Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial.
Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial.
复制标题
退伍军人和军人长期阿片类药物治疗慢性疼痛的正念康复增强：一项随机临床试验。
DOI：
10.1176/appi.ajp.20230272
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Donaldson,GaryW
中科院分区：
文献类型：
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作者：
Garland,EricL;Nakamura,Yoshio;Bryan,CraigJ;Hanley,AdamW;Parisi,Anna;Froeliger,Brett;Marchand,WilliamR;Donaldson,GaryW
这项随机临床试验评估了正念导向恢复增强（MORE）在过去和现在的美国军事人员中的疗效，这些人员具有长期阿片类药物治疗慢性疼痛的处方。1比MORE或支持性心理治疗（最初亲自提供，然后在COVID-19大流行爆发后通过视频会议提供）。主要结局是8个月随访期间的慢性疼痛（通过简明疼痛量表测量）和异常药物相关行为（通过当前阿片类药物滥用量表测量）。阿片类药物剂量是关键的次要结局。其他结果包括精神症状，灾难性的，积极的影响，阿片类药物的渴望，和阿片类药物attention bias.ResultsMORE的生态瞬间评估是上级支持性心理治疗，通过8个月的随访，减少疼痛相关的功能干扰，疼痛的严重程度，阿片类药物剂量。MORE将每日阿片类药物剂量减少了20.7%，而支持性心理治疗的剂量减少了3.9%。虽然阿片类药物滥用没有总体组间差异，但面对面的MORE干预在减少阿片类药物滥用方面优于支持性心理治疗。与支持性心理治疗相比，MORE在更大程度上减少了快感缺失、疼痛灾难化、渴望和阿片类药物注意力偏差，并增加了积极影响。更多还调制治疗过程，包括有意识的重新解释疼痛的感觉，nonreactivity，品味，积极的注意力，和reappraisal.ConclusionsAmong过去和现在的美国军事人员，更多的慢性疼痛，阿片类药物的使用，渴望，阿片类药物的线索反应性导致持续下降。MORE促进阿片类药物剂量减少，同时保持足够的疼痛控制和预防情绪障碍，表明其用于安全的阿片类药物减量。
ObjectiveThis randomized clinical trial evaluated the efficacy of Mindfulness-Oriented Recovery Enhancement (MORE) among past and present U.S. military personnel with prescriptions for long-term opioid therapy for chronic pain.MethodsIn this clinical trial, 230 past and present military personnel with prescriptions for long-term opioid therapy were randomized in a 1:1 ratio to MORE or supportive psychotherapy (initially delivered in person and then via videoconferencing after the onset of the COVID-19 pandemic). Primary outcomes were chronic pain, measured by the Brief Pain Inventory, and aberrant drug-related behaviors, measured by the Current Opioid Misuse Measure, through 8 months of follow-up. Opioid dose was a key secondary outcome. Other outcomes included psychiatric symptoms, catastrophizing, positive affect, ecological momentary assessments of opioid craving, and opioid attentional bias.ResultsMORE was superior to supportive psychotherapy through the 8-month follow-up in reducing pain-related functional interference, pain severity, and opioid dose. MORE reduced daily opioid dose by 20.7%, compared with a dose reduction of 3.9% with supportive psychotherapy. Although there was no overall between-group difference in opioid misuse, the in-person MORE intervention outperformed supportive psychotherapy for reducing opioid misuse. MORE reduced anhedonia, pain catastrophizing, craving, and opioid attentional bias and increased positive affect to a greater extent than supportive psychotherapy. MORE also modulated therapeutic processes, including mindful reinterpretation of pain sensations, nonreactivity, savoring, positive attention, and reappraisal.ConclusionsAmong past and present U.S. military personnel, MORE led to sustained decreases in chronic pain, opioid use, craving, and opioid cue reactivity. MORE facilitated opioid dose reduction while preserving adequate pain control and preventing mood disturbances, suggesting its utility for safe opioid tapering.