Enhancing interoceptive awareness in chronic pain and opioid misuse via mindfulness-oriented recovery enhancement

Individuals with substance use disorders often report altered interoceptive awareness of internal bodily signals. However, it is unclear whether these alterations also extend to patients with chronic pain who misuse opioids, and whether interventions that enhance interoceptive awareness, such as mindfulness-based therapies, may reduce opioid misuse in this population.

At baseline, participants (N = 372) with chronic pain on long-term opioid therapy completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), Current Opioid Misuse Measure (COMM), and the Brief Pain Inventory. A subset identified as having an elevated risk for opioid misuse (n = 250) were randomized to an 8 week Mindfulness-Oriented Recovery Enhancement (MORE) program or supportive group (SG) psychotherapy, and completed MAIA and COMM ratings through a 9-month follow-up period.

At baseline, lower scores on the MAIA Attention Regulation and Trusting subscales were associated with higher levels of opioid misuse, even after accounting for pain severity and interference. MORE led to significantly greater increases in MAIA total and subscale scores (Attention Regulation, Trusting, and others) compared to SG, which mediated its effects on reducing opioid misuse over the 9-month follow-up period.

Individuals with chronic pain who misuse opioids report lower interoceptive awareness than those using opioids as prescribed. By increasing interoceptive awareness, mindfulness-based interventions such as MORE may lessen the misuse of opioid analgesic medications. These findings suggest that interoceptive awareness is a promising intervention target for opioid misuse.