The prolonged physical discomfort of neck, back, or leg pain could limit the ability to carry out day-to-day activities, as the slightest move could provoke pain throughout the body’s joints. The prevalence of chronic pain has led physicians to prescribe opioid painkillers that do relatively little to alleviate the pain and, in turn, have contributed to its misuse among patients. Now, according to a recent study, published in the journal of Consulting and Clinical Psychology, a new non-narcotic treatment — Mindfulness-Oriented Recovery Enhancement, or MORE — can reduce chronic pain and opioid misuse in patients through the use of mental interventions.
Chronic pain — commonly defined as pain lasting more than three to six months — has been viewed as America’s biggest and most silent health problem. The American Academy of Pain Medicine says 100 million adult Americans suffer from chronic back pain, and it is also the main reason why people go to doctors. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain, and psychogenic pain. While there are several treatments for this pain including medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, there’s a growing number of non-narcotic treatments that are supported by scientific data.
Eric Garland, clinical researcher and psychotherapist, has developed the mental training program MORE, that combines aspects of mindfulness training, cognitive-behavior therapy, and positive psychological principles into treatment strategy for stress, addiction, and pain. MORE was designed to simultaneously target mechanisms that trigger chronic pain and opioid misuse. Mental interventions can help address physical problems, emphasizing the concept of "mind over matter."
To test the treatment, Garland and his team of researchers sought to conduct a study using an early-stage randomized controlled trial of MORE. A total of 115 chronic pain patients, with an average age of 48, were randomized to eight weeks of MORE or a support group. The outcomes of the study were measured at pre- and post-treatment, and at a three-month follow-up.
The Brief Pain Inventory was used by the researchers to assess severity of pain, the impact of pain on daily function, location of pain, pain medications, and amount of pain relief in the past 24 hours or the past week. Changes in opioid use disorder status were measured by using the Current Opioid Misuse Measure. The desire for opioids, stress, non-reactivity, reinterpretation of pain sensations, and reappraisal were also evaluated by the researchers.
Prior to the study, approximately 75 percent of the group was found to misuse opioid painkillers before they started the program by taking higher doses that prescribed. Patients also self-medicated themselves to reduce stress and anxiety, or other emotions, according to ScienceDaily. The accessibility to opioids and the dependency on the pills to reduce pain may have contributed to its high misuse.
The MORE program aimed to help participants using the three mindful components: mindfulness training, reappraisal, and savoring. Mindfulness helps to train the mind to increase awareness, gain control over one’s attention and regulate automatic habits. Reappraisal reconstructs the meaning of stress in a way that the patient can see it as purposeful or growth-promoting. Lastly, savoring helps patients focus their attention on positive events that help increase the appreciation for the little things in life.
The findings revealed MORE led to a 63 percent reduction in opioid misuse, compared to a 32 percent reduction among patients in the conventional support group. Those in the new treatment group also reported a 22 percent reduction in chronic pain, which lasted three months after the end of MORE therapy. "Mental interventions can address physical problems, like pain, on both psychological and biological levels because the mind and body are interconnected," said Garland in the news release. "Anything that happens in the brain happens in the body — so by changing brain functioning, you alter the functioning of the body."
MORE provides an alternative treatment that can reduce pain and also avoid the problems associated with chronic opioid use. When a person experiences physical pain, the pain signal travels to the brain through a sensory pathway and an emotional pathway, according to Psychology Today. The emotional component of this experience then travels to the amygdale and the anterior cingulated cortex, located in the brain.
Mind-controlling the body through a psychological technique can help build resilience and teach patients the skill of chronic pain management. The American Psychological Association makes a few recommendations for people to manage their stress, as emotional and physical pain, along with chronic pain, can increase stress levels. Also, eating well, getting plenty of sleep, and exercise are positive ways to manage stress and pain.
Source: Froeliger B, Garland EL, Howard MO, Kelly A, Manusov EG, Williams JM. Mindfulness-Oriented Recovery Enhancement for Chronic Pain and Prescription Opioid Misuse: Results From an Early-Stage Randomized Controlled Trial. Journal of Consulting and Clinical Psychology. 2014.