Mindfulness-Oriented Recovery Enhancement vs Supportive Group Therapy for Co-occurring Opioid Misuse and Chronic Pain in Primary Care: A Randomized Clinical Trial.
Mindfulness-Oriented Recovery Enhancement vs Supportive Group Therapy for Co-occurring Opioid Misuse and Chronic Pain in Primary Care: A Randomized Clinical Trial.
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初级保健中同时发生的阿片类药物滥用和慢性疼痛的正念导向康复增强与支持性团体治疗：一项随机临床试验。
DOI：
10.1001/jamainternmed.2022.0033
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发表时间：
2022-04-01
影响因子：
39
通讯作者：
Donaldson GW
中科院分区：
文献类型：
--
作者：
Garland EL;Hanley AW;Nakamura Y;Barrett JW;Baker AK;Reese SE;Riquino MR;Froeliger B;Donaldson GW
基于正念的干预是否比支持性心理治疗更能减少初级保健环境中的慢性疼痛和阿片类药物滥用？在这项随机临床试验中，包括250名患有慢性疼痛和阿片类药物滥用的成年人，45.0%接受正念导向恢复增强（MORE）的参与者在9个月的随访后不再滥用阿片类药物，而接受支持性团体心理治疗的参与者为24.4%。与接受支持性心理治疗的患者相比，接受MORE的患者也报告了慢性疼痛症状的显着改善。在这项研究中，MORE似乎是治疗慢性疼痛成人阿片类药物滥用的有效方法。在慢性疼痛患者中成功治疗阿片类药物滥用已被证明是难以捉摸的。指南建议使用非阿片类药物治疗，但基于正念的阿片类药物滥用干预措施的有效性尚不确定。评估正念导向恢复增强（MORE）减少阿片类药物滥用和慢性疼痛的疗效。这项访谈者设盲随机临床试验招募了2016年1月4日至2020年1月16日期间来自犹他州初级保健诊所的患者。该研究纳入了250名患有慢性疼痛、接受长期阿片类药物治疗并滥用阿片类药物的成年人。使用MORE（包括正念，重新评估和品味积极体验的培训）或支持性团体心理治疗（控制条件），每周8次，每次2小时。主要结局为（1）通过药物滥用指数（自我报告、访谈和尿液筛查）评估的阿片类药物滥用，以及（2）通过9个月随访期间简明疼痛量表的子量表评分评估的疼痛严重程度和疼痛相关功能干扰。次要结果是阿片类药物剂量，情绪困扰和阿片类药物渴求的生态瞬时评估。最小干预剂量被定义为4个或更多完成的MORE或支持性团体心理治疗。在250名参与者中（159名女性[63.6%];平均[SD]年龄，51.8 [11.9]岁），129名被随机分配到MORE组，121名被随机分配到支持性心理治疗组。总体而言，17名受试者（6.8%）为西班牙裔或拉丁裔，218名（87.2%）为白色，15名（6.0%）为其他人种和/或种族（2名美洲印第安人，3名亚洲人，1名黑人，2名太平洋岛民，7名未指明）。基线时，疼痛的平均持续时间为14.7年（范围：1 - 60年），平均（SD）吗啡等效阿片类药物剂量为101.0（266.3）mg（IQR，16.0 - 90.0 mg）。共有203名受试者（81.2%）接受了最小干预剂量（平均值[SD]，5.7 [2.2]次）;在9个月时，250名受试者中有92名（36.8%）终止了研究。与支持性心理治疗组相比，MORE组9个月随访期间阿片类药物滥用减少的总体比值比为2.06（95%CI，1.17 - 3.61; P =.01）。9个月时，MORE组80名参与者中有36名（45.0%）不再滥用阿片类药物，而支持性心理治疗组78名参与者中有19名（24.4%）不再滥用阿片类药物。混合模型表明，通过9个月的随访，MORE在疼痛严重程度（组间效应：0.49; 95%CI，0.17 - 0.81; P =.003）和疼痛相关功能干扰（组间效应：1.07; 95%CI，0.64 - 1.50; P <.001）方面优于支持性心理治疗。MORE组的参与者比支持性心理治疗组的参与者更大程度地减少了阿片类药物的剂量。MORE组的情绪困扰和阿片类药物渴望也较低。在这项随机临床试验中，在初级保健环境中的成年参与者中，与支持性团体心理治疗相比，MORE干预导致阿片类药物滥用和慢性疼痛症状的持续改善，以及阿片类药物剂量，情绪困扰和阿片类药物渴望的减少。尽管COVID-19大流行造成了损耗，样本也很脆弱，但MORE似乎能有效减少慢性疼痛成人中阿片类药物的滥用。ClinicalTrials.gov NCT02602535这项随机临床试验评估了正念导向恢复增强是否比支持性团体心理治疗更有效地减少接受长期阿片类药物治疗的慢性疼痛成人阿片类药物滥用。
Does a mindfulness-based intervention reduce comorbid chronic pain and opioid misuse in the primary care setting more than supportive psychotherapy? In this randomized clinical trial that included 250 adults with both chronic pain and opioid misuse, 45.0% of participants receiving Mindfulness-Oriented Recovery Enhancement (MORE) were no longer misusing opioids after 9 months of follow-up compared with 24.4% of participants receiving supportive group psychotherapy. Participants receiving MORE also reported significant improvements in chronic pain symptoms compared with those receiving supportive psychotherapy. In this study, MORE appeared to be an efficacious treatment for opioid misuse among adults with chronic pain. Successful treatment of opioid misuse among people with chronic pain has proven elusive. Guidelines recommend nonopioid therapies, but the efficacy of mindfulness-based interventions for opioid misuse is uncertain. To evaluate the efficacy of Mindfulness-Oriented Recovery Enhancement (MORE) for the reduction of opioid misuse and chronic pain. This interviewer-blinded randomized clinical trial enrolled patients from primary care clinics in Utah between January 4, 2016, and January 16, 2020. The study included 250 adults with chronic pain receiving long-term opioid therapy who were misusing opioid medications. Treatment with MORE (comprising training in mindfulness, reappraisal, and savoring positive experiences) or supportive group psychotherapy (control condition) across 8 weekly 2-hour group sessions. Primary outcomes were (1) opioid misuse assessed by the Drug Misuse Index (self-report, interview, and urine screen) and (2) pain severity and pain-related functional interference, assessed by subscale scores on the Brief Pain Inventory through 9 months of follow-up. Secondary outcomes were opioid dose, emotional distress, and ecological momentary assessments of opioid craving. The minimum intervention dose was defined as 4 or more completed sessions of MORE or supportive group psychotherapy. Among 250 participants (159 women [63.6%]; mean [SD] age, 51.8 [11.9] years), 129 were randomized to the MORE group and 121 to the supportive psychotherapy group. Overall, 17 participants (6.8%) were Hispanic or Latino, 218 (87.2%) were White, and 15 (6.0%) were of other races and/or ethnicities (2 American Indian, 3 Asian, 1 Black, 2 Pacific Islander, and 7 did not specify). At baseline, the mean duration of pain was 14.7 years (range, 1-60 years), and the mean (SD) morphine-equivalent opioid dose was 101.0 (266.3) mg (IQR, 16.0-90.0 mg). A total of 203 participants (81.2%) received the minimum intervention dose (mean [SD], 5.7 [2.2] sessions); at 9 months, 92 of 250 participants (36.8%) discontinued the study. The overall odds ratio for reduction in opioid misuse through the 9-month follow-up period in the MORE group compared with the supportive psychotherapy group was 2.06 (95% CI, 1.17-3.61; P = .01). At 9 months, 36 of 80 participants (45.0%) in the MORE group were no longer misusing opioids compared with 19 of 78 participants (24.4%) in the supportive psychotherapy group. Mixed models demonstrated that MORE was superior to supportive psychotherapy through 9 months of follow-up for pain severity (between-group effect: 0.49; 95% CI, 0.17-0.81; P = .003) and pain-related functional interference (between-group effect: 1.07; 95% CI, 0.64-1.50; P < .001). Participants in the MORE group reduced their opioid dose to a greater extent than those in the supportive psychotherapy group. The MORE group also had lower emotional distress and opioid craving. In this randomized clinical trial, among adult participants in a primary care setting, the MORE intervention led to sustained improvements in opioid misuse and chronic pain symptoms and reductions in opioid dosing, emotional distress, and opioid craving compared with supportive group psychotherapy. Despite attrition caused by the COVID-19 pandemic and the vulnerability of the sample, MORE appeared to be efficacious for reducing opioid misuse among adults with chronic pain. ClinicalTrials.gov Identifier: NCT02602535 This randomized clinical trial assesses whether Mindfulness-Oriented Recovery Enhancement is more efficacious than supportive group psychotherapy for reducing opioid misuse among adults with chronic pain receiving long-term opioid therapy.
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影响因子：
6.9
作者：
Garland, Eric L.;Fix, Spencer T.;Hudak, Justin P.;Bernat, Edward M.;Nakamura, Yoshio;Hanley, Adam W.;Donaldson, Gary W.;Marchand, William R.;Froeliger, Brett
通讯作者：
Froeliger, Brett
DOI：
10.1016/j.jpain.2008.10.008
发表时间：
2009-02
期刊：
The journal of pain
影响因子：
--
作者：
Chou R;Fanciullo GJ;Fine PG;Adler JA;Ballantyne JC;Davies P;Donovan MI;Fishbain DA;Foley KM;Fudin J;Gilson AM;Kelter A;Mauskop A;O'Connor PG;Passik SD;Pasternak GW;Portenoy RK;Rich BA;Roberts RG;Todd KH;Miaskowski C;American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
通讯作者：
American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
影响因子：
13.8
作者：
Darnall BD;Roy A;Chen AL;Ziadni MS;Keane RT;You DS;Slater K;Poupore-King H;Mackey I;Kao MC;Cook KF;Lorig K;Zhang D;Hong J;Tian L;Mackey SC
通讯作者：
Mackey SC
影响因子：
7.4
作者：
Butler, Stephen F.;Budman, Simon H.;Jamison, Robert N.
通讯作者：
Jamison, Robert N.
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R