Mindfulness-Oriented Recovery Enhancement reduces post-traumatic stress via reappraisal among patients with chronic pain and co-occurring opioid misuse

Abstract

Chronic pain and post-traumatic stress disorder (PTSD) are co-occurring conditions that exacerbate the risk of opioid misuse. In this secondary analysis of a randomized clinical trial (NCT02602535), we examined the efficacy of Mindfulness-Oriented Recovery Enhancement (MORE) for reducing PTSD symptoms in patients with chronic pain who misused opioids (N = 241) and who were randomized to MORE or supportive group psychotherapy. Self-reported cognitive reappraisal and skin conductance during an emotion regulation task were tested as mediators of the effect of MORE on changes in PTSD symptoms, and changes in PTSD symptoms were tested as a mediator of the effect of MORE on opioid misuse. MORE led to larger improvements in PTSD symptoms than supportive group psychotherapy across 9 months of follow-up, with 59% of those meeting criteria for a PTSD diagnosis showing clinically significant reductions in PTSD symptoms following treatment with MORE. Changes in reappraisal mediated the effect of MORE on PTSD symptoms, which in turn mediated reduced opioid misuse following MORE. Enhancing reappraisal through MORE may be efficacious for reducing PTSD in opioid-treated chronic pain.