I participated in the invitation-only NIH meeting “Contributions of Social and Behavioral Research in Addressing the Opioid Crisis” on March 5-6, 2018 (for a link to the webcast of the entire meeting, click here). This meeting was part of the series of NIH meetings on Cutting Edge Science to End the Opioid Crisis. The goals of this meeting were to: 1) specify the key social and behavioral science findings that can be brought to bear immediately to address the opioid crisis and 2) identify critical short-term research priorities that have to the potential to improve the opioid crisis response. The meeting participants represented some of the most accomplished researchers involved in the social and behavioral research relevant to the opioid crisis as well as senior leaders of various federal agencies and national organizations. I was tremendously honored to be invited as a subject matter expert to present my research to inform real-world policy and practice initiatives to address the opioid crisis.
I spoke on a panel entitled “Incorporating Nonpharmacologic Approaches to the Treatment of Opioid Abuse and Chronic Pain Management” along with luminaries in the pain research field including Francis Keefe (Duke University), Dennis Turk (University of Washington), and Dan Cherkin (Kaiser Permanente). In my talk, I discussed my research on Mindfulness-Oriented Recovery Enhancement (MORE) as a treatment for chronic pain and opioid misuse, and emphasized hedonic dysregulation (e.g., anhedonia) as a pathogenic process in opioid misuse/addiction and a key mechanistic target for novel behavioral therapies.
We presented our work to federal administrators including Francis Collins (Director of the National Institutes of Health), Nora Volkow (Director of the National Institute on Drug Abuse), Eliseo Pérez Stable (Director of the National Institute on Minority Health and Health Disparities), William Riley (Director of the Office of Behavioral and Social Science Research), David Shurtleff (Acting Director of the National Center for Complementary and Integrative Health), David Atkins (Director of Health Services Research and Development Service, U.S. Department of Veteran Affairs), and Sherry Ling (Deputy Chief Medical Officer of the Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services).
Areas of focus at the meeting included discussion of 1) Sociocultural and Socioeconomic Underpinnings of the Opioid Crisis in the United States; 2) Behavioral and Social Factors Preventing Opioid Initiation and Mitigating the Transition from Acute to Chronic Opioid Use; 3) Incorporating Nonpharmacologic Approaches to the Treatment of Opioid Abuse and Chronic Pain Management; 4) Prevention, Treatment and Recovery: Challenges and Barriers to Implementation; and 5) Effective Models of Integrated Approaches.
To summarize the meeting, research leaders and healthcare policy makers were highly focused on implementation and dissemination of evidence-based interventions and practices to target opioid misuse in chronic pain patients and to prevent/treat opioid addiction among those who have transitioned to illicit opioid use. There was much emphasis on the role of negative affect (e.g., despair), suicidality, and trauma as precipitants and correlates of opioid addiction, and the role of social support and meaningful engagement as protective factors against opioid addiction. Non-pharmacologic approaches (specifically, mindfulness and cognitive-behavioral therapy) were directly highlighted as empirically supported means of treating chronic pain and preventing opioid addiction. Finally, there was much discussion of the need to advance integrative treatment models that combine medication assisted treatment (e.g., buprenorphine, methadone) with behavioral interventions (e.g., mindfulness, exercise/physical therapy) to stop the crisis.
I was particularly struck by the framing of the opioid crisis as a “disease of despair” driven by socioeconomic disparity and disenfranchisement. Early in the morning on March 5, Nobel Prize winning economist Angus Deaton presented his work showing that mortality by opioids, alcohol, and suicide is differentially elevated in U.S. counties struck by structural inequalities. If opioid misuse and addiction are diseases of despair, then therapies like Mindfulness-Oriented Recovery Enhancement that aim to enhance joy and meaning in life may be a key part of the much-needed multifaceted solution to the greatest public health crisis of our era.
NPR recently covered another news story about my research on Mindfulness-Oriented Recovery Enhancement (MORE) as a therapy for chronic pain patients who are taking long-term prescription opioids. This story details the experience of a participant in the MORE intervention, and describes how mindfulness can be used to cope with pain and strengthen self-control.
National Public Radio recently covered a story on Mindfulness-Oriented Recovery Enhancement (MORE) as an intervention for chronic pain and prescription opioid-related problems. The story details new discoveries about the biobehavioral mechanisms of this novel therapy, as well as how mindfulness can be used to improve well-being in individuals suffering from chronic pain.
The NPR story can be found here.
My colleagues and I just published a new paper in the Journal of General Internal Medicine demonstrating that mindfulness training and hypnotic suggestion significantly reduced acute pain experienced by hospital inpatients. After participating in a single, 15-minute session of one of these mind-body therapies, patients reported an immediate decrease in pain levels similar to what one might expect from an opioid painkiller.
This study is the first to compare the effects of mindfulness and hypnosis on acute pain in the hospital setting.
The yearlong study’s 244 participants were patients at the University of Utah Hospital in Salt Lake City who reported experiencing unmanageable pain as the result of illness, disease, or surgical procedures. Willing patients were randomly assigned to receive a brief, scripted session in one of three interventions: mindfulness, hypnotic suggestion or pain coping education. Hospital social workers who completed basic training in each scripted method provided the interventions to patients.
While all three types of intervention reduced patients’ anxiety and increased their feelings of relaxation, patients who participated in the hypnotic suggestion intervention experienced a 29% reduction in pain, and patients who participated in the mindfulness intervention experienced a 23% reduction in pain, compared to a 9% reduction experienced by those who participated in the pain coping intervention. Patients receiving the two mind-body therapies also reported a significant decrease in their perceived need for opioid medication.
About a third of the study participants receiving one of the two mind-body therapies achieved close to a 30% reduction in pain intensity. This clinically significant level of pain relief is roughly equivalent to the pain relief produced by five milligrams of oxycodone.
My previous research has indicated that an 8-week long course of Mindfulness-Oriented Recovery Enhancement can be an effective way to reduce chronic pain symptoms and decrease prescription opioid misuse. This new study added a new dimension to my work by revealing the promise of brief mind-body therapies for acute pain patients.
It was really exciting and quite amazing to see such dramatic results from a single mind-body session. Given our nation’s current opioid epidemic, the implications of this study are potentially huge. These brief mind-body therapies could be cost-effectively and feasibly integrated into standard medical care as useful adjuncts to pain management.
My interdisciplinary team at Center for Mindfulness and Integrative Health Intervention Development plan to continue to investigate mind-body therapies as non-opioid means of alleviating pain by conducting a national replication study in a sample of thousands of patients in multiple hospitals around the country.
Because of its public health relevance, so far the study has been covered by more than 40 television stations around the country. Here is a brief clip about the study.
Image of Mattieu Ricard provided by the Mind and Life Institute
Please join us for the University of Utah’s new Center on Mindfulness and Integrative Health Intervention Development’s (C-MIIND) first symposium, which focuses on “Translating Basic Biobehavioral Science into Integrative Health.”
The keynote will be delivered by Susan Bauer-Wu, PhD, RN, FAAN, President of the Mind & Life Institute, the world’s premier multidisciplinary organization for the scientific study of mindfulness and meditation, founded in 1991 by the Dalai Lama and neurobiologist Francisco Varela. Dr. Bauer-Wu will discuss how scientific research on ancient contemplative practices is positively impacting healthcare, education, and society.
Next, Brett Froeliger, PhD, Associate Professor of Neuroscience at the Medical University of South Carolina, will discuss the neural mechanisms of emotion dysregulation in addiction as a target for treatment development research.
Finally, C-MIIND Director Eric Garland, PhD, LCSW, Associate Dean for Research at the University of Utah College of Social Work, will discuss the latest discoveries from his psychophysiological research on mind-body interventions for addiction, stress, and chronic pain, with a specific focus on addressing the prescription opioid epidemic.
This event is free and lunch is included, however pre-registration is requested: http://bit.ly/cmiind2017symposium
Wednesday, July 26, 2017
11:30 am – 12:00 pm
Lunch & Networking
12:00 pm – 1:30 pm
Keynote & Presentations
Okazaki Community Meeting Room (155)
University of Utah College of Social Work
395 South 1500 East, Salt Lake City
The University of Utah has launched a new center dedicated to providing a transformative influence on healthcare by unifying research on mindfulness and other integrative behavioral health interventions.
Eric Garland, Associate Dean for Research at the U’s College of Social Work, will serve as Director of the new Center on Mindfulness and Integrative Health Intervention Development (C-MIIND). The Center, which will assume oversight of more than $17 million in federal research grants, will be housed in the College of Social Work.
“The center will advance a vision of a new model of healthcare, in which behavioral health experts work in tandem with medical providers to address the physical, psychological and social needs of people suffering from an array of health conditions,” said Garland, whose research focuses on using mindfulness to help individuals who experience chronic pain.
The center will bring together researchers and clinicians from across main campus and University of Utah Health, including faculty in social work, psychiatry, primary care, anesthesiology, neuroscience, oncology, psychology, and health, who are pioneering integrative interventions aimed at improving physical and mental well-being. C-MIIND will strive to attract top faculty and provide research opportunities for undergraduate, graduate and post-doctoral fellows interested in studying mindfulness and integrative behavioral health.
A focus of the center also will be to train post-graduates and health care providers in innovative therapies to be used in primary care clinics, hospitals, community mental health centers and addiction treatment facilities.
News coverage of the Center launch can be found here.
An NPR interview with Dr. Garland about the Center can be found here.
I
‘m pleased to announce that the first fMRI brain imaging study of Mindfulness-Oriented Recovery Enhancement (MORE) has been published in the open-access journal Evidence-Based Complementary and Alternative Medicine (Froeliger et al., 2017). My colleague Brett Froeliger and I conducted this proof-of-concept pilot study at his TRAIN Lab at the Medical University of South Carolina to examine the effects of MORE on reward processes in the brains of people addicted to cigarettes. A sample of 13 smokers participated in a study testing MORE versus a comparison group. All participants underwent two fMRI scans 8 weeks apart. Between the first and second fMRI scan, participants in the MORE group learned mindfulness and reappraisal skills to decrease addictive reactions to cigarettes and savoring skills to increase responsiveness to natural rewards (e.g., social connection, natural beauty, healthy behaviors). Participants in the comparison group completed research measures but did not receive any treatment. Relative to the comparison group, MORE was associated with significant decreases in smoking (66% decrease) and significant increases in positive emotions. Crucially, MORE participants evidenced significant decreases in neural activity while viewing cigarette images in reward-related brain regions including the ventral striatum and ventral prefrontal cortex. MORE participants also demonstrated significant increases in neural activity in these same reward-related brain regions while they savored positive, natural-reward related images. Importantly, increases in brain activity during savoring were significantly correlated with smoking reduction and increased positive affect. Though this study had a number of limitations, including the small sample size and lack of a randomized design, these pilot findings provide preliminary evidence that MORE may facilitate the restructuring of reward processes and play a role in treating the pathophysiology of nicotine addiction. These findings converge with results from our other psychophysiological studies indicating that MORE may restructure reward processes in prescription opioid misuse (Garland, Froeliger, & Howard, 2014; Garland, Froeliger, & Howard, 2015; Garland, Howard, Zubieta, & Froeliger, 2017). Taken together, these data provide initial support for my restructuring reward hypothesis which asserts that mindfulness training may enhance a domain-general cognitive resource for restructuring reward learning from valuation of drug-related rewards to valuation of natural rewards and thereby reverse the downward spiral of addiction.
