A new study in the journal Mindfulness has found evidence that a combination of treatments can help people with chronic pain who are on long-term opioid therapy. This treatment involves a method called Mindfulness-Oriented Recovery Enhancement (MORE) delivered through online Zoom sessions and a smartwatch-based intervention. The findings highlight the feasibility of integrating therapeutic interventions with wearable technology to enhance real-time mindfulness practices.
MORE is an evidence-based intervention designed to address issues related to chronic pain, opioid misuse, and addiction. It combines mindfulness practices with cognitive behavioral therapy (CBT) techniques. MORE aims to enhance individuals’ ability to regulate their emotions, reduce cravings for substances like opioids, and increase positive emotions.
The new study was conducted to assess the efficacy of MORE coupled with a technology-driven approach in mitigating the challenges faced by individuals with chronic pain reliant on opioid therapy. Opioid therapy for chronic pain often entails complications such as heightened cravings and potential misuse. The investigation aimed to ascertain whether the integration of the MORE therapeutic approach with technological intervention could yield benefits in pain and craving management for this demographic.
“We were interested in using wearable sensors to detect stress and remind the patient to practice their mindfulness skills in the exact moment when they needed them – when they were most vulnerable to engaging in opioid misuse,” explained study author Eric Garland, Distinguished Endowed Chair in Research, Distinguished Professor, and Associate Dean for Research in the University of Utah College of Social Work. “There are many mindfulness apps out there but none that provide a personalized mindfulness treatment approach that adapts to the physiological state of the user.”
The researchers recruited participants from various sources, including electronic health records, physician referrals, community advertisements, and online advertisements in the Intermountain West region. Eligible participants were aged 18 or older, prescribed opioids daily for at least 3 months, and diagnosed with chronic pain by a physician. Exclusion criteria included active suicidality or psychosis, clinically unstable systematic illness, and prior exposure to mindfulness interventions.
The study included a total of 66 participants. The majority were white (92.1%), and the mean age was 53.6 years. The most common pain conditions were low back pain (66.6%) and joint pain (36.5%). Participants had been in pain for an average of 18.4 years and were taking opioids with a mean morphine equivalent daily dose of 130.3 mg.
The participants were randomly assigned to two distinct groups: one receiving the MORE intervention via online video sessions, and the other engaging in supportive group therapy in a virtual setting. Both groups were equipped with smartwatches capable of gauging physiological stress indicators.
During the course of the study, participants were subjected to periodic inquiries about their opioid cravings, pain levels, positive affect, and stress using smartphone-based surveys. Concurrently, the smartwatch system issued reminders for mindfulness practices when detecting elevated stress levels. The comprehensive data collected throughout the study were analyzed to gauge the potential impact of the MORE therapy and smartwatch intervention on pain and craving management.
Compared to the group that had supportive group therapy, the group that received the MORE treatment reported greater reductions in both craving and pain symptoms over time. The smartwatch system, which reminded people to do mindfulness exercises based on their stress levels, was linked to improvements in stress, positive feelings, cravings, and pain. The smartwatch-initiated mindfulness exercises even seemed to enhance the body’s ability to manage stress (as measured via heart rate variability).
“Combining a therapist-led Mindfulness-Oriented Recovery Enhancement intervention with an app and cheap, commercially available wearable sensor that reminds people to practice mindfulness when they are experiencing stress led to significant reductions in pain and opioid craving. This study is way forward to developing a personalized mindfulness treatment approach,” Garland told PsyPost.
But the study possesses certain limitations that warrant consideration. While the study was conducted as a randomized controlled trial, its design does not allow for isolating the individual impacts of the telehealth MORE treatment and the smartwatch-based intervention.
Despite the limitations, the study provides valuable insights into the potential efficacy of a novel intervention approach for individuals grappling with chronic pain and long-term opioid therapy. The findings underscore the feasibility of delivering mindfulness-based interventions through telehealth platforms and utilizing smartwatch apps to prompt mindfulness practices in real-time.
The study, “Zoom‑Based Mindfulness‑Oriented Recovery Enhancement Plus Just‑in‑Time Mindfulness Practice Triggered by Wearable Sensors for Opioid Craving and Chronic Pain“, was authored by Eric L. Garland, Bhanu T. Gullapalli, Kort C. Prince, Adam W. Hanley, Mathias Sanyer, Mark Tuomenoksa, and Tauhidur Rahman.
