Associate Dean for Research Eric Garland was recently awarded $3.4 million in research funding from the Department of Defense to support a five-year clinical trial of an intervention Garland developed, Mindfulness-Oriented Recovery Enhancement (MORE), as a treatment for veterans and military personnel with chronic pain. Dr. Garland will be joined by an interdisciplinary team of expert co-investigators from the University of Utah, including Jon-Kar Zubieta (Psychiatry), Craig Bryan (Psychology), Yoshio Nakamura (Anesthesiology), Gary Donaldson (Anesthesiology), and Bill Marchand (Psychiatry).
The co-occurrence of chronic pain, psychological distress, and misuse of prescription opioids undermines the mission of the U.S. military and inflicts suffering upon veterans and their families. Approximately one-half of service members have chronic pain following deployment, and nearly one-fifth engage in opioid misusing behaviors like unauthorized dose escalation and use of opioids to self-medicate stress and anxiety. Many U.S. veterans experience multiple health and mental health issues simultaneously. And, 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,” said Garland, “we do not have any evidence-based treatments that are able to simultaneously address pain, opioid misuse, and psychological distress.” 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.
The 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. MORE aims to strengthen self-control over habit behaviors, increase flexible thinking under conditions of stress, and promote the sense of reward and meaning in the face of adversity.
“New research shows that stress worsens pain and increases habit (or addictive) responses in the brain,” Garland explained. “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-related problems. A secondary objective of the project is to utilize lab-based assessments and mobile technology to understand how MORE works to create therapeutic change. To accomplish this objective, lab-based assessments will evaluate psychophysiological reactivity to cues associated with past episodes of pain and opioid use, and a smartphone-based assessment will be used to evaluate opioid craving, pain, and negative mood in “the real world.” Because changes in heart rate and other autonomic nervous system measures may indicate the extent to which a person’s brain has been triggered by opioid-related cues, this application of mind-body assessments could facilitate early risk detection and predict treatment outcomes.
The final objective of the project is to understand for whom MORE works best, to help ensure more efficient healthcare resource allocation to the service members and veterans who need it most. The proposed project will enable health care providers to more effectively deliver low-cost treatment, thereby averting costly inpatient stays, discharge from active duty military service, and social, legal, and occupational problems among Veterans. Ultimately, the proposed research could significantly enhance the psychological and physical health of military personnel and Veterans by addressing the need for new integrative medicine treatment options with findings from the leading edge of science.
If the study indeed demonstrates that MORE is an effective intervention for military personnel, it could easily be implemented in military installations and VA medical centers around the world and might help civilians with similar issues.