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SALT LAKE CITY — A University of Utah clinical trial suggests that "mindfulness" is useful in decreasing opioid misuse and reducing symptoms of chronic pain.
The trial evaluated an eight-week mindfulness-based therapy program known as MORE — Mindfulness-Oriented Recovery Enhancement.
This was the first large-scale clinical trial to demonstrate that psychological interventions can reduce opioid misuse among those who are prescribed opioids to manage chronic pain.
"MORE demonstrated one of the most powerful treatment effects I've seen," said Eric Garland, lead author of the study. "There's nothing else out there that works this well in alleviating pain and curbing opioid misuse."
The therapy teaches participants to break down their pain experience and opioid craving into different components — like heat, tightness and tingling — and notice how these change over time. It also teaches them to savor positive everyday experiences and to reframe stressful events to recognize learning.
"Rather than getting caught up in the pain or craving," Garland explained, "we teach people how to step back and observe that experience from the perspective of an objective witness. When they can do that, people begin to recognize that who they truly are is bigger than any one thought or sensation. They are not defined by their experiences of pain or craving; their true nature is something more."
Garland is the associate dean for research at the University of Utah College of Social Work and directs the Center on Mindfulness and Integrative Health Intervention Development. He is a leader in the academic field of mindfulness research.
He said that the data from the study definitively shows that this therapy is effective for chronic pain and opioid misuse. They expected the therapy to prove helpful, but Garland said he was surprised by how powerful the effect of the therapy was on the individuals in the trial.
Garland said that the effects of Mindfulness-Oriented Recovery Enhancement appear to get stronger over time, which could be attributed to people integrating the mindfulness skills they learn into their lives or their brains restructuring how they process rewards so they value healthy rewards more.
The trial saw the effects of the program grow for nine months after the study. Garland said that was as far as the funding allowed them to track progress, but he expects the trend will continue.
The study, which was published in the Journal of the American Medical Association, followed 250 adults with chronic pain who were on opioid therapy, primarily taking oxycodone or hydrocodone. Over half of them had a diagnosable opioid use disorder.
After the therapy, which included weekly two-hour group therapy sessions and 15 minutes of homework each day, 45% of participants reported they were no longer misusing opioids, 36% reported they had cut opioid use in half or more.
"Patients in MORE had more than twice the odds of those in standard psychotherapy to stop misusing opioids by the end of the study. Additionally, participants in the MORE group reported clinically significant improvements in chronic pain symptoms, decreased opioid craving and reduced symptoms of depression to levels below the threshold for major depressive disorder," the University of Utah press release states.
One reason this approach has been successful is it addresses pain and opioid use simultaneously, which is significant because opioid misuse has been shown to increase pain sensitivity, causing further misuse.
According to Garland, the therapy reduces physical pain, emotional pain from depression or post-traumatic stress disorder, along with the addictive behavior. He said at the beginning of the study, almost 70% of participants met the criteria for major depression. But on average, they did not show the same symptoms after treatment.
"You can use one single intervention to simultaneously help with all of these problems, that's what's really exciting to me," Garland said.
He said that Mindfulness-Oriented Recovery Enhancement has primarily been used to study opioid misuse and chronic pain, but that they have also done smaller-scale studies on its use in treating other addictive behaviors, including alcohol, drugs, cigarettes and video games. They have also considered using it for helping with weight loss.
This five-year clinical study was funded by a $2.8 million grant from the National Institute on Drug Abuse.
Garland said now that it has been proven that the mindfulness program is effective, he hopes that they are able to help more people access the therapy, which will involve training for therapists, social workers, psychologists, nurses, doctors and health care systems.
He said he hopes money that Utah will soon be receiving from a settlement with opioid companies will help fund this effort, as it is one of the most effective therapies for treating opioid addiction.