Military personnel and veterans who have been taking opioids for chronic pain may experience greater benefits from group therapy that integrates mindfulness techniques than from supportive psychotherapy, according to a reportpublished today in The American Journal of Psychiatry.
The randomized clinical trial, which compared outcomes in veterans and military from Utah, found that those who received Mindfulness-Oriented Recovery Enhancement (MORE) reported greater reductions in chronic pain symptoms and opioid use than those who received supportive psychotherapy.
“The pain-relieving effects of MORE were coupled with reductions in pain catastrophizing and an increased capacity to mindfully reinterpret pain as an innocuous sensory signal that does not necessarily signify harm,” wrote Eric Garland, Ph.D., of the Center on Mindfulness and Integrative Health Intervention Development at the University of Utah and colleagues.
Garland and colleagues recruited past and current military personnel from the Salt Lake City Veterans Affairs Medical Center, the Utah Army National Guard, and Salt Lake Valley for the study. To be eligible, the participants were required to be 18 years or older, have a chronic pain–related diagnosis, and were taking daily prescribed opioids for at least three months. A total of 230 participants were randomized to receive eight weekly two-hour group sessions of MORE or supportive psychotherapy. Group sessions were initially held in person but switched to remote teleconferencing during the COVID-19 pandemic.
Participants in the MORE group received training in mindfulness (for example, mindful breathing), reappraisal (reframing reaction to pain), and savoring techniques (focusing on pleasant events and pleasurable sensations) as well as psychoeducation about opioid misuse and chronic pain. The participants were also instructed to practice a three-minute mindfulness technique (mindful breathing) before taking opioids each day to help reduce use and delay taking as-needed opioids.
Participants in the supportive psychotherapy group were invited to share with the group about their experiences of coping with chronic pain, opioid use, and emotional distress; no mindfulness training or education was provided.
The researchers tracked the participants’ chronic pain, measured by the Brief Pain Inventory, and opioid misuse, measured by the Current Opioid Misuse Measure, from the start of the study through eight months. Other outcomes evaluated included the participants’ daily opioid dose, catastrophizing, positive affect, and craving.
MORE was superior to supportive psychotherapy through the eight-month follow-up in reducing pain interference, pain severity, and daily opioid dose, Garland and colleagues reported. “There was a 20.7% reduction in the mean opioid dose (18.88 mg, SD=8.40 mg) in the MORE condition compared with a 3.9% reduction (3.19 mg, SD=4.38 mg) in the supportive psychotherapy condition,” they wrote. MORE also reduced anhedonia (the inability to experience pleasure), pain catastrophizing, craving, and increased positive affect to a greater extent than supportive psychotherapy. Opioid misuse decreased significantly in both groups.
“MORE facilitated opioid dose reduction while preserving adequate pain control and preventing disturbances in mood, suggesting the utility of MORE as an adjunctive therapy for safe opioid tapering among veterans and military personnel,” the researchers wrote. “[R]esearch should assess how to best deliver MORE to individuals across the Veterans Health Administration and the Department of Defense.”
For related information, see the Psychiatric News article “Meditation, CBT May Ease Opioid-Treated Pain.”
