Using mindfulness approach to tackle opioid crisis

Boston Medical Center (BMC) was awarded a multi-million dollar grant from the National Institutes of Health to improve function for chronic lower back pain (cLBP) using a non-pharmacologic approach. One of the most common conditions treated in primary care is cLBP, yet treatment remains unsatisfactory for many patients. The opioid crisis has underscored the urgency of alleviating patients' cLBP with effective therapies, including the underutilized but evidence-based Mindfulness-Based Stress Reduction (MBSR) approach.

Led by Natalia Morone, MD, MS, a clinician investigator in internal medicine at Boston Medical Center, the pragmatic clinical trial titled Optimizing Pain Treatment in Medical Setting Using Mindfulness (OPTIMUM), will be conducted to determine whether this approach is effective for treating cLBP in primary care. If effective in alleviating patients' pain, this approach could be a useful tool in treating chronic pain and reducing opioid dosage prescribing and usage.

The study will look at whether patients report that their physical function and pain level has improved, as well their psychological function, and their likelihood to start, reduce and stop an opioid prescription for cLBP.

This study will allow us to help address patient needs using evidence-based practices that could help reduce the need for prescription opioids for pain, which is important in the midst of the opioid crisis. We really need to focus on long-term treatments that will help those with chronic pain achieve better results."

Natalia Morone, associate professor of general internal medicine at Boston University School of Medicine

The approach of BMC's study will be to incorporate an 8-week group mindfulness program for persons with cLBP into the primary care setting. It will be modeled on the MBSR approach, an evidence-based program that teaches mindfulness and mindful meditation. These methods take regular activities like sitting, walking, eating and lying down, and transforms them into meditation through directed breathing and mindful awareness of thoughts, emotions, and sensations.

The entire award of $7.3 million over five years is contingent on achieving specific milestones in the first year. BMC received one of 375 grant awards across 41 states made by the National Institutes of Health in 2019 to apply scientific solutions to reverse the national opioid crisis. The Helping to End Addiction Long-term, or the NIH HEAL Initiative aims to improve treatments for chronic pain, curb the rates of opioid use disorder and overdose and achieve long-term recovery from opioid addiction.

"It's clear that a multi-pronged scientific approach is needed to reduce the risks of opioids, accelerate development of effective non-opioid therapies for pain and provide more flexible and effective options for treating addiction to opioids," said NIH Director Francis S. Collins, MD, PhD, who launched the initiative in early 2018. "This unprecedented investment in the NIH HEAL Initiative demonstrates the commitment to reversing this devastating crisis."