Objective:

This randomized clinical trial evaluated the efficacy of Mindfulness-Oriented Recovery Enhancement (MORE) among past and present U.S. military personnel with prescriptions for long-term opioid therapy for chronic pain.

Methods:

In this clinical trial, 230 past and present military personnel with prescriptions for long-term opioid therapy were randomized in a 1:1 ratio to MORE or supportive psychotherapy (initially delivered in person and then via videoconferencing after the onset of the COVID-19 pandemic). Primary outcomes were chronic pain, measured by the Brief Pain Inventory, and aberrant drug-related behaviors, measured by the Current Opioid Misuse Measure, through 8 months of follow-up. Opioid dose was a key secondary outcome. Other outcomes included psychiatric symptoms, catastrophizing, positive affect, ecological momentary assessments of opioid craving, and opioid attentional bias.

Results:

MORE was superior to supportive psychotherapy through the 8-month follow-up in reducing pain-related functional interference, pain severity, and opioid dose. MORE reduced daily opioid dose by 20.7%, compared with a dose reduction of 3.9% with supportive psychotherapy. Although there was no overall between-group difference in opioid misuse, the in-person MORE intervention outperformed supportive psychotherapy for reducing opioid misuse. MORE reduced anhedonia, pain catastrophizing, craving, and opioid attentional bias and increased positive affect to a greater extent than supportive psychotherapy. MORE also modulated therapeutic processes, including mindful reinterpretation of pain sensations, nonreactivity, savoring, positive attention, and reappraisal.

Conclusions:

Among past and present U.S. military personnel, MORE led to sustained decreases in chronic pain, opioid use, craving, and opioid cue reactivity. MORE facilitated opioid dose reduction while preserving adequate pain control and preventing mood disturbances, suggesting its utility for safe opioid tapering.

中文翻译：

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退伍军人和军事人员长期阿片类药物治疗慢性疼痛的正念康复增强：一项随机临床试验

客观的：

这项随机临床试验评估了过去和现在使用长期阿片类药物治疗慢性疼痛处方的美国军人中正念导向恢复增强 (MORE) 的疗效。

方法：

在这项临床试验中，230 名持有长期阿片类药物治疗处方的过去和现在的军人按 1:1 的比例随机接受 MORE 或支持性心理治疗（最初亲自进行，然后在 COVID-19 大流行爆发后通过视频会议进行） ）。主要结果是在 8 个月的随访期间，通过简短疼痛量表测量的慢性疼痛，以及通过当前阿片类药物滥用测量测量的异常药物相关行为。阿片类药物剂量是一个关键的次要结果。其他结果包括精神症状、灾难化、积极情绪、阿片类药物渴望的生态瞬时评估和阿片类药物注意力偏差。

结果：

通过 8 个月的随访，MORE 在减少疼痛相关功能干扰、疼痛严重程度和阿片类药物剂量方面优于支持性心理治疗。MORE 将每日阿片类药物剂量减少了 20.7%，而支持性心理治疗的剂量减少了 3.9%。尽管阿片类药物滥用方面没有总体组间差异，但在减少阿片类药物滥用方面，面对面的 MORE 干预优于支持性心理治疗。与支持性心理治疗相比，更能减少快感缺乏、疼痛灾难化、渴望和阿片类药物注意力偏差，并在更大程度上增加积极情绪。MORE 还调节治疗过程，包括用心重新解释疼痛感觉、不反应、品味、积极关注和重新评估。

结论：

在过去和现在的美国军事人员中，“更多”导致慢性疼痛、阿片类药物使用、渴望和阿片类药物提示反应持续减少。MORE 有助于减少阿片类药物剂量，同时保持足够的疼痛控制和防止情绪障碍，这表明它对于安全阿片类药物逐渐减少具有实用性。