Mindfulness Therapy Can Reduce Chronic Pain and Opioid Misuse

So this is a subject that is near and dear to my heart (as well as my joints, nerves, and muscles). As such, I figured I would add in my own (admittedly subjective) experience as well as provide a summary to this article (whose link you will find below per usual).

Due to the opioid epidemic in the United States, opioid usage has, understandably, come under scrutiny. By themselves, in a vacuum, opioid analgesics are not inherently bad. However, their effectiveness in relieving pain has to be leveraged against their effect on the reward-centers of the brain.

As for myself, my own personal journey with them (along with mindfulness therapy) is as follows. In my early 20s, I noticed my body started to develop chronic pain–particularly in my back. This turned out to be a function of my spastic diplegia cerebral palsy. Soon enough, I found myself a patient of a physician who specialized in pain management. Over the next few years, I began to use opioids (hydrocodone) as a maintenance medication, twice a day.

As a preventative measure for myself (due to the understandable stigma/scrutiny as well as to track my progress), I began to tabulate in a written daily journal my daily usage of the medication. This proved to be especially enlightening, as with weight-loss, I was able to decrease my body’s pain by a fairly hefty margin. These days, the medication has gone from being of the daily maintenance variety to as-needed. I’ve enjoyed breaks of days, up to a week without it–especially in the warmer weather.

But yeah, I would also be remiss if I neglected to mention (and per this article) the effect that mindfulness-based meditation has had on me with regard to pain management. While I will always think (and feel) that dropping excess weight was the biggest factor for me in my improvement, I can honestly say that mindfulness has allowed me to view my body’s pain through an entirely different lens.

Previously, I think like a lot of people, I tended to view pain solely as the annoying (to say the least) negative stimulus that it is on the body. I certainly do not, and never will enjoy it, but being mindful of my pain (physical and emotional) has allowed me to at least somewhat change how I want to perceive it. Truly, I wish there were better words for me to articulate this, as I know what I am describing is an abstract, subjective experience. But if I had to sum it up, I do believe that mindfulness (even just in general) allows us to affect the intensity of our thinking and our perceptions.

Anyways, this article states that 25% of individuals receiving opioid therapy for longer than 90 days misuse opioids. This misuse is defined as not taking the drug as prescribed, such as taking opioids to facilitate feeling euphoric or to alleviate negative emotions. Again, I thankfully never have had to deal with this myself, but I have to interject and vouch for mindfulness here from personal experience. Because as has been posted in other articles, we as humans really tend to not want to have to feel or experience negative emotions. But, because they are endemic to the human condition and experience, they are pretty much unavoidable. And again, mindfulness is so key to cultivating that mindset of acceptance. For pain, for negative emotions, and for the many things that are inherently out of our control in this life.

To this end, a study in the magazine JAMA Internal Medicine demonstrated that an 8-week mindfulness-based therapy—Mindfulness-Oriented Recovery Enhancement (MORE)—decreased opioid use and misuse while reducing chronic pain symptoms. Moreover, these effects lasted up to nine months post-intervention. This is the first large-scale clinical trial to demonstrate that psychological intervention can simultaneously reduce opioid misuse and chronic pain among people who were prescribed opioid pain medications.

This study consisted of 250 adults who were receiving long-term opioid therapy for their chronic pain. Half of these adults had issues with their usage and most of the adults in the study met the clinical criteria for depression. Depression, unsurprisingly, is a fairly common comorbidity with chronic pain. I’ve been through it myself in the past, personally, and can attest to the fact that one’s mental state definitely affects their perception of pain.

The MORE method starts with mindfulness which is done through meditation. This allowed the adults in the study to strengthen self-regulation of obsessive/compulsive opioid use, and to mitigate pain and opioid craving by reinterpreting these experiences as benign/neutral sensory information. Again, speaking from personal experience, being able to reframe, reevaluate, or simply just observe the physical state of our body in a neutral fashion is so helpful for both our physical and mental health.

Next in the MORE method comes the reappraisal factor, which focuses on reframing stressful events to find a sense of meaning in the face of adversity, to recognize what can be learned from difficult events and how dealing with those experiences might make a person stronger. While on the surface, this may just come across as the cliched “whatever doesn’t kill me makes me stronger,” I can again personally attest to the benefits of being able to find purpose and learning through pain.

And finally, to complement reappraisal, is the act of savoring. Savoring allows us to train our attention to focus on the pleasurable events in our lives that can be both healthy and life-affirming.Thus, applying positive emotions, and even joy to everyday events.

After 9 months post-treatment, 45% of participants in the MORE group were no longer misusing opioids, and 36% had cut their opioid use in half or greater. Additionally, participants receiving MORE also reported significant improvements in chronic pain symptoms compared with those receiving supportive psychotherapy, as well as decreased opioid cravings, and reduced symptoms of depression to levels below the threshold for major depressive disorder.

So, in conclusion, the MORE method allowed those individuals to step-back from their chronic pain experiences into a more observational state. This led to decreased dependence on their pain medication as well as less depression. Two factors, that when combined, lead to less sensations of chronic pain overall.

Read the full article here.

And as a question for you all, regardless if you have had any experience with chronic pain itself, how have you been able to reframe or adjust your perspective(s) on the physically and emotionally painful events that have occurred to you in your lives?

#Mindfulness #Pain #Opioids