Can mindfulness treat opioid abuse and chronic pain?

“Mindfulness is a mental training approach of focusing attention on the present moment, becoming aware of thoughts, emotions, bodily sensations, perceptions, without clinging to the experience, but simply by looking at her. Like an observer, or a witness.”

This is Professor Eric Garland, the director of the Center on Mindfulness and development of integrative health interventions at the University of Utah.

For some, “mindfulness” is just a buzzword, or a relaxation tool, that lacks any real medical substance. But using the gold standard in medical research; In the randomized clinical trial, Garland and colleagues showed that Mindfulness-Oriented Recovery Enhancement (MORE) is effective in treating patients with chronic pain and opioid abuse.

“Mindfulness-Based Recovery Enhancement is an 8-week therapy. We delivered it in the form of group therapy. Each session begins with a formal mindful breathing practice. In fact, we teach people how to use mindfulness to zoom in on pain and break it down. Getting people to cultivate this kind of awareness of the pain itself, it sounds counterintuitive, but it actually reduced the intensity of the pain,” Garland said.

Garland said unbeknownst to many patients, they are turning to opioids for reasons other than pain. He said mindfulness allows them to realize when they need opioids to manage their physical pain and when they misuse them to self-medicate for stress, depression, emotional pain or anger.

“When they were going to take their opioid, instead of just taking the pill without thinking about it, we were asking them to sit down with the pill bottle, practice mindfulness and be aware of all the thoughts that came to them. ‘spirit. And a lot of people found that by doing this practice, they actually didn’t need to take as many opioids,” Garland said.

According to Garland, the chronic use of addictive drugs, such as opioids, alters brain wiring in ways that reduce the pleasure of everyday experiences; like sunsets, birdsong, the warmth of a loved one’s hand, become less pleasant. Simultaneously, the brain becomes hypersensitive to drug-related cues such as the presence of an opioid pill bottle. This imbalance in the brain’s reward system is one of the main drivers of the addiction cycle. To combat this, Garland says patients have been taught what is called “savoring.”

“We bring a bouquet of roses. The patients took out a rose and we asked them to pay close attention to the rose and appreciate the pleasant colors, textures and scent of the flower, and the feel of the petals against their skin,” Garland said. .

In 2019, Garland and colleagues showed that MORE reduces the brain’s sensitivity to drug-related signals and increases one’s sensitivity to natural healthy pleasures.

However, it wasn’t until February 2022 that the results of the last large-scale randomized trial were published in the Journal of American Medical Associations Internal Medicine. In this trial MORE has been shown to be clinically effective in the treatment of opioid abuse.

“MORE reduced opioid abuse by 45%, so it was more than twice as powerful as standard supportive psychotherapy. Thirty-six percent of patients were able to reduce their opioid dose by half or more. And at the same time, MORE significantly reduced physical pain.Nearly 70% of patients met criteria for major depressive disorder at the start of the study.On average, MORE patients reported levels of depression symptoms below the threshold for major depression,” Garland said.

Dr. Zev Schuman-Olivier is an assistant professor of psychiatry at Harvard Medical School. He is also Director of Addictions Research and Director of the Cambridge Health Alliance Center for Mindfulness and Compassion.

“What stood out to me was the reduction in opioid abuse, as well as the reduction in the percentage of people who continue to abuse opioids despite opioid treatment for chronic pain. For many people, especially middle-aged and older adults, the path to opioid use disorder begins with chronic pain. So to be able to have an intervention that can specifically target people who are in pain and who have chronic pain, and to prevent that transition to opioids, that’s particularly important,” Schuman-Olivier said.

Dr Schuman-Olivier is currently leading a national clinical trial using a mindfulness-based approach in patients taking the drug for an opioid use disorder called buprenorphine, often known as suboxone.

“And one of the things that we really built into this intervention. Was it a conscious tasting, based on Eric’s pioneering work,” Schuman-Olivier said.

Utah resident Jon Spencer has suffered from back pain for over a decade. In 2018, he underwent major back surgery which resulted in manageable pain only through the daily use of hydrocodone. He didn’t like how the opioids affected his memory and made him feel, but he couldn’t handle the pain without them. So when he heard about Garland’s mindfulness clinical trial, he signed up.

“Basically, there are two parts to pain. This is where the pain originates. It’s not pain at the time, it’s just a stimulus. And it happens to the brain and the brain interprets it as “it hurts”. But there’s not much you can do about the pain. So the only other way to handle this is in the brain. It’s mindfulness, that’s what they call it. What it is is that it gives you techniques to control what is going on in your brain. And that sounds weird. And it feels a bit new age to me, but it worked,” Spencer said.

Although he still feels pain, Spencer said his mindfulness training helped him find another way to control it.

“From the last two weeks of the study to date, I haven’t taken a single opioid. My goal is to never take an opioid pill again for the rest of my life. That’s my goal and I know that I can do it. I know I can do it,” Spencer said.

According to Dr. Schuman-Olivier, it took researchers a decade and a half to lay the groundwork for mindfulness-based therapies to be scientifically tested as psychological interventions, as Garland’s study did. And to Garland’s knowledge, this is the largest clinical trial to date to show that psychological intervention can reduce opioid abuse and chronic pain.

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