About 10% of patients who are prescribed opioids for their chronic pain go on to develop opioid use disorders, which are characterized by urges to use, difficulty in tapering off use, and impairment in daily activities. Given that mindfulness-based interventions have been used for the treatment of chronic pain and substance abuse disorders, they may also offer potential benefits to people who are diagnosed with both disorders concurrently. 

Ellerbroek et al. [Brain and Behavior] conducted a pilot study aimed at assessing the feasibility of using Mindfulness-Based Cognitive Therapy (MBCT) among patients with co-occurring chronic pain and opioid use disorder.

The researchers recruited 23 Dutch patients (60% female; average age = 48 years) who had dual diagnoses of chronic pain and opioid use disorder and were hospitalized for the initiation of opioid-agonist buprenorphine/naloxone treatment. All participants were given the opportunity to participate in outpatient MBCT three months after their hospitalization. MBCT was delivered in the standard curriculum format of 8-week 2.5 hour group sessions and a 6-hour retreat.

The MBCT groups were not restricted to study patients alone, but also included patients with other psychiatric diagnoses. Study patients were interviewed prior to the start of MBCT to assess factors that might facilitate or hinder their participation. Patients who initially agreed to participate in MBCT but later declined were interviewed on two occasions. Patients who participated in MBCT were also interviewed post-intervention to assess their perception of whether and how they had changed. Interviews were audiotaped, transcribed, coded, and thematically analyzed.

Nine patients initially declined to participate in MBCT. Their reasons included previous MBI experience, being in too much pain, fear that participation could exacerbate pain and negative mood, challenges related to travel and scheduling conflicts with sessions, and a general lack of interest in psychosocial interventions. Twelve patients initially expressed interest in participating, but during the three months leading up to the start of the intervention, eight of them changed their minds. Many of those thought MBCT was occurring too late in their treatment process or were anticipating practical difficulties that would hinder their attendance.

Four patients participated in MBCT: one attended all 8 sessions, two attended 7 sessions, one attended 6 sessions, and all attended the 6-hour retreat. Participants reported being more in touch with their emotions and better able to focus their attention, diminished self-blame, anxiety, and anger, and a greater ability to experience happiness and calm. While their pain levels did not generally decrease, they reported coping better with pain by employing strategies of acceptance, letting go, and seeking distraction.

The researchers concluded that although patients derived benefits from participating in the intervention, MBCT was not feasible for most individuals with co-occurring chronic pain and opioid use disorder. Offering MBCT earlier in the treatment cycle, providing a trial session prior to requiring a commitment, or offering MBCT in an individualized online format were noted as potential strategies to address barriers to feasibility.

The study is limited by its small number of participants and lack of objective outcome measures.

Reference:

Ellerbroek, H., Hanssen, I., Lathouwers, K., Cillessen, L., Dekkers, S., Veldman, S. E., van den Heuvel, S. A. S., Speckens, A. E. M., & Schellekens, A. F. A. (2023). Mindfulness-based cognitive therapy for chronic noncancer pain and prescription opioid use disorder: A qualitative pilot study of its feasibility and the perceived process of change. Brain and Behavior.

Link to study