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. 2019 Nov 4;180(1):91–105. doi: 10.1001/jamainternmed.2019.4917

Table 2. Limitations of Existing Studies of MBTs and Suggestions for Future Research in this Area.

Limitations of Existing Studies Suggestions for Future Research
Insufficient reporting of opioid dosing outcomes Record the type of opioid agent prescribed, the dose per unit, the dose form, dose frequency, and duration of opioid use
Outcomes for opioid-using subgroups were not analyzed separately in the results Conduct a priori subgroup analyses for opioid users in future clinical trials
High levels of intervention heterogeneity preclude examination of effect modifiers, including intervention dosage and delivery format Increase the number of studies of each type of MBT of various dosages (brief vs multiweek MBT) and delivery formats (delivered in person by practitioner vs audio recording or internet); randomly assign participants to different MBT dosages and delivery formats
High levels of heterogeneity in study design preclude determinations of the durability of treatment effects Use standardized and consistent assessment points and outcome measures to facilitate meta-analytic comparisons across studies
Some studies have small sample sizes Increase sample size to ensure full power to detect treatment effects
Some studies had risk of bias because of a lack of blinding of participants, personnel, and assessors Blind participants, personnel, and assessors, as well as use double-blind or active placebo-controlled designs whenever possible
Some studies had risk of bias because of a lack of intent-to-treat analysis Use intent-to-treat analyses to assess primary and secondary outcomes
Some studies relied on self-report of opioid dosing or opioid misuse–related outcomes Triangulate data from self-reports, practitioner evaluation, PDMPs, and urine toxicologic screenings via modeling strategies capable of analyzing latent dependent variables composed of multiple observed indicators (eg, structural equation modeling); use psychophysiologic testing to detect addictive tendencies toward opioids

Abbreviations: MBT, mind-body therapy; PDMPs, prescription drug monitoring plans.