Research Program: Peer Reviewed Medical Research Program

Award Information: FY15 Clinical Trial Award, W81XWH-16-1-0522

Award Outcome: Garland EL, Bryan CJ, Hanley AW, Parisi A, Froeliger B, Marchand WR, Donaldson, GW. Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial. American Journal of Psychiatry 181, no. 2, 2024.

What is this study? This is a clinical trial testing Mindfulness-Oriented Recovery Enhancement, MORE, in Veterans and active-duty military personnel living with chronic pain and receiving long-term opioid therapy.

Participants included in the study experienced diverse types of chronic pain, including back pain, osteoarthritis pain, cervical pain, neuropathic pain, fibromyalgia, migraine or tension headache and extremity pain.

What is MORE? MORE is a mental training intervention that aims to strengthen thoughts that control reward responses. This training uses cognitive behavioral therapy and positive reinforcement principles to retrain the brain to devalue drugs. Retraining with MORE includes learned mindful breathing techniques, how to reframe stressful situations, and how to savor positive events and sensations.

How is the study conducted? Participants randomized into two groups received the MORE program or the traditional standard of care of supportive psychotherapy, a type of therapy focused on providing emotional support, encouragement and validation when psychological challenges are present.

What are the results? Compared to supportive therapy, MORE proved to be a more successful intervention for participants with chronic pain. Participants demonstrated significant reductions in pain interference, severity of pain, aberrant drug use behavior and daily opioid use.

Over the course of the eight-month follow-up, both treatment groups showed decreased drug use, emotional distress and post-traumatic stress disorder. However, MORE participants showed better attitudes and an improved ability to experience joy.

MORE provided the largest opioid dose reductions among patients with lower back pain and arthritis.

Why is this research important? Researchers identified an association between long-term opioid use and dysregulation of the reward center in the brain, which may result in opioid misuse. Among Veterans prescribed long-term opioid therapies, 25% to 29% demonstrate abnormal drug use behaviors associated with drug misuse.

By focusing on the cycle of behavior escalation that can become dysregulated after long-term opioid use or stressful conditions, MORE improved chronic pain symptoms and sustained improved opioid misuse among past and present military personnel. This study suggests MORE for safe opioid tapering.

Who is the principal investigator leading this research?

Eric Garland, Ph.D., LCSW is a clinical researcher and psychotherapist at the University of Utah. The results reported here are outcomes of an FY15 Peer Reviewed Medical Research Program Clinical Trial Award, expanding Garland’s previous work, funded by other sources, evaluating MORE in civilians. Garland is the principal investigator of a subsequent FY20 Clinical Trial Award funded by the PRMRP to evaluate MORE in Veterans and Service Members following post-surgical intervention for osteoarthritis. In this follow-on study, he incorporates a wearable, biometric device to evaluate the patient’s response to mindfulness practices. He aims to determine if the specific application of MORE to musculoskeletal disorders improves surgical outcomes while also decreasing pain and dependence on opioid treatment.

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