Another huge study has demonstrated the positive effects of mindfulness-based therapy on the brain.
Utah researchers conducted a random clinical trial to compare mindfulness-based therapy and cognitive behavioral therapy (CBT), in order to reduce opioid use and pain for chronic pain patients.
This trial was published in JAMA Internal Medicine, February 2022. It is the latest in a series that uses mindfulness-based techniques for pain relief and opioid use reduction in chronic pain patients. Eric Garland, PhD is a doctoral candidate in clinical social work, an outstanding professor and director of the Center on Mindfulness and Integrative Health Intervention Development (Utah), which developed the Mindfulness-Oriented Rehabilitation Enhancement (MORE). This approach combines mindfulness training, positive psychology, positive psychology, and changes in the course of negative thought. It encourages people not to dwell on their weaknesses but to be more mindful.
The trial involved 250 people suffering from chronic pain who misused the opioids prescribed for them. Half of the participants met the criteria for opioid abuse disorder (OUD) when they were enrolled in this trial. Eight weeks of group mindfulness training using MORE was completed by approximately half the patients. The control group received CBT in a group setting and standard CBT.
Researchers encouraged patients to do what was best for them, and didn’t force anyone to stop taking opioids. MORE was a tool that helped patients to reduce the risk of misuse and pain relief.
The MORE group saw an average 45 percent drop in opioid misuse, which is twice that of the CBT. The MORE group saw more than 35% of participants cut their opioid usage by at least half. People in the MORE group reported less pain and opioid cravings. They also experienced less emotional distress even though they took fewer pain medications. The effects lasted at most until the nine-month follow up period by researchers. The effects of CBT appeared to have slowed in the MORE group for six to nine months, but they actually declined in the control group.
“It is difficult to make general statements about chronic pain because it’s so varied in everyone, but there seems a way of modulating one’s relationship to pain modulates their craving for a drug,” Fadel Zeidan, PhD, associate professor of anesthesiology, University of California, San Diego, director of the Pain, Health, and Mindfulness Lab, which was not part of the new research.
Dr. Garland and his coworkers also asked participants to keep track of their mindfulness practices during the first month after their eight-week treatment.
Garland says that data shows that people who practice mindfulness are more likely to experience the benefits of opioid use and chronic pain. Future research will examine the longevity of mindfulness-based treatments for chronic pain.
This new study was the longest and most extensive of all the trials that evaluated the mindfulness intervention for chronic pain patients who had misused opioids. These patients have two goals: To reduce opioid dependence and manage pain.
Garland says, “We need non-opioid adjunctive therapies that are safe to use and that can treat unrelieved pain.” “This study shows the effectiveness of an intervention that can help those who have been prescribed opioids to continue to receive the pain relief they need, while also reducing the opioid-related harm and risks.”
Dr. Zeidan says that the MORE approach is unique because it focuses on helping those who have taken opioids for a long time to enjoy pleasure again.
“Opioids have thrown their reward systems out of balance. He says that the physiology of the opioid-using patients has changed to the point where their drive for the drug has overtaken their reward systems. This multimodal approach by Garland shows that the missing component of savoring that chronic pain sufferers who use opiate can be remediated.
Opioids provide only temporary relief for pain
Garland points out that even though opioids were administered at relatively high doses, chronic pain was still a major issue for many of the participants in the trial.
Zeidan explains that “opiates don’t work for chronic pain.”
Opiates like morphine, however, can be used to relieve temporary pain, such as post-surgery. Chronic pain is, however, often lifelong. This makes mindfulness an especially effective modality to help people with chronic pain, according to Zeidan.
According to Zeidan, “The immediate effect mindfulness can have on pain is based on the research we’ve done so far.” “It is one of the few techniques that immediately reduces pain and we are just beginning to understand why.”
Zeidan says that research has shown that mindfulness’s effect on pain perception is more than a placebo effect. And unlike other pain-relieving methods, it seems to work outside of the body’s opioid system.
Prescription opioids and over-the-counter pain relief medications like ibuprofen work in the body’s opioid system. They block pain signals from reaching the brain where they are processed and perceived to be pain.
Mindfulness is a unique combination of neural and physiological processes. Zeidan says that we can’t relieve pain without the opioid system.
Chronic pain is not ‘in your head’
There has been much debate in recent years about whether chronic pain may have psychological roots.
Garland says, “I disagree with the idea that chronic pain can be primarily psychological.” While there are certain psychological factors that can influence pain, people also have medical conditions that can be very painful. We shouldn’t try to reduce their pain by making it psychological.
Mindfulness can be an effective way to reduce pain, even if it is from a physiological source such as a herniated disc or an arthritic joint.
“Pain is psychological, but that is not why it is so. Garland says that all pain is processed in our brains and that mindfulness can change how the brain processes signals of damage to the body.”
More evidence has been shown that mindfulness can help with the emotional side effects associated with living with chronic pain. Nearly 70% of patients who completed the trial met the criteria for major depression disorder (MDD) at the start. People treated with MORE had fewer symptoms of depression by the end of the trial. They were no longer considered to have MDD.
Zeidan says that this effect is as important as pain relief or reduced dependence on opioids.
Chronic pain sufferers will always feel the pain. “The pain is not the problem, it’s the result of depression, anxiety, sleeplessness and suffering that causes you to become your pain,” he said.
Zeidan believes that chronic pain management should be based on a multimodal approach and not pain medication.
Zeidan says, “I don’t see mindfulness-based therapies or physical therapy as alternatives therapies.” They are essential.”
