An 8-week mindfulness-based therapy — Mindfulness-Oriented Recovery Enhancement (MORE) — decreased opioid use and misuse while reducing chronic pain symptoms, with effects lasting as long as 9 months, according to a study published in JAMA Internal Medicine.

This is the first large-scale clinical trial to demonstrate that a psychological intervention can simultaneously reduce opioid misuse and chronic pain among people who were prescribed opioid pain relievers.

The study followed 250 adults with chronic pain on long-term opioid therapy who met the criteria of misusing opioids. Most participants took oxycodone or hydrocodone, reported 2 or more painful conditions, and met the clinical criteria for major depression. More than half of participants also had a diagnosable opioid use disorder.

Study participants were randomised to receive standard supportive psychotherapy group or MORE, both engaging in 8 weekly 2-hour group sessions, as well as 15 minutes of daily homework. The study treatment groups were delivered in doctor’s offices, in the same clinical care setting where patients received their opioid pain management.

Nine months after the treatment period ended, 45% of participants in the MORE group were no longer misusing opioids compared with 24.4% of participants receiving supportive group psychotherapy. In addition, patients in MORE had more than twice the odds of those in standard psychotherapy to stop misusing opioids by the end of the study.

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.

“MORE demonstrated one of the most powerful treatment effects I’ve seen,” said lead author Eric Garland, MD, University of Utah, Salt Lake City, Utah. “There’s nothing else out there that works this well in alleviating pain and curbing opioid misuse. Remarkably, the effects of MORE seem to get stronger over time. One possible explanation is that these individuals are integrating the skills they’ve learned through MORE into their everyday lives.”

MORE combines meditation, cognitive-behavioural therapy, and principles from positive psychology into sequenced training in mindfulness, savouring, and reappraisal skills. Participants are taught to break down the experience of pain or opioid craving into their sensory components, “zooming in” on what they are feeling and breaking it down into different sensations like heat, tightness, or tingling. They are trained to notice how those experiences change over time, and to adopt the perspective of an observer. They are also taught to savour pleasant, healthful, and life-affirming experiences, amplifying the sense of joy, reward, and meaning that can come from positive, everyday events. Finally, participants are taught to reframe stressful events to find a sense of meaning in the face of adversity, to recognise what can be learned from difficult events and how dealing with those experiences might make a person stronger.

“Rather than getting caught up in the pain or craving, we teach people how to step back and observe that experience from the perspective of an objective witness,” said Dr. Garland. “When they can do that, people begin to recognise 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.”