Chronic pain affects about one-third of Americans, and many of them take prescription opioid medications. Misusing these drugs, however, can cause an addiction or lead to an overdose.
Eric Garland, Ph.D., LCSW, an associate professor at the University of Utah, has come up with a new way to reduce pain and lower the incidence of painkiller abuse in patients with chronic pain. He’s hoping to roll out the program nationwide over the next year.
The therapy, dubbed Mindfulness-Oriented Recovery Enhancement (MORE) trains people to alter their response to pain, stress, and drug-related cues. Garland details the technique in a new study in the Journal of Consulting and Clinical Psychology.
In his study, 115 chronic pain suffers participated in eight weeks of a MORE support group or a conventional support group. About three-quarters of the participants misused opioid painkillers by taking higher doses than prescribed, or self-medicated with opioids to ease stress and other symptoms.
Garland found that MORE led to a 63 percent reduction in painkiller misuse, compared to a 32 percent reduction in patients who were part of the traditional support group. People who used MORE also had a 22 percent reduction in pain-related impairment, which lasted for three months after treatment ended.
“Anything that happens in the brain happens in the body—so by changing brain functioning, you alter the functioning of the body,” Garland said.
What Is MORE?
MORE uses mindfulness training to pinpoint the underlying processes involved in chronic pain and opioid abuse. It involves training the mind to boost awareness and control automatic habits, reframe events that may trigger drug abuse so they are used to promote growth, and savor positive events to enhance naturally rewarding experiences.
It's an 8-week mental training program delivered in a group format. The training involves coping exercises that participants practice at home for 15 minutes a day. They also learn how to practice three minutes of mindful breathing before each dose of painkillers they take.
“People who are in chronic pain need relief, and opioids are medically appropriate for many individuals,” Garland said. “However, a new option is needed because existing treatments may not adequately alleviate pain while avoiding the problems that stem from chronic opioid use.”
MORE is currently being tested in a pilot brain imaging trial at the Medical University of South Carolina to help smokers quit. And there are plans to test the intervention in people suffering from mental health problems and alcoholism. Further testing on active-duty soldiers with chronic pain and a larger trial among civilians are in the works.
“My plan is to conduct an even larger and better controlled trial of MORE for alcohol-related problems and mental health issues over the next two years,” said Garland, who is evaluating MORE as a treatment for opioid misuse among active duty soldiers—that study should be complete in 2016.
Garland plans to teach therapists his technique in the coming year and hopes it will then be launched in clinics and private practices across the country. As of now, only three therapists in the U.S. know how to administer MORE.
Driven to Change
Garland said that people who are less motivated to change their lives may benefit less from the program, but those ready to roll up their sleeves could find it effective.
“I believe you must be motivated to change in order to benefit from MORE. You must be willing to work hard to change and challenge your ways of thinking and reacting to stress and pain,” he said.
“MORE requires effort and practice—conscious effort and practice result in learning, and can stimulate the brain to grow new neural connections—to rewire itself,” he added.
In related news, researchers may have found a way to "dim the switch" on several pain sensitivity genes. Drugs or lifestyle changes may enable scientists to reset a patient's pain threshold or make someone feel pain less intensely, said Tim Spector, a professor of genetic epidemiology at King's College London.