Methadone maintenance therapy (MMT) is an efficacious form of medication assisted
treatment for opioid use disorder (OUD), yet many individuals on MMT relapse. Chronic
pain and deficits in positive affective response to natural rewards may result in
dysphoria that fuels opioid craving and promotes relapse. As such, behavioral therapies
that ameliorate chronic pain and enhance positive affect may serve as useful adjuncts
to MMT. This analysis of ecological momentary assessment (EMA) data from a Stage 1
pilot clinical trial examined effects of Mindfulness-Oriented Recovery Enhancement
(MORE) on opioid craving, pain, and positive affective state. Participants with OUD
and chronic pain (N=30) were randomized to 8 weeks of MORE or treatment as usual (TAU).
Across 8 weeks of treatment, participants completed up to 112 random EMA measures
of craving, pain, and affect, as well as event-contingent craving ratings. Multilevel
models examined the effects of MORE on craving, pain, and affect, as well as the association
between positive affect and craving. EMA showed significantly greater improvements
in craving, pain unpleasantness, stress, and positive affect for participants in MORE
than for participants in TAU. Participants in MORE reported having nearly 1.3 times
greater self-control over craving than those in TAU. Further, positive affect was
associated with reduced craving, an association that was significantly stronger among
participants in MORE than TAU. MORE may be a useful non-pharmacological adjunct among
individuals with OUD and chronic pain in MMT.