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Randomized Controlled Trial
. 2019 Oct;87(10):927-940.
doi: 10.1037/ccp0000390.

Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial

Eric L Garland  1 , Adam W Hanley  1 , Michael R Riquino  1 , Sarah E Reese  1 , Anne K Baker  1 , Karen Salas  1 , Brooke P Yack  1 , Carter E Bedford  1 , Myranda A Bryan  1 , Rachel Atchley  1 , Yoshio Nakamura  2 , Brett Froeliger  3 , Matthew O Howard  4
Affiliations
Randomized Controlled Trial

Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial

Eric L Garland et al. J Consult Clin Psychol. 2019 Oct.

Abstract

Objective: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health.

Method: Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up.

Results: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p < .001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p = .048), which in turn predicted decreases in opioid misuse risk by follow-up (p = .02).

Conclusions: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT03298269.

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Figures

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Figure 1.
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Figure 2.
Confirmatory factor analysis of latent positive psychological functioning variable (N = 95).
Figure 3.
Figure 3.
Path analysis of the effects of treatment (Mindfulness-Oriented Recovery Enhancement versus Support Group) on changes in pain severity and opioid misuse risk as mediated by improvements in positive psychological functioning (N = 95).
See this image and copyright information in PMC

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