Pain Scores as Secondary Outcomes —Opioid Reduction Studies—Reply

In Reply In the response from Hogans to our study describing the effects of telehealth Mindfulness-Oriented Recovery Enhancement (MORE), they note that baseline Brief Pain Inventory (BPI) scores differed from the initial ecological momentary assessment (EMA) rating of pain and question whether this discrepancy relates to either a pain spike in the intervention group or excessive variance. It is unlikely that any potential increase in pain was due to MORE, given that MORE significantly reduced pain in our pilot study in the same population of patients with pain and opioid use disorder receiving methadone treatment, and MORE produced significant reductions in pain relative to active control conditions across 10 effect sizes from randomized clinical trials (RCTs) in a recent meta-analysis (standardized mean change  = 0.60; 95% CI, −0.83 to −0.37; P <  .001). Mean (SD) composite BPI scores at baseline and 16 weeks were 5.5 (2.0) and 4.8 (2.2), respectively, among participants in the MORE plus methadone treatment as usual (TAU) group and 5.7 (1.9) and 5.0 (2.6), respectively, among participants in the TAU-only group; these data argue aga inst the notion that study interventions may have caused an increase in pain. More likely, this discrepancy may stem from the fact that EMA pain ratings and the BPI represent distinct measurement approaches, ie, some studies have shown that EMA and BPI scores are correlated (Pearson r = 0.64) bu t not perfectly. In contr...
Source: JAMA Psychiatry - Category: Psychiatry Source Type: research