Mindfulness and chronic pain: limited evidence of effectiveness

Bawa, F. L. M., et al. (2015). Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis. British Journal of General Practice, 65, 635, e387-e400. Full text.

Background: Chronic pain and its associated distress and disability are common reasons for seeking medical help. Patients with chronic pain use primary healthcare services five times more than the rest of the population. Mindfulness has become an increasingly popular self-management technique.

Aim: To assess the effectiveness of mindfulness-based interventions for patients with chronic pain.

Conclusion: There is limited evidence for effectiveness of mindfulness-based interventions for patients with chronic pain. Better-quality studies are required.

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Efficacy of meditation on stress-related outcomes (review)

Goyal, M., et al.  (2014). Meditation Programs for Psychological Stress and Well-Being. Comparative Effectiveness Reviews, No. 124. Full text.

Objective: Meditation, a mind-body method, employs a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. An increasing number of patients are using meditation programs despite uncertainty about the evidence supporting the health benefits of meditation. We aimed to determine the efficacy and safety of meditation programs on stress-related outcomes (e.g., anxiety, depression, stress, distress, well-being, positive mood, quality of life, attention, health-related behaviors affected by stress, pain, and weight) compared with an active control in diverse adult clinical populations.

Conclusions: Meditation programs, in particular mindfulness programs, reduce multiple negative dimensions of psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health as well as stress-related behavioral outcomes.

Single-session meditation in oncology outpatient clinic

Chaoul, A., et al. (2014). An Analysis of Meditation Consultations in an Integrative Oncology Outpatient Clinic. The Journal of Alternative and Complementary Medicine, 20(5), A86-A86.

From the Abstract. The majority of cancer patients use some complementary medicine modality. Mind-body practices, and especially meditation, are amongst the most utilized. Research shows that they help cancer patients manage psychological distress and control symptoms such as pain, nausea, and sleep disturbances. However, the effects of a single meditation session on self-reported symptoms, including physical, psychological and symptom distress in an outpatient setting, are largely unknown.

All patients [received] an individual meditation consultation (60 minute initial visits, and 30 minute follow-up visits). Our analysis included 81 meditation visits for 121 participants over 32 months. The [results] revealed a significant reduction from pre- to post-meditation session in physical, psychological, and symptom distress component scores. The greatest mean reductions for individual symptoms were for: Anxiety, Fatigue, Distress, Well Being, Sleep, and Pain; all changes reaching statistically and clinically significant thresholds.

Further research with a larger sample size is needed to better understand the symptoms that meditation can help control and the frequency of self-practice outside of the clinic to help maintain the long-term benefits.

MBI for physical conditions: evaluating levels of evidence

Carlson, L. E. (2012). Mindfulness-based interventions for physical conditions: a narrative review evaluating levels of evidence. ISRN psychiatry. Article ID 651583. Full text.

Research on mindfulness-based interventions (MBIs) for treating symptoms of a wide range of medical conditions has proliferated in recent decades. Mindfulness is the cultivation of nonjudgmental awareness in the present moment. It is both a practice and a way of being in the world. based cognitive therapy (MBCT).

This paper begins with a discussion of the phenomenological experience of coping with a chronic and potentially life-threatening illness, followed by a theoretical discussion of the application of mindfulness in these situations. The literature evaluating MBIs within medical conditions is then comprehensively reviewed, applying a levels of evidence rating framework within each major condition. The bulk of the research looked at diagnoses of cancer, pain conditions (chronic pain, low back pain, fibromyalgia, and rheumatoid arthritis), cardiovascular disease, diabetes, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and irritable bowel syndrome.

Most outcomes assessed are psychological in nature and show substantial benefit, although some physical and disease-related parameters have also been evaluated. The field would benefit from more adequately powered randomized controlled trials utilizing active comparison groups and assessing the moderating role of patient characteristics and program “dose” in determining outcomes.

Mindful attention and experimental pain among adolesents

Petter, M., et al. (2014). The Effects of Mindful Attention and State Mindfulness on Acute Experimental Pain among Adolescents. Journal of Pediatric Psychology, jsu007. Abstract

Objective: Attention-based coping strategies for pain are widely used in pediatric populations. The purpose of this study was to test a novel mindful attention manipulation on adolescent’s experimental pain responses. Furthermore, the relationship between state mindfulness and experimental pain was examined.

Methods: A total of 198 adolescents were randomly assigned to a mindful attention manipulation or control group prior to an experimental pain task. Participants completed measures of state mindfulness immediately prior to the pain task, and situational catastrophizing  and pain intensity following the task.

Results: Overall the manipulation had no effect on pain. Secondary analysis showed that meditation experience moderated the effect of the manipulation. State mindfulness predicted pain outcomes, with reductions in situational catastrophizing mediating this relationship.

Conclusions: The mindful attention manipulation was effective among adolescents with a regular meditation practice. State mindfulness was related to ameliorated pain responses, and these effects were mediated by reduced catastrophizing.

Beneficial for medical and psychiatric illness

Marchand, W. R. (2012). Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress. Journal of Psychiatric Practice, 18(4), 233-252.

Abstract: Mindfulness has been described as a practice of learning to focus attention on moment-by-moment experience with an attitude of curiosity, openness, and acceptance. Mindfulness practices have become increasingly popular as complementary therapeutic strategies for a variety of medical and psychiatric conditions.

This paper provides an overview of three mindfulness interventions that have demonstrated effectiveness for psychiatric symptoms and/or pain. The goal of this review is to provide a synopsis that practicing clinicians can use as a clinical reference concerning Zen meditation, mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). All three approaches originated from Buddhist spiritual practices, but only Zen is an actual Buddhist tradition. MBSR and MBCT are secular, clinically based methods that employ manuals and standardized techniques.

Studies indicate that MBSR and MBCT have broad-spectrum antidepressant and antianxiety effects and decrease general psychological distress. MBCT is strongly recommended as an adjunctive treatment for unipolar depression. The evidence suggests that both MBSR and MBCT have efficacy as adjunctive interventions for anxiety symptoms. MBSR is beneficial for general psychological health and stress management in those with medical and psychiatric illness as well as in healthy individuals. Finally, MBSR and Zen meditation have a role in pain management.

Controlling chronic pain

Gardner-Nix,  J., et al. (2012). Exploring the Effectiveness of a Mindfulness-Based Chronic Pain Management Course Delivered Simultaneously to On-Site and Off-Site Patients Using Telemedicine. Mindfulness (online journal). Full abstract.

The present study investigated the effectiveness of a mindfulness-based pain management program developed to increase accessibility and acceptability for a severe chronic pain population. … Sixty chronic pain patients completed a 12-week Mindfulness-Based Chronic Pain Management program, while 59 individuals on the waiting list served as a control group. Ages ranged from 32 to 79 (mean age 52). … Program participants showed significant improvements in mental health, pain catastrophizing, and suffering levels, while the controls remained relatively unchanged. Neither group showed significant changes in the physical quality of life measures or usual pain levels.

The present study lends support for the effectiveness of mind–body interventions in improving mental health and suffering in chronic pain sufferers seeking help in tertiary pain clinic settings. It also provides evidence for the usefulness of a mindfulness-based program modified specifically for the chronic pain population, and supports its delivery through telemedicine.