Meditation-induced pain relief

Zeidan, F., et al. (2015). Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia. The Journal of Neuroscience, 35(46), 15307-15325. Full text.

Significance Statement. Recent findings have demonstrated that mindfulness meditation significantly reduces pain. Given that the “gold standard” for evaluating the efficacy of behavioral interventions is based on appropriate placebo comparisons, it is imperative that we establish whether there is an effect supporting meditation-related pain relief above and beyond the effects of placebo.

Here, we provide novel evidence demonstrating that mindfulness meditation produces greater pain relief and employs distinct neural mechanisms than … sham mindfulness meditation [placebo]. Specifically, mindfulness meditation-induced pain relief activated higher order brain regions, including the orbitofrontal and cingulate cortices. In contrast, placebo analgesia was associated with decreased pain-related brain activation.

These findings demonstrate that mindfulness meditation reduces pain through unique mechanisms and may foster greater acceptance of meditation as an adjunct pain therapy.

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Compassion meditation and chronic pain

Chapin, H. L., Darnall, B. D., Seppala, E. M., Doty, J. R., Hah, J. M., & Mackey, S. C. (2014). Pilot study of a compassion meditation intervention in chronic pain. Journal of Compassionate Health Care, 1(1), 1-12. Full Text.

The emergence of anger as an important predictor of chronic pain outcomes suggests that treatments that target anger may be particularly useful within the context of chronic pain. Eastern traditions prescribe compassion cultivation to treat persistent anger. Compassion cultivation has been shown to influence emotional processing and reduce negativity bias in the contexts of emotional and physical discomfort, thus suggesting it may be beneficial as a dual treatment for pain and anger.

Our objective was to conduct a pilot study of a 9-week group compassion cultivation intervention in chronic pain to examine its effect on pain severity, anger, pain acceptance and pain-related interference. We also aimed to describe observer ratings provided by patients’ significant others and secondary effects of the intervention. Twelve chronic pain patients completed the intervention (F = 10). Data were collected from patients at enrollment, treatment baseline and post-treatment; participant significant others contributed data at the enrollment and post-treatment time points.

In this predominantly female sample, patients had significantly reduced pain severity and anger and increased pain acceptance at post-treatment compared to treatment baseline. Significant other qualitative data corroborated patient reports for reductions in pain severity and anger.

Meditation for migraines

Wells, R. E., et al. (2014). Meditation for Migraines: A Pilot Randomized Controlled Trial. Headache: The Journal of Head and Face Pain. Epub ahead of print.

From the Abstract: Our objective was to assess the safety, feasibility, and effects of the standardized 8-week mindfulness-based stress reduction (MBSR) course in adults with migraines.

Stress is a well-known trigger for headaches. Research supports the general benefits of mind/body interventions for migraines, but there are few rigorous studies supporting the use of specific standardized interventions. MBSR is a standardized 8-week mind/body intervention that teaches mindfulness meditation/yoga. Preliminary research has shown MBSR to be effective for chronic pain syndromes, but it has not been evaluated for migraines.

We conducted a randomized controlled trial with 19 episodic migraineurs randomized to either MBSR (n = 10) or usual care (n = 9). Our primary outcome was change in migraine frequency from baseline to initial follow-up. Secondary outcomes included change in headache severity, duration, self-efficacy, perceived stress, migraine-related disability/impact, anxiety, depression, mindfulness, and quality of life from baseline to initial follow-up.

CONCLUSIONS: MBSR is safe and feasible for adults with migraines. Although the small sample size of this pilot trial did not provide power to detect statistically significant changes in migraine frequency or severity, secondary outcomes demonstrated this intervention had a beneficial effect on headache duration, disability, self-efficacy, and mindfulness.

Theoretical model for MB pain management

Day, M. A., Jensen, M. P., Ehde, D. M., & Thorn, B. E. (2014). Toward a Theoretical Model for Mindfulness-Based Pain Management. The Journal of Pain, 15(7), 691-703. Abstract.

Mindfulness, as both a process and a practice, has received substantial research attention across a range of health conditions, including chronic pain. Previously proposed mechanisms underlying the potential health-related benefits of mindfulness and mindfulness-based interventions (MBIs) are based on a strong theoretical background. However, to date, an empirically grounded, integrated theoretical model of the mechanisms of MBIs within the context of chronic pain has yet to be proposed.

This is a surprising gap in the literature given the exponential growth of studies reporting on the benefits of MBIs for heterogeneous chronic pain conditions. Moreover, given the importance of determining how, and for whom, psychological interventions for pain management are effective, it is imperative that this gap in the literature be addressed. The overarching aim of the current theoretical paper was to propose an initial integrated, theoretically driven, and empirically based model of the mechanisms of MBIs for chronic pain management. Theoretical and research implications of the model are discussed.

The theoretical considerations proposed herein can be used to help organize and guide future research that will identify the mechanisms underlying the benefits of mindfulness-based treatments, and perhaps psychosocial treatments more broadly, for chronic pain management.

Positive affect buffers maladaptive pain responses

Finan, P. H., & Garland, E. L. (2014). The Role of Positive Affect in Pain and Its Treatment. The Clinical Journal of Pain. Abstract ahead of publication.

This narrative review summarizes and integrates the available literature on positive affect (PA) and pain to: (1) Provide a brief overview of PA and summarize the key findings that have emerged in the study of PA and chronic pain; (2) Provide a theoretical foundation from which to understand how PA operates in the context of chronic pain; and (3) Highlight how the prevailing psychosocial treatments for chronic pain address PA in the therapeutic context, and offer suggestions for how future treatment development research can maximize the benefit of PA for patients with chronic pain.

To that end, we review experimental studies that have assessed the association of evoked PA and pain sensitivity, as well as clinical studies that have assessed the association of naturally occurring PA and clinical pain in the context of chronic pain. The evidence suggests PA influences pain, over and above the influence of NA. We offer an “upward spiral” model of positive affect, resilience and pain self-management, which makes specific predictions that PA will buffer maladaptive cognitive and affective responses to pain, and promote active engagement in valued goals that enhance chronic pain self-management.

Responding rather than reacting to back pain

Doran, N. J. (2014). Experiencing Wellness Within Illness: Exploring a Mindfulness-Based Approach to Chronic Back Pain. Qualitative Health Research, 1049732314529662. From the Abstract.

I explore how mindfulness-based techniques affect perceptions and management of back pain and discuss these findings in relation to embodiment theory and liminality. Sixteen volunteers attending… for persistent back pain took part in this study.

The theme of “embodied awareness” formed the core category, as all participants reported a change in their experience of pain. Such embodied changes are described in relation to five subthemes: unpacking the pain experience, changing relationship to pain, letting go of the label, self-compassion and acceptance, and wellness within illness.

Learning to respond rather than react, and living moment by moment enabled participants to replace a cycle of suffering with one of acceptance. Rather than fearing pain, participants found ways to move through it and live with it. Although some expressed finding a sense of wellness despite ongoing pain, all participants reported greater acceptance and a better quality of life.

Multiple sclerosis: systematic review

Simpson, R., et al. (2014). Mindfulness based interventions in multiple sclerosis — a systematic review. BMC neurology, 14(1), 15. Full text.

Conclusions: Although the evidence is limited, this review indicates that MBIs can hold benefit for people with MS, specifically in terms of quality of life, mental health, and some physical aspects of the condition. It is unclear at this time whether these result are generalisable to different ethnic groups; both genders; all age groups; different disease phenotypes; and diverse socio-economic groups. There is no evidence regarding health service utilisation costs. It also remains unclear what benefit MBIs may hold for people with more advanced MS. Further high quality studies are needed to clarify the feasibility, practicality, acceptability, health and psychosocial benefits of MBIs for people with MS.