psychotherapy-based program.

At ACT for PAIN we are looking to see if our program can help reduce the opioid use of long-term users and improve their quality of their lives in association with a UK NHS Primary Care Network group.


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