Reduce Pain with Mindfulness

Reduce Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

Meditation (which is the ‘formal’ practice of mindfulness) actually changes the way the mind perceives pain (2) so that it’s more bearable. It is a natural and effective way to ease physical pain.” – Melli O’Brien

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.

 

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. There is an accumulating volume of research findings to demonstrate that mind-body therapies have highly beneficial effects on the health and well-being of humans. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain in adults.

 

Hospital inpatients frequently are in pain and the management of that pain is important to the patients and to the amount of hospitalization time. It is not known whether mindfulness training is effective for the relief of acute pain in hospitalized patients. In today’s Research News article “Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602767/ ), Garland and colleagues examined the effectiveness of mindfulness training in comparison to hypnotic suggestion and psychoeducation for the relief of inpatient acute pain.

 

They recruited hospital inpatients who reported intolerable pain that was not adequately managed. They were randomly assigned to receive either mindfulness training in a “single, scripted 15-min training session in focused attention on breathing and body sensations, with concomitant metacognitive monitoring and acceptance of discursive thoughts, negative emotions, and pain”, or a hypnotic suggestion in a “single, scripted 15-min self-hypnosis session which invited patients to roll their eyes upward, close their eyes, and breathe deeply, focus on sensations of floating, and imagine the visual, auditory, olfactory, and tactile details of a pleasant scene of their choosing”, or a psychoeducation session of a “single 15-min session in which a social worker provided empathic responses to the patient and then attempted to increase perception of pain control by reviewing common behavioral pain coping strategies (e.g., stretching, using hot and cold compresses).” They were measured before and after the training for pain intensity, pain unpleasantness, anxiety, relaxation, pleasant body sensations, and desire for opioids.

 

They found that both the mindfulness and the hypnotic suggestion groups but not the psychoeducation group had significant decreases in pain intensity and pain unpleasantness. The mindfulness group also reported significantly higher relaxation and pleasant body sensations after training than the psychoeducation group while the hypnotic suggestion group reported significantly lower desire for opioids after training than the psychoeducation group. All three groups showed a reduction in anxiety.

 

Hence, a brief mindfulness training or hypnotic suggestion in hospital patients significantly improved their pain and psychological state. These are interesting results that suggest that these trainings may be useful for the relief of acute pain in hospital patients. But this trial was very brief. It remains for future research to establish the duration of effectiveness and the ability of continued training to potentiate the effectiveness and its duration.

 

So, reduce pain with mindfulness.

 

“When we’re in pain, we want it to go away. Immediately. And that’s understandable. Chronic pain is frustrating and debilitating. . . The last thing we want to do is pay more attention to our pain. But that’s the premise behind mindfulness, a highly effective practice for chronic pain.” –  Margarita Tartakovsky

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

Garland, E. L., Baker, A. K., Larsen, P., Riquino, M. R., Priddy, S. E., Thomas, E., Hanley, A. W., Galbraith, P., Wanner, N., … Nakamura, Y. (2017). Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting. Journal of general internal medicine, 32(10), 1106-1113.

 

Abstract

Background

Medical management of acute pain among hospital inpatients may be enhanced by mind-body interventions.

Objective

We hypothesized that a single, scripted session of mindfulness training focused on acceptance of pain or hypnotic suggestion focused on changing pain sensations through imagery would significantly reduce acute pain intensity and unpleasantness compared to a psychoeducation pain coping control. We also hypothesized that mindfulness and suggestion would produce significant improvements in secondary outcomes including relaxation, pleasant body sensations, anxiety, and desire for opioids, compared to the control condition.

Methods

This three-arm, parallel-group randomized controlled trial conducted at a university-based hospital examined the acute effects of 15-min psychosocial interventions (mindfulness, hypnotic suggestion, psychoeducation) on adult inpatients reporting “intolerable pain” or “inadequate pain control.” Participants (N = 244) were assigned to one of three intervention conditions: mindfulness (n = 86), suggestion (n = 73), or psychoeducation (n = 85).

Key Results

Participants in the mind-body interventions reported significantly lower baseline-adjusted pain intensity post-intervention than those assigned to psychoeducation (p < 0.001, percentage pain reduction: mindfulness = 23%, suggestion = 29%, education = 9%), and lower baseline-adjusted pain unpleasantness (p < 0.001). Intervention conditions differed significantly with regard to relaxation (p < 0.001), pleasurable body sensations (p = 0.001), and desire for opioids (p = 0.015), but all three interventions were associated with a significant reduction in anxiety (p < 0.001).

Conclusions

Brief, single-session mind-body interventions delivered by hospital social workers led to clinically significant improvements in pain and related outcomes, suggesting that such interventions may be useful adjuncts to medical pain management.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602767/

 

Increase Pain Tolerance and Spirituality with a Brief Meditation

Increase Pain Tolerance and Spirituality with a Brief Meditation

 

By John M. de Castro, Ph.D.

“Bit by bit, as I sat noticing my breath and body sensations, I began to feel the deep knots of pain in my body start to untie themselves.” – Avi Craimer

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.

 

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. There is an accumulating volume of research findings to demonstrate that mind-body therapies have highly beneficial effects on the health and well-being of humans. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain in adults.

 

In today’s Research News article “Spirituality in pain medicine: A randomized experiment of pain perception, heart rate and religious spiritual well-being by using a single session meditation methodology.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128533/ ), Sollgruber and colleagues recruited adults and randomly assigned them to receive either a 20-minute guided meditation or a 20-minute relaxation. They were measured before and after the brief meditation or relaxation for symptoms of psychological disorders and spirituality, including hope, immanent, forgiveness, experience of sense and meaning, hope transcendent, general religiosity and connectedness. They were measured for perception of cold and warmth and cold and warmth pain, their threshold for pain, and their heart rate. They were also asked to rate their subjective religious faith, dimension of religious faith, dimension of spirituality and attachment to an ecclesiastical community and also stress, pain, relaxation and spirituality.

 

They found that the meditation group reported a greater sense of spirituality as a result of the brief meditation while both groups reported increased relaxation. The meditation group in comparison to the relaxation group also showed a greater increase in pain tolerance and intensity of heat pain. and a significant increase in religious spiritual well-being including general religiosity, forgiveness, and connectedness. These effects were of moderate effect sizes.

 

These are relatively remarkable results that suggest that even a one-time, very brief meditation can significantly improve pain tolerance and increase spirituality. It has been previously demonstrated that much greater amounts of meditation training decrease pain perception and increase spirituality. But, the fact that a single 20-minute meditation is sufficient to produce these changes, at least on the very short-term, is quite impressive.

 

The results are also impressive as they were demonstrated in comparison to a comparable relaxation control condition which produced equivalent relaxation to meditation. This suggests that it was the meditation and not simple relaxation that was responsible for the effects. Further research is needed to see if these changes endure beyond the immediate aftermath of the meditation and are applicable to patients with chronic pain.

 

So, increase pain tolerance and spirituality with a brief meditation

 

“Mindful mediation is an appealing option for treating your pain because it has an unusual benefit; it places you in a position of control. Unlike pain medications or surgical procedures, meditation is not done to you—but rather it is something you do for yourself.” – Stephanie Burke

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Sollgruber, A., Bornemann-Cimenti, H., Szilagyi, I. S., & Sandner-Kiesling, A. (2018). Spirituality in pain medicine: A randomized experiment of pain perception, heart rate and religious spiritual well-being by using a single session meditation methodology. PloS one, 13(9), e0203336. doi:10.1371/journal.pone.0203336

 

Abstract

The aim of this study is to investigate different effects on pain perception among randomly assigned volunteers practicing meditation compared to a relaxation condition. The study examines whether participants of the experimental conditions (meditation versus relaxation) differ in the change of pain perception and heart rate measurement and in religious and spiritual well-being after an intervention. Method: 147 volunteers (long-term practitioners and novices) were randomly assigned to the experimental conditions with a headphone guided 20-minute single session intervention. The change in their pre- and post-intervention pain perception was measured using Quantitative Sensory Testing and Cold Pressor Testing (CPTest), their stress-level was compared by monitoring heart rate, and their religious and spiritual well-being by using the Multidimensional Inventory for Religious/Spiritual Well-Being (MI-RSB48). Additionally, dimensions of the Brief Symptom Inventory (BSI) measured the psychological resilience of the participants; pain and stress experience, and the state of relaxation and spirituality experience were assessed. Five persons were excluded due to failure in measuring the heart rate and 29 participants had to be excluded because of high values on the BSI. Results: The meditation group showed an increase in their pain tolerance on the CPTest and a decrease in their pain intensity for heat after the experimental condition, in contrast to the relaxation group. Futhermore, the meditation group showed a higher level of religious spiritual well-being (MI-RSB48 Total score) as well as in the sub-dimensions General Religiosity, Forgiveness, and Connectedness after the experimental condition, compared to the relaxation group. Our data is consistent with the hypothesis that meditation increases pain tolerance and reduces pain intensity, however, further work is required to determine whether meditation contains similar implications for pain patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128533/

 

Improve Knee Osteoarthritis with Tai Chi

Improve Knee Osteoarthritis with Tai Chi

 

By John M. de Castro, Ph.D.

 

“Experts have long recommended tai chi as a low-impact workout that’s gentle on the joints. Research . . . revealed additional benefits: It may be as effective as physical therapy for knee osteoarthritis (OA).” – Sharon Liao

 

Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. It is the leading cause of disability in the U.S., with about 43% of arthritis sufferers limited in mobility and about a third having limitations that affect their ability to perform their work. Knee osteoarthritis effects 5% of adults over 25 years of age and 12% of those over 65. It is painful and disabling. Its causes are varied including, hereditary, injury including sports injuries, repetitive stress injuries, infection, or from being overweight.

 

There are no cures for knee osteoarthritis. Treatments are primarily symptomatic, including weight loss, exercise, braces, pain relievers and anti-inflammatory drugs, corticosteroids, arthroscopic knee surgery, or even knee replacement. Gentle movements of the joints with exercise and physical therapy appear to be helpful in the treatment of knee osteoarthritis. This suggests that alternative and complementary practices that involve gentle knee movements may be useful in for treatment. Indeed, yoga practice has been shown to be effective in treating arthritis. Various forms of traditional Chinese exercises, such as Tai Chi, Qigong, and Baduanjin involve slow gentle movements of the limbs and mindfulness and have been shown to reduce the physical symptoms of knee osteoarthritis. So, it would seem reasonable to look further into the effectiveness of Tai Chi relative to physical therapy in treating knee osteoarthritis.

 

In today’s Research News article “Effects of Tai Chi versus Physical Therapy on Mindfulness in Knee Osteoarthritis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5612617/ ), Lee and colleagues recruited adults over the age of 40 who were diagnosed with knee osteoarthritis and randomly assigned them to receive either Tai Chi for 60 minutes, twice a week, for 12 weeks, or physical therapy for knee osteoarthritis for 30 minutes twice a week for the first 6 weeks and 4 times a week for the second 6 weeks. They were measured before and after training for mindfulness, pain, stiffness, and physical function, 6-minute walk test, quality of life, depression, perceived stress, and arthritis self-efficacy.

 

Overall, compared to baseline the patients showed significantly reduced pain, depressive symptoms, and stress; and improved physical function, quality of life, self-efficacy, and walk distance. There were no significant differences between the groups. Hence, Tai Chi practice was found to be as effective as physical therapy in alleviating the symptoms of knee osteoarthritis.

 

Tai Chi practice, though has a number of advantages. It is completely safe, can be used with the elderly and sickly, is inexpensive to administer, can be performed in groups or alone, at home or in a facility or even public park, and can be quickly learned. In addition, it can also be practiced in social groups without professional supervision. This can make it fun, improving the likelihood of long-term engagement in the practice. Hence, Tai Chi would appear to be an excellent treatment for the symptoms of knee osteoarthritis.

 

So, improve knee osteoarthritis with Tai Chi.

 

Tai chi helps improve physical strength and mobility and promotes a sense of well-being. . . participants with knee osteoarthritis who practiced tai chi twice a week had less pain and better physical function compared with study participants enrolled in a wellness education and stretching program.” – Harvard Health

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Lee, A. C., Harvey, W. F., Wong, J. B., Price, L. L., Han, X., Chung, M., Driban, J. B., Morgan, L., Morgan, N. L., … Wang, C. (2017). Effects of Tai Chi versus Physical Therapy on Mindfulness in Knee Osteoarthritis. Mindfulness, 8(5), 1195-1205.

 

Abstract

Tai Chi mind-body exercise is widely believed to improve mindfulness through incorporating meditative states into physical movements. A growing number of studies indicate that Tai Chi may improve health in knee osteoarthritis (OA), a chronic pain disease and a primary cause of global disability. However, little is known about the contribution of mindfulness to treatment effect of Tai Chi practice. Therefore, our purpose was to investigate the effect of Tai Chi mind-body practice compared to physical therapy (PT) on mindfulness in knee OA. Adults with radiographic-confirmed, symptomatic knee OA were randomized to either 12 weeks (twice weekly) of Tai Chi or PT. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ) before and after intervention along with commonly-used patient-reported outcomes for pain, physical function, and other health-related outcomes. Among 86 participants (74% female, 48% white, mean age 60 years, 85% at least college educated), mean total FFMQ was 142±17. Despite substantial improvements in pain, function, and other health-related outcomes, each treatment group’s total FFMQ did not significantly change from baseline (Tai Chi= 0.76, 95% CI: −2.93, 4.45; PT= 1.80, 95% CI: −2.33, 5.93). The difference in total FFMQ between Tai Chi and PT was not significant (−1.04 points, 95% CI: −6.48, 4.39). Mindfulness did not change after Tai Chi or PT intervention in knee OA, which suggests that Tai Chi may not improve health in knee OA through cultivating mindfulness. Further study is needed to identify underlying mechanisms of effective mind-body interventions among people with knee OA.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5612617/

 

Improve Quality of Life with Low Back Pain with Yoga

Improve Quality of Life with Low Back Pain with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga is great for working on flexibility and core stability, correcting posture, and breathing—all of which are necessary for a healthy back.” – Sasha Cyrelson

 

Low Back Pain is the leading cause of disability worldwide and affects between 6% to 15% of the population. It is estimated, however, that 80% of the population will experience back pain sometime during their lives. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs. These therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years and opiate pain killers are dangerous and can lead to abuse, addiction, and fatal overdoses. Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects.

 

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back painYoga practice has been shown to have a myriad of health benefits. These include relief of chronic painYoga practice has also been shown to be effective for the relief of chronic low-back pain.  Many forms of yoga focus on the proper alignment of the spine, which could directly address the source of back and neck pain for many individuals. So, it makes sense to further explore the effectiveness of yoga practice for chronic low back pain.

 

In today’s Research News article “A Randomized Trial Comparing Effect of Yoga and Exercises on Quality of Life in among nursing population with Chronic Low Back Pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134737/ ), Patil and colleagues recruited nurses who worked in a tertiary care hospital and who also were diagnosed with chronic low back pain. They were randomly assigned to either participate in yoga or physical exercise. In the yoga condition, the participants practiced a 1-hour Integrated Approach to Yoga Therapy module 5 times per week for 6 weeks. The physical exercise group practiced on the same schedule and performed stretching and gym exercises such as leg lifts, curls, and pull ups. Participants were measured before and after training with the “World Health Organization Quality of Life-brief questionnaire. . . The scale provides a measure of an individual’s perception of QOL on four domains: (1) physical health (seven items), (2) psychological health (six items), (3) social relationships (three items), and (4) environmental health” (Patil et al., 2018).

 

They found that both groups of nurses showed significant improvements after training in physical and psychological health and social relationships. But, the yoga group had significantly greater improvements in all three quality of life dimensions.

 

The fact that yoga was compared to a comparable exercise is a strength of this research project. The results are potentially important and suggest that yoga practice is superior to other exercise in improving the quality of life of nursing professionals with chronic low back pain. This may be of great importance in allowing the nurses to better perform their duties and also to prevent turnover and burnout that are prevalent with nurses.

 

So, improve quality of life with low back pain with yoga.

 

“Achy back? Give yoga a go. Numerous studies have shown the power of the ancient practice, which emphasizes stretching, strength, and flexibility, to relieve back soreness and improve function. . . yoga may even help reduce the need for pain medication.” – Annie Hauser

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Patil, N. J., Nagaratna, R., Tekur, P., Manohar, P., Bhargav, H., & Patil, D. (2018). A Randomized Trial Comparing Effect of Yoga and Exercises on Quality of Life in among nursing population with Chronic Low Back Pain. International Journal of Yoga, 11(3), 208–214. http://doi.org/10.4103/ijoy.IJOY_2_18

 

Abstract

Background:

Chronic low back pain (CLBP) adversely affects quality of life (QOL) in nursing professionals. Integrated yoga has a positive impact on CLBP. Studies assessing the effects of yoga on CLBP in nursing population are lacking. Aim: This study was conducted to evaluate the effects of integrated yoga and physical exercises on QOL in nurses with CLBP.

Methods:

A total of 88 women nurses from a tertiary care hospital of South India were randomized into yoga group (n = 44; age – 31.45 ± 3.47 years) and physical exercise group (n = 44; age – 32.75 ± 3.71 years). Yoga group was intervened with integrated yoga therapy module practices, 1 h/day and 5 days a week for 6 weeks. Physical exercise group practiced a set of physical exercises for the same duration. All participants were assessed at baseline and after 6 weeks with the World Health Organization Quality of Life-brief (WHOQOL-BREF) questionnaire.

Results:

Data were analyzed by Paired-samples t-test and Independent-samples t-test for within- and between-group comparisons, respectively, using the Statistical Package for the Social Sciences (SPSS). Within-group analysis for QOL revealed a significant improvement in physical, psychological, and social domains (except environmental domain) in both groups. Between-group analysis showed a higher percentage of improvement in yoga as compared to exercise group except environmental domain.

Conclusions:

Integrated yoga was showed improvements in physical, psychological, and social health domains of QOL better than physical exercises among nursing professionals with CLBP. There is a need to incorporate yoga as lifestyle intervention for nursing professionals.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134737/

 

Improve Chronic Conditions with Mindfulness Taught over the Internet

Improve Chronic Conditions with Mindfulness Taught over the Internet

 

By John M. de Castro, Ph.D.

 

“It’s important for people living with health conditions to recognize what they are feeling, instead of trying to push painful thoughts and emotions away, which can actually amplify them. For those living with serious medical conditions, mindfulness can help them accept and respond to difficult feelings, including fear, loneliness and sadness. By bringing mindfulness to emotions (and the thoughts that may underlie them), we can begin to see them more clearly and recognize that they are temporary.” – Shauna Shapiro

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health and particularly with the physical and psychological reactions to stress. The vast majority of the mindfulness training techniques, however, require a certified trained therapist. This results in costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. This makes delivery to individuals in remote locations nearly impossible.

 

As an alternative, applications over the internet and on smartphones have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, eliminating the need to go repeatedly to specific locations, and being available to patients in remote areas. But, the question arises as to the level of compliance with the training and the effectiveness of these internet applications in inducing mindfulness and improving physical and psychological health in chronically ill patients.

 

In today’s Research News article “Digital Characteristics and Dissemination Indicators to Optimize Delivery of Internet-Supported Mindfulness-Based Interventions for People With a Chronic Condition: Systematic Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107686/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123540/  ), Russell and colleagues review and summarize the published research literature on the effectiveness of internet based mindfulness training programs for the treatment of patients with chronic diseases. They identified 10 randomized controlled studies that contained a control group where mindfulness training was performed over the internet. The patients were afflicted with chronic pain in 3 of the studies, and in single studies with fibromyalgia, heart disease, cancer post-treatment, anxiety disorder, major depressive disorder, residual depressive symptoms, and psychosis.

 

They found that internet-based mindfulness interventions in general had significant beneficial effects that improved patient functioning in comparison to the control groups. Half of the studies reported follow-up measurements that reflected persisting benefits. They noted that when measured participant adherence to the programs was in general low.

 

Hence, it appears that internet-based mindfulness interventions are safe and effective treatments for the well-being of patients with chronic diseases. This is potentially very important as these interventions can be administered inexpensively, conveniently, and to large numbers of patients regardless of their locations, greatly increasing the impact of the treatments.

 

There are some caveats. The majority of the participants by far were women and there was no study that compared the efficacy of the internet-based intervention to the comparable face-to-face intervention or another treatment. So, it was recommended that future studies include more males and a comparison to another treatment.

 

So, improve chronic conditions with mindfulness taught over the internet.

 

“MBSR programs might not reverse underlying chronic disease, but they can make it easier to cope with symptoms, improve overall well-being and quality of life and improve health outcomes.” – Monika Merkes

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

Russell, L., Ugalde, A., Milne, D., Austin, D., & Livingston, P. M. (2018). Digital Characteristics and Dissemination Indicators to Optimize Delivery of Internet-Supported Mindfulness-Based Interventions for People With a Chronic Condition: Systematic Review. JMIR Mental Health, 5(3), e53. http://doi.org/10.2196/mental.9645

 

Abstract

Background

Internet-supported mindfulness-based interventions (MBIs) are increasingly being used to support people with a chronic condition. Characteristics of MBIs vary greatly in their mode of delivery, communication patterns, level of facilitator involvement, intervention period, and resource intensity, making it difficult to compare how individual digital features may optimize intervention adherence and outcomes.

Objective

The aims of this review were to (1) provide a description of digital characteristics of internet-supported MBIs and examine how these relate to evidence for efficacy and adherence to the intervention and (2) gain insights into the type of information available to inform translation of internet-supported MBIs to applied settings.

Methods

MEDLINE Complete, PsycINFO, and CINAHL databases were searched for studies assessing an MBI delivered or accessed via the internet and engaging participants in daily mindfulness-based activities such as mindfulness meditations and informal mindfulness practices. Only studies using a comparison group of alternative interventions (active compactor), usual care, or wait-list were included. Given the broad definition of chronic conditions, specific conditions were not included in the original search to maximize results. The search resulted in 958 articles, from which 11 articles describing 10 interventions met the inclusion criteria.

Results

Internet-supported MBIs were more effective than usual care or wait-list groups, and self-guided interventions were as effective as facilitator-guided interventions. Findings were informed mainly by female participants. Adherence to interventions was inconsistently defined and prevented robust comparison between studies. Reporting of factors associated with intervention dissemination, such as population representativeness, program adoption and maintenance, and costs, was rare.

Conclusions

More comprehensive descriptions of digital characteristics need to be reported to further our understanding of features that may influence engagement and behavior change and to improve the reproducibility of MBIs. Gender differences in determinants and patterns of health behavior should be taken into account at the intervention design stage to accommodate male and female preferences. Future research could compare MBIs with established evidence-based therapies to identify the population groups that would benefit most from internet-supported programs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123540/

 

Improve Opioid-Treated Chronic Low Back Pain with Mindfulness

Improve Opioid-Treated Chronic Low Back Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness meditation and CBT-based interventions have the potential to safely reduce pain severity in patients with chronic lower back pain that’s treated with opioids,” – Dr. Aleksandra Zgiersk

 

Low Back Pain is the leading cause of disability worldwide and affects between 6% to 15% of the population. It is estimated, however, that 80% of the population will experience back pain sometime during their lives. The pain interferes with daily living and with work, interfering with productivity and creating absences. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs. These therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years and opiate pain killers are dangerous and can lead to abuse, addiction, and fatal overdoses. Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects.

 

Pain involves both physical and psychological issues. Physically, exercise can be helpful in strengthening the back to prevent or relieve pain. Psychologically, the stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back pain. There is a need to explore the utility of mindfulness training when it is used as a supplement to opioid treatment for chronic low back pain.

 

In today’s Research News article “Cost of Opioid-Treated Chronic Low Back Pain: Findings from a Pilot Randomized Controlled Trial of Mindfulness Meditation-Based Intervention.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836724/ ), Zgierska and colleagues recruited adults with chronic low back pain and were being treated with opioids. They were randomly assigned to either continue with only treatment as usual or receive additional mindfulness training delivered in 8-weekly 2-hour sessions with home practice. They were measured before and after training for pain severity, pain responses to heat, healthcare utilization, productivity loss, medication use, and costs associated with disability and treatment.

 

They found that in comparison to baseline and the treatment as usual control, the patients that received mindfulness training had significantly reduced pain severity and pain response to heat. In addition, the mindfulness group tended to have fewer lost days of work while the control group tended to use more opioid medication. In looking at the economic costs of opioid treatment for low back pain, they found that adding the mindfulness training did not increase overall costs. Hence, mindfulness training appears to additionally relieve chronic low back pain beyond the effects of opioid medication, yet does not cost any more.

 

So, improve opioid-treated chronic low back pain with mindfulness.

 

“Chronic pain is a condition best managed when patients take an active role and . . . . according to the research, mindfulness should now be a part of a multi-disciplinary strategy for those willing to put in the effort.” —Stephani Sutherland

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Zgierska, A. E., Ircink, J., Burzinski, C. A., & Mundt, M. P. (2017). Cost of Opioid-Treated Chronic Low Back Pain: Findings from a Pilot Randomized Controlled Trial of Mindfulness Meditation-Based Intervention. Journal of Opioid Management, 13(3), 169–181. http://doi.org/10.5055/jom.2017.0384

 

Abstract

Objective

Opioid-treated chronic low back pain (CLBP) is debilitating, costly and often refractory to existing treatments. This secondary analysis aims to pilot-test the hypothesis that mindfulness meditation (MM) can reduce economic burden related to opioid-treated CLBP.

Design

26-week unblinded pilot randomized controlled trial, comparing MM, adjunctive to usual-care, to usual care alone.

Setting

Outpatient

Participants

Thirty-five adults with opioid-treated CLBP (≥ 30 morphine-equivalent mg/day) for 3+ months enrolled; none withdrew.

Intervention

8 weekly therapist-led MM sessions and at-home practice.

Outcome Measures

Costs related to self-reported healthcare utilization, medication use (direct costs), lost productivity (indirect costs), and total costs (direct+indirect costs) were calculated for 6-month pre- and post-enrollment periods and compared within and between the groups.

Results

Participants (21 MM; 14 control) were 20% men, age 51.8 ± 9.7 years, with severe disability, opioid dose of 148.3 ± 129.2 morphine-equivalent mg/day, and individual annual income of $18,291 ± $19,345. At baseline, total costs were estimated at $15,497 ± 13,677 (direct: $10,635 ± 9,897; indirect: $4,862 ± 7,298) per participant. Although MM group participants, compared to controls, reduced their pain severity ratings and pain sensitivity to heat-stimuli (p<0.05), no statistically significant within-group changes or between-group differences in direct and indirect costs were noted.

Conclusions

Adults with opioid-treated CLBP experience a high burden of disability despite the high costs of treatment. Although this pilot study did not show a statistically significant impact of MM on costs related to opioid-treated CLBP, MM can improve clinical outcomes and should be assessed in a larger trial with long-term follow-up.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836724/

 

Relieve Depression in Patients with Chronic Pain with Mindfulness-Based Cognitive Therapy (MBCT)

Relieve Depression in Patients with Chronic Pain with Mindfulness-Based Cognitive Therapy (MBCT)

 

By John M. de Castro, Ph.D.

 

“By developing a routine meditation practice, clients can use the technique whenever they start to feel overwhelmed by negative emotions. When sadness occurs and starts to bring up the usual negative associations that trigger relapse of depression, the client is equipped with tools that will help them replace negative thought patterns with positive.” – Psychology Today

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.

 

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. There is an accumulating volume of research findings to demonstrate that mind-body therapies have highly beneficial effects on the health and well-being of humans. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain in adults.

 

Chronic pain is often accompanied with depression. The most commonly used mindfulness technique for the treatment of depression is Mindfulness-Based Cognitive Therapy (MBCT).  MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. It is not known, however if MBCT is also effective for the depression accompanying chronic pain.

 

In today’s Research News article “A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients with Chronic Pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020018/ ), De Jong and colleagues recruited adult patients with chronic pain and who were also clinically depressed. They were randomly assigned to either receive an 8-week program of Mindfulness-Based Cognitive Therapy (MBCT) or to a treatment as usual wait list control. The MBCT group met once a week for 2 hours in groups of 7 and also engaged in daily home practice. They were measured before and after training for depression, pain, quality of life, anxiety, and perceptions of improvement.

 

They found that in comparison to baseline and the wait list control group that the participants who received MBCT had a significant decrease in depression but not pain. Hence, MBCT was an effective treatment for depression for patients with chronic pain. It did so by not affecting the levels of pain experienced. So, the effectiveness of MBCT was due to influencing depression directly independent of pain. It should be noted that there was not an active control condition and the sample sizes were small. So, these results need to be replicated in a larger randomized controlled clinical trial with an active control. Regardless, the results are encouraging and extend the types of depressed patients helped by MBCT.

 

So, relieve depression in patients with chronic pain with Mindfulness-Based Cognitive Therapy (MBCT).

 

“Most importantly, I seemed to be developing a whole new relationship with my thoughts. It wasn’t that they’d really changed; they were still the same old wolf- and fire- and death-fearing thoughts, but I could see that they were simply that: thoughts. I did not have to judge them, act on them or indeed do anything very much about them.– Julie Myerson

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available at the Contemplative Studies Blog http://contemplative-studies.org/wp/

They are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

De Jong, M., Peeters, F., Gard, T., Ashih, H., Doorley, J., Walker, R., … Mischoulon, D. (2018). A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients with Chronic Pain. The Journal of Clinical Psychiatry, 79(1), 15m10160. http://doi.org/10.4088/JCP.15m10160

 

Abstract

Objective

Chronic Pain (CP) is a disabling illness, often comorbid with depression. We performed a randomized controlled pilot study on mindfulness-based cognitive therapy (MBCT) targeting depression in a CP population.

Methods

Participants with CP lasting ≥ 3 months, DSM-IV Major Depressive Disorder (MDD), Dysthymic Disorder, or Depressive disorder NOS, and a Quick Inventory of Depression scale (QIDS-C16) score ≥ 6 were randomized to MBCT (n = 26) or waitlist (n = 14). We adapted the original MBCT intervention for depression relapse prevention by modifying the psychoeducation and Cognitive Behavioral Therapy (CBT) elements to an actively depressed chronic pain population. We analyzed an intent-to treat (ITT) and a per protocol sample; the per protocol sample included participants in the MBCT group who completed at least 4 out of 8 sessions. The change in the QIDS-C16 and Hamilton Rating Sale for Depression (HRSD17) were the primary outcome measures. Pain, quality of life and anxiety were secondary outcome measures. Data collection took place between January 2012 and July 2013.

Results

Nineteen (73%) participants completed the MBCT program. No significant adverse events were reported in either treatment group. ITT analysis (n=40) revealed no significant differences. Repeated measures ANOVAs for the per protocol sample (n=33) revealed a significant treatment × time interaction (F (1, 31) = 4.67, p = 0.039, η2p = 0.13) for the QIDS-C16, driven by a significant decrease in the MBCT group (t (18) = 5.15, p < 0.001, d = 1.6), but not in the control group (t (13) = 2.01, p = 0.066). The HRSD17 scores did not differ significantly between groups. The study ended before the projected sample size was obtained, which might have prevented effect detection in some outcome measures.

Conclusions

MBCT shows potential as a treatment for depression in individuals with CP, but larger controlled trials are needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020018/

 

Decrease Chronic Pain with HIV Infection with Mindfulness

Decrease Chronic Pain with HIV Infection with Mindfulness

 

By John M. de Castro, Ph.D.

 

“When it came to processing my HIV diagnosis, meditation offered me a framework for reflection, self-forgiveness, forgiving others and moving toward a place of acceptance.” – Seb Stuart

 

More than 35 million people worldwide and 1.2 million people in the United States are living with HIV infection. In 1996, the advent of the protease inhibitor and the so-called cocktail changed the prognosis for HIV. Since this development a 20-year-old infected with HIV can now expect to live on average to age 69. Hence, living with HIV is a long-term reality for a very large group of people. People living with HIV infection experience a wide array of physical and psychological symptoms which decrease their perceived quality of life. The symptoms include chronic pain, muscle aches, anxiety, depression, weakness, fear/worries, difficulty with concentration, concerns regarding the need to interact with a complex healthcare system, stigma, and the challenge to come to terms with a new identity as someone living with HIV.

 

Mindfulness training has been found to be effective in treating chronic pain conditions. In addition, mindfulness training has been shown to improve psychological well-being, lower depression and strengthen the immune system of patients with HIV infection. Hence it makes sense to examine the ability of mindfulness training to help relieve the chronic pain associated with HIV infection.

 

In today’s Research News article “A Mixed-Methods Pilot Study of Mindfulness Based Stress Reduction for HIV-Associated Chronic Pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005203/ ), George and colleagues recruited  HIV-infected adults who had been experiencing neuropathic and/or musculoskeletal pain for at least 3 months. They were randomly assigned to receive either an 8-week program of Mindfulness-Based Stress Reduction (MBSR) or health education. The MBSR program was comprised of guided meditations, gentle movement exercises, and group discussion. Health education concerned HIV-related pain topics. The participants were measured before and after training and 3 months later for pain intensity, pain interference with activities, HIV symptoms, perceived stress, and autonomic nervous system function.

 

They found that both groups improved modestly on all measures after training. But at the 3-month follow-up the Mindfulness-Based Stress Reduction (MBSR) had a further significant decline in pain intensity while the health education group reverted to pretreatment levels. At the follow-up 79% of the MBSR patients were still practicing which may account for the continued improvements. MBSR is composed of an array of different practices and it cannot be determined here which or which combination of components were necessary and sufficient for the benefits.

Regardless, MBSR appears to help in all areas of HIV symptoms but particularly with HIV-related pain and it is not only lasting but appears to continue producing reductions in pain intensity over time. This is a blessing for the patients as the torment of the pain produces suffering and reduces the quality of their lives.

 

So, decrease chronic pain with HIV infection with mindfulness.

 

“Given the stress-reduction benefits of mindfulness meditation training, these findings indicate there can be health protective effects not just in people with HIV but in folks who suffer from daily stress,” – David Creswell

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

George, M. C., Wongmek, A., Kaku, M., Nmashie, A., & Robinson-Papp, J. (2017). A Mixed-Methods Pilot Study of Mindfulness Based Stress Reduction for HIV-Associated Chronic Pain. Behavioral Medicine (Washington, D.C.), 43(2), 108–119. http://doi.org/10.1080/08964289.2015.1107525

 

Abstract

Treatment guidelines for chronic pain recommend non-pharmacologic modalities as part of a comprehensive management plan. Chronic pain is common among people living with HIV/AIDS, but there is little data to guide the choice of non-pharmacologic therapies in this complex population. We performed a mixed-methods feasibility study of Mindfulness Based Stress Reduction (MBSR) versus health education control with 32 inner city, HIV-infected participants. Outcome measures included: the Brief Pain Inventory, Perceived Stress Scale, HIV Symptoms Index, autonomic function testing, and audiotaped focus groups. Post-intervention, participants reported modest improvements in pain measures and perceived stress, but no effect of group assignment was observed. At 3-month follow-up, 79% of MBSR participants were still practicing, and pain intensity was improved, whereas in the control group pain intensity had worsened. Qualitative analysis revealed a strong sense of community in both groups, but only MBSR was perceived as useful for relaxation and pain relief.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005203/

 

Improve Pain Tolerance After Athletic Injuries with Mindfulness

Improve Pain Tolerance After Athletic Injuries with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Meditation is not something that only benefits yogis. Meditation gives athletes the ability to stay calm in the eye of the storm, it improves your ability to ignore distractions, and it has a powerful impact on the state of your nervous systems. All of these elements are significant to recovery time.” – Jennifer Houghton

 

Athletic performance requires the harmony of mind and body. Excellence is in part physical and in part psychological. That is why an entire profession of Sports Psychology has developed. “In sport psychology, competitive athletes are taught psychological strategies to better cope with a number of demanding challenges related to psychological functioning.” They use a number of techniques to enhance performance including mindfulness training. It has been shown to improve attention and concentration and emotion regulation and reduces anxiety and worry and rumination, and the physiological and psychological responses to stress. As a result, mindfulness training has been employed by athletes and even by entire teams to enhance their performance.

 

Athletes, however, often get injured. It has been shown that mindfulness can help with pain management. But, it is not known if mindfulness training can help in dealing with and recovering from severe athletic injuries. In today’s Research News article “Effect of Mindfulness Based Stress Reduction (MBSR) in Increasing Pain Tolerance and Improving the Mental Health of Injured Athletes.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00722/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_650705_69_Psycho_20180524_arts_A ), Mohammed and colleagues examined the ability of a Mindfulness Based Stress Reduction (MBSR) program to reduce the physical and psychological effects of severe athletic injuries.

 

They recruited university athletes who had severe injuries that kept them from participating in their sport for at least 3 months. All athletes received usual care consisting of the standard physiotherapy treatments throughout the study. They were randomly assigned to receive either an additional 8-week program of Mindfulness Based Stress Reduction (MBSR). They met once a week for 90 minutes and were asked to practice at home for 20 minutes per day. MBSR contains meditation, yoga and body scan practices. For this study the practices were adapted to the physical needs and capabilities of the injured athletes. All athletes were measured before and after training for pain tolerance with a cold pressor test, rated their own levels of pain, and completed measures of mindfulness, positive and negative emotions, anxiety, and depression.

 

They found that following training the athletes receiving MBSR training had a significantly greater level of pain tolerance, and mindfulness compared to baseline and the control group. Both groups had significant improvements in mood, especially significant reductions in anxiety and stress. This is a small study and it needs to be repeated with larger groups and an active control condition. But, the results indicate that Mindfulness Based Stress Reduction (MBSR) improves pain tolerance and mindfulness in injured athletes. It has been previously demonstrated that mindfulness training reduces pain perception in general. The present study suggests that it also does so for severely injured athletes. This may be important for the athlete’s recovery from their injuries.

 

It will be interesting to see if the heightened mindfulness produces improved athletic performance when the athletes recover and return to their respective sporting activities. It has been shown that mindfulness training improves athletic performance. But it is not known whether it is effective with athletes returning to competition after serious injury.

 

So, improve pain tolerance after athletic injuries with mindfulness.

 

Athletes that fall into reactive habits are being mindful when under stress.  They are at the mercy of these destructive habits.  Becoming mindful creates a pause between the stimulus that occurs and the athletes reaction to the event.” – Robert Andrews

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Mohammed WA, Pappous A and Sharma D (2018) Effect of Mindfulness Based Stress Reduction (MBSR) in Increasing Pain Tolerance and Improving the Mental Health of Injured Athletes. Front. Psychol. 9:722. doi: 10.3389/fpsyg.2018.00722

 

Abstract

Literature indicates that injured athletes face both physical and psychological distress after they have been injured. In this study, a Mindfulness Based Stress Reduction (MBSR) was utilised as an intervention for use during the period of recovery with injured athletes and, to the best of our knowledge, this is the first study using MBSR as an intervention for this purpose.

Objective: The aim of this research was to investigate the role of MBSR practise in reducing the perception of pain and decreasing anxiety/stress, as well as increasing pain tolerance and mindfulness. An additional aim was to increase positive mood and decrease negative mood in injured athletes.

Methods: The participants comprised of twenty athletes (male = 14; female = 6; age range = 21–36 years) who had severe injuries, preventing their participation in sport for more than 3 months. Prior to their injury, the participants had trained regularly with their University teams and participated in official university championships. Both groups followed their normal physiotherapy treatment, but in addition, the intervention group practised mindfulness meditation for 8 weeks (one 90-min session/week). A Cold Pressor Test (CPT) was used to assess pain tolerance. In contrast, the perception of pain was measured using a Visual Analogue Scale. Other measurements used were the Mindful Attention Awareness Scale (MAAS), Depression Anxiety and Stress Scale (DASS), and Profile of Mood States (POMS).

Results: Our results demonstrated an increase in pain tolerance for the intervention group and an increase in mindful awareness for injured athletes. Moreover, our findings observed a promising change in positive mood for both groups. Regarding the Stress/Anxiety scores, our findings showed a notable decrease across sessions; however, no significant changes were observed in other main and interaction effects in both groups.

Conclusion: Injured athletes can benefit from using mindfulness as part of the sport rehabilitation process to increase their pain tolerance and awareness. Further research is required to assess whether increasing pain tolerance could help in the therapeutic process.

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00722/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_650705_69_Psycho_20180524_arts_A

Reduce the Symptoms of Fibromyalgia with Tai Chi

Reduce the Symptoms of Fibromyalgia with Tai Chi

 

By John M. de Castro, Ph.D.

 

“Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment. This mind-body approach may be considered a therapeutic option in the multi-disciplinary management of fibromyalgia.” – Wang et al.

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers.

 

There are no completely effective treatments for fibromyalgia. Symptoms are generally treated with pain relievers, antidepressant drugs and exercise. But, these only reduce the severity of the symptoms and do not treat the disease directly. Mindfulness practices have also been shown to be effective in reducing pain from fibromyalgia. Mindfulness practices that are also exercises may be particularly effective. Indeed, yoga practice has been shown to improve the symptoms of fibromyalgia. This suggests that Tai Chi, another mindful exercise might be similarly effective.

 

In today’s Research News article “Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861462/ ), Wang and colleagues recruited patients with fibromyalgia and randomly assigned them to one of three groups; 60 minutes of Tai Chi once a week for 24 weeks, 60 minutes of Tai Chi twice a week for 12 weeks, or 60 minutes of light to moderate aerobic exercises twice a week for 24 weeks. Participants were encouraged to practice at home and continue the exercises after the end of formal sessions. Participants were measured before and at 12, 24, and 52 weeks into the intervention for overall severity of fibromyalgia, including intensity of pain, physical function, fatigue, morning tiredness, depression, anxiety, job difficulty, and overall wellbeing, anxiety, depression, self-efficacy, sleep quality, symptom severity, physical and mental health, coping strategies, social support, disability, and physical function, including muscle strength and power.

 

They found that at 24 and again at 52 weeks all groups showed significant improvement but the Tai Chi groups had significantly greater improvement than the aerobic exercise group in overall fibromyalgia severity, self-efficacy, anxiety, and coping strategies. Hence, participation in Tai Chi exercise produce significant improvement in the symptoms of fibromyalgia that were better than those produced by aerobic exercise.

 

These are remarkable findings that Tai Chi practice is better than aerobic exercise in treating the symptoms of fibromyalgia. Both helped, but Tai Chi helped more. Fibromyalgia patients suffer greatly and to bring relief with a simple, gentle, safe exercise is very important. Tai Chi is inexpensive to administer, can be performed in groups or alone, at home or in a facility or even public park, and can be quickly learned. In addition, it can be practiced in social groups without professional supervision. This can make it fun, improving the likelihood of long-term engagement in the practice. Hence, Tai Chi practice would appear to be a wonderful effective treatment for the relief of the suffering of fibromyalgia patients.

 

So, reduce the symptoms of fibromyalgia with Tai Chi.

 

“The authors attributed the success of the program to the postures and low impact movements of Tai Chi, and to the “controlled breathing and movements leading to restful state and mental tranquility.” Pain thresholds were likely raised in the process, which helped break the cycle of movement pain.“ – Joanna Fernandes

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Wang, C., Schmid, C. H., Fielding, R. A., Harvey, W. F., Reid, K. F., Price, L. L., … McAlindon, T. (2018). Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. The BMJ, 360, k851. http://doi.org/10.1136/bmj.k851

 

Abstract

Objectives

To determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends on its dosage or duration.

Design

Prospective, randomized, 52 week, single blind comparative effectiveness trial.

Setting

Urban tertiary care academic hospital in the United States between March 2012 and September 2016.

Participants

226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria) were included in the intention to treat analyses: 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group.

Interventions

Participants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly). Participants were followed for 52 weeks. Adherence was rigorously encouraged in person and by telephone.

Main outcome measures

The primary outcome was change in the revised fibromyalgia impact questionnaire (FIQR) scores at 24 weeks compared with baseline. Secondary outcomes included changes of scores in patient’s global assessment, anxiety, depression, self efficacy, coping strategies, physical functional performance, functional limitation, sleep, and health related quality of life.

Results

FIQR scores improved in all five treatment groups, but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes (patient’s global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005). Tai chi treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks, twice weekly) had greater benefit (between group difference in FIQR scores=16.2 points, 8.7 to 23.6, P<0.001). The groups who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks (difference in FIQR scores=9.6 points, 2.6 to 16.6, P=0.007). There was no significant increase in benefit for groups who received tai chi twice weekly compared with once weekly. Participants attended the tai chi training sessions more often than participants attended aerobic exercise. The effects of tai chi were consistent across all instructors. No serious adverse events related to the interventions were reported.

Conclusion

Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement. This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861462/