Mindfulness-Oriented Recovery Enhancement reduces opioid craving, pain, and negative affect among chronic pain patients on long-term opioid therapy: An analysis of within- and between-person state effects

Mindfulness-Oriented Recovery Enhancement (MORE) is an integrative treatment that simultaneously addresses chronic pain and opioid misuse. MORE has been found to produce sustained reductions in opioid craving, pain, and negative affect—key risk mechanisms precipitating opioid misuse for patients on long-term opioid therapy (LTOT). However, less is known about MORE's impact on state measures of acute symptoms. We examined the impact of MORE versus a supportive psychotherapy group (SG) among chronic pain patients on LTOT. Mixed models examined session and momentary effects of MORE (n = 50) versus SG (n = 45) on state measures of craving, pain, and negative affect. Decentering, curiosity, and time spent engaging in daily mindfulness practice were examined as session effect predictors. For session effects, statistically significant medium-to-large effects of treatment group were observed in favor of MORE for craving, pain, and negative affect. Higher levels of curiosity predicted improvements in craving, whereas greater decentering and mindfulness practice were associated with improvements in negative affect. For momentary effects, a significant group by time interaction was observed for craving and pain. Findings suggest that MORE provides immediate symptom relief on therapeutic targets in daily life among chronic pain patients receiving LTOT. •Individuals with chronic pain are at heightened risk for opioid misuse.•Mindfulness-Oriented Recovery Enhancement (MORE) is an integrative treatment.•MORE reduced state pain, craving, and negative affect throughout 8 weekly sessions.•Higher levels of curiosity predicted greater improvements in craving.•Decentering and mindfulness practice were associated with improved negative affect.