Mindfulness: Principles and Application to Decrease Opiate Use in Primary Care With an Osteopathic Component

Mindfulness is a focused approach toward accepting one’s thoughts without judgment or perseveration, with ancient Indo-Sino-Tibetan philosophical origins. Many variations exist; however, they typically include focused attention where one concentrates on a specific sensation such as breathing and open monitoring where one concentrates on consciousness itself. Mindfulness-based interventions (MBIs) are specific, organized, targeted methods to teach mindfulness with specific goals.  MBIs have shown benefit in pain patients. MBIs teach the individual the concept of pain coping, encouraging cognitive flexibility and attempting to discourage the fear or alarm reaction of pain, instead focusing on the quality of life and functionality. Mindfulness-based stress reduction (MBSR) showed a 30% significant improvement in pain intensity and pain coping at six months in patients with chronic low back pain, compared to opiates and NSAIDs, which showed no benefit.  MBIs have also shown benefit in addiction, as they help the individual relearn to control cravings, habit modification and attempt to restore the natural reward system while improving regulation of emotions. Applications to opiate use disorder are significant as patients learn to enjoy the lifestyle of recovery and learn to believe they can improve. Additionally, other comorbid conditions are known to improve with MBIs and mindfulness-based principles support the holistic principle of mind, spirit and body consistent with osteopathic medicine.