Opioid therapy for chronic pain is associated with increased risk for opioid misuse, abuse and overdose.1 “Opioid misuse” can be described as any use of opioid medication that is outside the prescribed parameters.2 Among patients taking opioids, rates of misuse have been estimated to be between 21 and 29%.3
In a study examining the role of a mindfulness intervention for chronic pain and opioid misuse, 115 patients with chronic pain and on opioids, were randomized to an 8-week mindfulness intervention or a support group.4 The mindfulness group demonstrated significantly greater reductions in pain severity and interference compared to the support group. These results were maintained at 3 month follow-up. In addition, post-intervention, the mindfulness group showed significantly less stress arousal, opioid craving and likelihood of meeting criteria for opioid use disorder. However, these latter results were not maintained at 3 month follow-up.
In an analysis of data from a subset of participants (N=55) who tracked momentary pain and affect over the 8-weeks of the intervention, the mindfulness group reported significantly greater improvements in momentary pain and affect compared with the support group.2 Improvements in positive affect, but not pain, were associated with reduced risk of misusing opioids at post-treatment.
That improvements in positive affect, but not pain, were associated with reduced risk of misusing opioids should be of interest to rehabilitation professionals. In our care of patients at risk of opioid misuse, this research suggests that promoting positive affect through engagement in pleasurable activities and taking delight in life’s momentary wonders and joys may be important to reduce risk of opioid misuse. That less stress arousal, opioid craving and likelihood of meeting criteria for opioid use disorder were not maintained at 3 month follow-up speaks to the challenges sustaining these improvements and the need for ongoing support to maintain treatment gains.
1Chou R, Turner JA, Devine AB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Int Med. 2015;162(4):276-86
2Garland EL, Bryan C, Finan P, et al. Pain, hedonic regulation, and opioid misuse: Modulation of momentary experience by Mindfulness-Oriented Recovery Enhancement in opioid-treated chronic pain patients. Drug Alcohol Depend. 2017 Apr 1;173 Suppl 1:S65-S72.
3Vowles KE, McEntee ML, Julnes PS, et al. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis.2015;156(4):569-76.
4Garland EL, Manusov EG, Froeliger B, et al. Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial.J Consult Clin Psychol. 2014;82(3):448-59.