Pilot Feasibility of a Virtual Tai Chi Easy Intervention for Opioid Use Disorder, Anxiety, and Chronic Pain

Abstract

Background: Opioid use disorder (OUD) is a public health crisis and disproportionately affects persons with chronic pain (CP) and anxiety. CP and anxiety are important contributors to OUD treatment discontinuation and relapse. Medication Assisted Treatment (MAT) (e.g., Suboxone, Methadone) is underutilized and approximately 50% of people discontinue treatment prematurely or relapse. Mind-body therapies (e.g., mindfulness, acupuncture, Tai Chi) help improve opioid use, anxiety, pain, self-efficacy, stress, and quality of life. However, the feasibility of Tai Chi to ameliorate cravings, anxiety, and CP symptoms among individuals with OUD is not known. This study examined the feasibility of an 8-week virtual Tai Chi Easy (vTCE) adjunct intervention for adults with OUD, CP, and anxiety. vTCE is a multi-component mind-body therapy, delivered remotely, including 1) Gentle movement, 2) Breath practice, 3) Self-massage, and 4) Meditation to improve intrinsic motivation and develop self-care tools for pain and emotional regulation.Methods: A theory-driven, pre-post, single-group, quasi-experimental design was used to undertake three study aims. Aim 1, determined the feasibility of vTCE intervention using feasibility criteria benchmarks. Aim 2, determined the perceptions of vTCE intervention using individual interviews. Aim 3, explored within-subject changes and baseline comparisons between inpatient and outpatient groups in generalized anxiety, CP intensity, opioid cravings, and basic psychological needs. A new holistic theoretical framework (Complexity of Opioid Use Disorder Model; COUDM) guided this project. Results: Thirty-two individuals were screened for eligibility, 19 participants enrolled, and 15 individuals participated in an 8-week/16-session vTCE intervention. Recruitment was not efficient and did not meet the participant recruitment goal of 20 within two months. Only six (30% of the goal) participants from the inpatient detox setting were enrolled within two months. After study modifications to expand recruitment to the outpatient settings, an additional 13 (65% of goal) participants were successfully enrolled within one month. Retention was not met, of the 19 participants enrolled, only three (15.8%) were retained through the final assessment. The data collection goal was met for the pre-intervention survey (95% collected); however, due to high attrition (84.3%), only three participants from the outpatient setting completed the post-intervention survey. Adherence goal (retention after session 1) was not met (3/15, 20%). Intervention acceptability, appropriateness, and feasibility goals were less than the target. Average reported acceptability was 3.5/5, appropriateness was 3.5/5, and feasibility was 4/5 (i.e., three valid 4-item measures, 5-point Likert scale). The safety goal was met with 0% reported injury issues. Conclusion: The 8-week vTCE intervention was not found to be feasible; however, when exploring the differences in implementing the vTCE in the outpatient vs. inpatient setting, there were notable differences in feasibility and reported opioid cravings at baseline. The lessons learned from this pilot study may contribute to the body of knowledge surrounding OUD and Tai Chi. Further investigation of the vTCE, as an adjunct to MAT, with a recorded delivery method, in the outpatient setting for adults with OUD is warranted.