Moderators of Treatment Response to Mindfulness-Oriented Recovery Enhancement In Chronic Pain Patients Receiving Long-Term Opioid Therapy

Background and Purpose: Mindfulness-Oriented Recovery Enhancement (MORE) is an evidence-based, integrative mind-body intervention designed to ameliorate addiction, chronic pain, and emotional distress. Multiple randomized controlled trials (RCTs) have demonstrated MORE's efficacy among individuals with chronic pain receiving long-term opioid therapy (LTOT). However, chronic pain populations vary widely in demographic, psychosocial, and pain-related characteristics that may influence how they respond to treatments for pain and addiction, including mind-body interventions like MORE. Identifying these baseline characteristics is integral to understanding MORE’s effects across diverse chronic pain populations, inform clinical decision making, and determine the need for intervention adaptations. This secondary data analysis examines pooled data from three RCTs of MORE to explore whether pretreatment demographic, clinical, and pain-related factors moderated treatment response, measured in terms of reduced opioid misuse, opioid dose, pain severity, and pain interference.

Methods: Data were drawn from three RCTs involving 595 chronic pain patients prescribed LTOT randomized to receive MORE (n = 302) or supportive group psychotherapy (SG; n = 293). Across studies, primary outcomes (opioid misuse, opioid dose, pain severity, and pain interference) were assessed at baseline, post-treatment, and 2-3 month follow-up. A mixed-effects repeated measures analysis of covariance approach was used to examine MORE’s effects on these outcomes at posttreatment and 2-3-month follow-up assessments, as well as whether these effects varied as a function of pretreatment demographic characteristics, comorbid psychiatric diagnoses, dispositional mindfulness, and primary pain type.

Results: Across studies, MORE led to significant improvements in opioid misuse (F₄₄₈ = 4.57, p = .033), opioid dosing (F₄₁₀ = 5.55, p = .019), pain severity (F₄₄₆ = 8.14, p = .005), and pain interference (F₄₄₇ = 21.18, p <.001). Pretreatment posttraumatic stress disorder (PTSD) status significantly moderated the effects of MORE on opioid misuse (F₄₁₀ = 4.26, p - .040), such that individuals meeting criteria for PTSD treated with MORE demonstrated greater reductions in opioid misuse across follow-up assessments than those participating in SG. Dispositional mindfulness at pretreatment was shown to moderate MORE’s effects on opioid dosing (F₄₁₀ = 5.25, p = .022), with individuals reporting higher levels of dispositional mindfulness at baseline exhibiting larger reductions in opioid dosing in MORE compared to SG. No other significant moderating effects were observed, suggesting that the effects of MORE on opioid misuse, opioid dose, pain severity, and pain interference were robust to the demographic characteristics, presence of comorbid psychiatric conditions other than PTSD, and primary type of pain across study samples.

Conclusions and Implications: Study findings point to the importance of considering how individual characteristics interact with treatment to influence outcomes of mind-body interventions. Our results suggest that chronic pain patients with comorbid PTSD, as well as those with higher levels of dispositional mindfulness, may be especially likely to benefit from MORE’s effects on opioid-related outcomes. Moreover, the consistent efficacy of MORE across study samples provides evidence of its broad-spectrum benefits, underscoring its utility as an evidence-based intervention that social workers can employ to simultaneously address chronic pain and opioid misuse across diverse clinical populations.