Eric Garland, associate dean for research at the University of Utah College of Social Work, has received two prestigious multi-million dollar grants to investigate the effectiveness of Mindfulness-Oriented Recovery Enhancement treatment for chronic pain and opioid misuse.
The grants from the National Institutes of Health and the Department of Defense will look at whether this innovative, mindfulness-based treatment modality can, as previous research has shown, reduce a person’s craving for opioid painkillers and improve the ability to cope with the intense pain for which these drugs are most often prescribed.
The grants come as the nation grapples with an opioid and heroin epidemic. President Barack Obama issued a proclamation declaring Sept. 18-24, 2016, the nation’s inaugural Prescription Opioid and Heroin Epidemic Awareness Week. This week—dedicated to improving awareness of what the U.S. Department of Health & Human Services has called “an unprecedented opioid epidemic”—emphasizes the importance of prevention and evidence-based treatment options such as Mindfulness-Oriented Recovery Enhancement (MORE).
Earlier this month, Garland landed a five-year phased innovation award from the National Institutes of Health’s National Center for Complementary and Integrative Health. An initial award of $800,000 will fund a two-year phase of the study, Effects of Mindfulness-Oriented Intervention on Endogenous Opioid Mechanisms of Hedonic Regulation in Chronic Pain. Garland, principal investigator, and Jon-Kar Zubieta, co-principal investigator, will use PET and fMRI neuroimaging methods to assess the effects of MORE on restoring brain levels of endorphins in patients with chronic back pain who are being treated with prescription opioids.
Following a successful first phase of the project, a three-year second phase ($2.2 million) will investigate whether patients with a certain genetic makeup might benefit more from the mindfulness-based treatment.
Opioids are powerful painkillers that are intended for the short-term management of severe pain, such as one might experience after a major surgery.
“However, opioids are often used to manage chronic pain, despite an absence of data on their long-term effects, as well as clear evidence of significant health risks,” said Garland.
Prolonged opioid use changes the way the brain functions, leading to heightened pain sensitivity, insensitivity to natural pleasure, and vulnerability to addiction—factors that may result in opioid dose escalation, which can end in overdose and death. Based on the results of previous research, Garland hopes that with this grant he will find evidence that mindfulness meditation training through MORE will restore proper function to the brain’s opioid receptors.
“We will be able to measure how MORE changes the brain’s ability to regulate pain and respond to natural rewards, as well as deepen our understanding of exactly how these changes in neural mechanisms happen,” said Garland.
This award came just one month after Garland received a larger five-year, $3.4 million grant from the Department of Defense Peer Reviewed Medical Research Program to test MORE as an intervention for veterans and military personnel with chronic pain. Many U.S. veterans experience multiple health and mental health issues simultaneously. Since veterans and military personnel have even higher rates of pain-related conditions than the general population, along with serious combat-related and occupational stress, their risk for opioid-related problems is significantly higher.
“Currently, we do not have any evidence-based treatments that are able to simultaneously address pain, opioid misuse and psychological distress,” Garland said.
But Garland’s research project, Targeting Chronic Pain and Co-Occurring Disorders in the Community with Mindfulness-Oriented Recovery Enhancement, aims to fill that void.
This study will involve 260 active-duty service members and veterans with chronic pain conditions who are on long-term opioid analgesic therapy. The community-based, randomized clinical trial will compare the efficacy of MORE plus opioid pain management versus supportive counseling plus opioid pain management plus a social support group.
“New research shows that stress worsens pain and increases habit or addictive responses in the brain,” Garland said. “So, people who use opioids to cope with stress in addition to pain are likely to have the most serious and difficult to treat opioid-related problems.”
With this study, Garland and his research partners hope to help active-duty service members and veterans better manage their stress and chronic pain in a way that will not increase their risk for opioid abuse. This research will contribute to a better understanding of how MORE works to create therapeutic change and may also help predict when service members and veterans are at risk for opioid misuse.
If the study indeed demonstrates that MORE is an effective intervention for military personnel, Garland said it could easily be implemented in military installations and VA medical centers around the world and may help civilians with similar issues.
Utah, where both studies will take place, has one of the highest incidences of nonmedical use of opioids in the United States and a rapidly increasing rate of prescription opioid-related deaths. It is estimated that in the last year, 1 in 5 adults in Utah was prescribed opioids and, of those individuals, approximately 1 in 5 report taking more than prescribed.