PMID- 38196335
OWN - NLM
STAT- MEDLINE
DCOM- 20240202
LR  - 20240329
IS  - 1535-7228 (Electronic)
IS  - 0002-953X (Print)
IS  - 0002-953X (Linking)
VI  - 181
IP  - 2
DP  - 2024 Feb 1
TI  - Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on 
      Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial.
PG  - 125-134
LID - 10.1176/appi.ajp.20230272 [doi]
AB  - OBJECTIVE: This randomized clinical trial evaluated the efficacy of 
      Mindfulness-Oriented Recovery Enhancement (MORE) among past and present U.S. 
      military personnel with prescriptions for long-term opioid therapy for chronic 
      pain. METHODS: In this clinical trial, 230 past and present military personnel 
      with prescriptions for long-term opioid therapy were randomized in a 1:1 ratio to 
      MORE or supportive psychotherapy (initially delivered in person and then via 
      videoconferencing after the onset of the COVID-19 pandemic). Primary outcomes 
      were chronic pain, measured by the Brief Pain Inventory, and aberrant 
      drug-related behaviors, measured by the Current Opioid Misuse Measure, through 8 
      months of follow-up. Opioid dose was a key secondary outcome. Other outcomes 
      included psychiatric symptoms, catastrophizing, positive affect, ecological 
      momentary assessments of opioid craving, and opioid attentional bias. RESULTS: 
      MORE was superior to supportive psychotherapy through the 8-month follow-up in 
      reducing pain-related functional interference, pain severity, and opioid dose. 
      MORE reduced daily opioid dose by 20.7%, compared with a dose reduction of 3.9% 
      with supportive psychotherapy. Although there was no overall between-group 
      difference in opioid misuse, the in-person MORE intervention outperformed 
      supportive psychotherapy for reducing opioid misuse. MORE reduced anhedonia, pain 
      catastrophizing, craving, and opioid attentional bias and increased positive 
      affect to a greater extent than supportive psychotherapy. MORE also modulated 
      therapeutic processes, including mindful reinterpretation of pain sensations, 
      nonreactivity, savoring, positive attention, and reappraisal. CONCLUSIONS: Among 
      past and present U.S. military personnel, MORE led to sustained decreases in 
      chronic pain, opioid use, craving, and opioid cue reactivity. MORE facilitated 
      opioid dose reduction while preserving adequate pain control and preventing mood 
      disturbances, suggesting its utility for safe opioid tapering.
FAU - Garland, Eric L
AU  - Garland EL
AD  - Center on Mindfulness and Integrative Health Intervention Development, University 
      of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care 
      Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care 
      System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of 
      Pain Medicine, Department of Anesthesiology, University of Utah School of 
      Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and 
      Behavioral Health, Ohio State University, Columbus (Bryan); Departments of 
      Psychiatry and Psychological Sciences, University of Missouri, Columbia 
      (Froeliger); Department of Psychiatry, University of Utah School of Medicine, 
      Salt Lake City (Marchand).
FAU - Nakamura, Yoshio
AU  - Nakamura Y
AD  - Center on Mindfulness and Integrative Health Intervention Development, University 
      of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care 
      Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care 
      System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of 
      Pain Medicine, Department of Anesthesiology, University of Utah School of 
      Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and 
      Behavioral Health, Ohio State University, Columbus (Bryan); Departments of 
      Psychiatry and Psychological Sciences, University of Missouri, Columbia 
      (Froeliger); Department of Psychiatry, University of Utah School of Medicine, 
      Salt Lake City (Marchand).
FAU - Bryan, Craig J
AU  - Bryan CJ
AD  - Center on Mindfulness and Integrative Health Intervention Development, University 
      of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care 
      Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care 
      System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of 
      Pain Medicine, Department of Anesthesiology, University of Utah School of 
      Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and 
      Behavioral Health, Ohio State University, Columbus (Bryan); Departments of 
      Psychiatry and Psychological Sciences, University of Missouri, Columbia 
      (Froeliger); Department of Psychiatry, University of Utah School of Medicine, 
      Salt Lake City (Marchand).
FAU - Hanley, Adam W
AU  - Hanley AW
AD  - Center on Mindfulness and Integrative Health Intervention Development, University 
      of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care 
      Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care 
      System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of 
      Pain Medicine, Department of Anesthesiology, University of Utah School of 
      Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and 
      Behavioral Health, Ohio State University, Columbus (Bryan); Departments of 
      Psychiatry and Psychological Sciences, University of Missouri, Columbia 
      (Froeliger); Department of Psychiatry, University of Utah School of Medicine, 
      Salt Lake City (Marchand).
FAU - Parisi, Anna
AU  - Parisi A
AD  - Center on Mindfulness and Integrative Health Intervention Development, University 
      of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care 
      Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care 
      System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of 
      Pain Medicine, Department of Anesthesiology, University of Utah School of 
      Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and 
      Behavioral Health, Ohio State University, Columbus (Bryan); Departments of 
      Psychiatry and Psychological Sciences, University of Missouri, Columbia 
      (Froeliger); Department of Psychiatry, University of Utah School of Medicine, 
      Salt Lake City (Marchand).
FAU - Froeliger, Brett
AU  - Froeliger B
AD  - Center on Mindfulness and Integrative Health Intervention Development, University 
      of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care 
      Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care 
      System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of 
      Pain Medicine, Department of Anesthesiology, University of Utah School of 
      Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and 
      Behavioral Health, Ohio State University, Columbus (Bryan); Departments of 
      Psychiatry and Psychological Sciences, University of Missouri, Columbia 
      (Froeliger); Department of Psychiatry, University of Utah School of Medicine, 
      Salt Lake City (Marchand).
FAU - Marchand, William R
AU  - Marchand WR
AD  - Center on Mindfulness and Integrative Health Intervention Development, University 
      of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care 
      Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care 
      System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of 
      Pain Medicine, Department of Anesthesiology, University of Utah School of 
      Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and 
      Behavioral Health, Ohio State University, Columbus (Bryan); Departments of 
      Psychiatry and Psychological Sciences, University of Missouri, Columbia 
      (Froeliger); Department of Psychiatry, University of Utah School of Medicine, 
      Salt Lake City (Marchand).
FAU - Donaldson, Gary W
AU  - Donaldson GW
AD  - Center on Mindfulness and Integrative Health Intervention Development, University 
      of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care 
      Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care 
      System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of 
      Pain Medicine, Department of Anesthesiology, University of Utah School of 
      Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and 
      Behavioral Health, Ohio State University, Columbus (Bryan); Departments of 
      Psychiatry and Psychological Sciences, University of Missouri, Columbia 
      (Froeliger); Department of Psychiatry, University of Utah School of Medicine, 
      Salt Lake City (Marchand).
LA  - eng
GR  - R01 AT011772/AT/NCCIH NIH HHS/United States
GR  - R01 DA056537/DA/NIDA NIH HHS/United States
GR  - R01 DA057631/DA/NIDA NIH HHS/United States
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20240110
PL  - United States
TA  - Am J Psychiatry
JT  - The American journal of psychiatry
JID - 0370512
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Humans
MH  - Analgesics, Opioid/therapeutic use
MH  - *Mindfulness
MH  - *Veterans
MH  - *Military Personnel
MH  - *Chronic Pain/drug therapy/psychology
MH  - Pandemics
MH  - *Opioid-Related Disorders/drug therapy
PMC - PMC10976433
MID - NIHMS1958751
OTO - NOTNLM
OT  - Mindfulness
OT  - Opioid Misuse
OT  - Opioid Tapering
OT  - Pain
OT  - Reward
OT  - Savoring
COIS- Dr. Garland is director of the Center on Mindfulness and Integrative Health 
      Intervention Development; he has received honoraria and payment for seminars, 
      lectures, and teaching engagements (related to training clinicians in 
      mindfulness) sponsored by institutions of higher education, government agencies, 
      academic teaching hospitals, and medical centers; he receives royalties from the 
      sale of books related to Mindfulness-Oriented Recovery Enhancement; and he is a 
      licensor to BehaVR. The other authors report no financial relationships with 
      commercial interests.
EDAT- 2024/01/10 06:41
MHDA- 2024/02/02 06:43
PMCR- 2024/08/01
CRDT- 2024/01/10 03:10
PHST- 2024/08/01 00:00 [pmc-release]
PHST- 2024/02/02 06:43 [medline]
PHST- 2024/01/10 06:41 [pubmed]
PHST- 2024/01/10 03:10 [entrez]
AID - 10.1176/appi.ajp.20230272 [doi]
PST - ppublish
SO  - Am J Psychiatry. 2024 Feb 1;181(2):125-134. doi: 10.1176/appi.ajp.20230272. Epub 
      2024 Jan 10.