Improve Pain Responding in Adolescents with Mindfulness

Improve Pain Responding in Adolescents with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness was a significant predictor of both real-world and experimental pain outcomes. Adolescents who were more mindful tended to experience less interference in their day-to-day life as a result of pain. Additionally, . . . more mindful adolescents reported less intense pain and a higher level of pain tolerance.” – Mark Petter

 

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. Sadly, about a quarter to a third of children experience chronic pain. It has to be kept in mind that pain is an important signal that there is something wrong or that damage is occurring. This signals that some form of action is needed to mitigate the damage. This is an important signal that is ignored at the individual’s peril. So, in dealing with pain, it’s important that pain signals not be blocked or prevented. They need to be perceived. But, methods are needed to mitigate the psychological distress produced by chronic pain.

 

The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and prescription opioid overdoses kill more than 14,000 people annually. The use of drugs in adolescents is even more complicated and potentially directly harmful or could damage the developing brain. So, there is a great need to find safe and effective ways to lower the psychological distress and improve adolescents’ 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. These include meditationyogatai chi, qigong, biofeedback, progressive muscle relaxation, guided imagery, hypnosis, acupuncture, and deep breathing exercises. 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. But there is very little systematic study of the application of these practices for the treatment of chronic pain in adolescents.

 

In today’s Research News article “I Learned to Let Go of My Pain”. The Effects of Mindfulness Meditation on Adolescents with Chronic Pain: An Analysis of Participants’ Treatment Experience.” (See summary below or view the full text of the study at:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742755/ ), Ruskin and colleagues recruited adolescents between the ages of 12 to 18 years who suffered from chronic pain. They provided the adolescents with an 8-week program or Mindfulness-Based Stress Reduction (MBSR) modified for adolescents, including meditation, yoga, and body scan, but with reduced expectation for home practice and shortened sessions. One week after the end of the program the youths were asked about their satisfaction with the program and participated in focus groups to provide feedback, evaluations, and suggestions regarding the program. The groups discussions were transcribed and a content analysis performed.

 

The participants rated their satisfaction program at 8.29 out of 10, suggesting a high degree of satisfaction. Ruskin and colleagues found that the “Qualitative analysis of focus group transcripts revealed six main themes: Mindfulness Skills, Supportive Environment, Group Exercises, Empowerment, Program Expectations, and Logistics.”

 

In terms of the mindfulness category the participants reported that the program improved their awareness of the present moment, their ability to let go of their pain, their ability to cope with the emotions produced by the pain, and increased their overall emotional well-being and happiness. In addition, they reported that the mindfulness skills transferred to other aspects of their life such as work, and became a part of how they normally viewed the world.

 

In terms of the supportive environment, the participants reported that the group developed a sense of openness and trust, provided emotional support and made them feel less alone. They also reported that being able to discuss their pain issues with others who were also suffering was very beneficial. In terms of the group exercises, the participants reported that the “weather report”, reporting on their current state with the group was very helpful, that focusing on the pain in meditation was helpful. In terms of empowerment, the participants felt that the program did not actually ease their pain but empowered them to take actions to cope with it and not let it interfere with their activities. In terms of the program expectations, they reported that they had great misconceptions of mindfulness at the beginning believing it to be uninteresting and dumb and some reported that they thought the program would actually lower their pain levels. Finally,

in terms of the logistics, the meeting room was too sterile and needed to be decorated in a more interesting fashion, there needed to be more meetings, and they liked working with other adolescents with chronic pain.

 

Hence, the participants viewed the program very positively as improving their ability to appreciate and stay in the present moment and better cope with the emotional and practical consequences of their pain. That the practice was conducted in a group of other adolescents with chronic pain was viewed as an important and helpful characteristic of the program. In other words, they were pleased and felt the program was helpful to them in dealing with their pain.

 

These results must be interpreted carefully. They should be viewed as constructive feedback on the program and nothing more. More empirical evidence is needed to reach firm conclusions regarding the programs efficacy. But, the results are suggestive that more systematic studies are warranted as mindfulness training may be very helpful to adolescents in coping with chronic pain.

 

 “Mindful meditation can have profound effects for those who suffer from chronic pain. This simple practice seems to be able to change a patient’s perception of pain, making it less intense. . . . consistent meditation helped patients locate and turn down the “volume knob” on sensations. Often pain sufferers are unable to focus on anything but their pain, which increases their perception of it.” – Pain Doctor

 

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

 

Danielle Ruskin, Lauren Harris, Jennifer Stinson, Sara Ahola Kohut, Kathryn Walker, Erinn McCarthy. I Learned to Let Go of My Pain”. The Effects of Mindfulness Meditation on Adolescents with Chronic Pain: An Analysis of Participants’ Treatment Experience. Children (Basel) 2017 Dec; 4(12): 110. Published online 2017 Dec 15. doi: 10.3390/children4120110

 

Abstract

Chronic pain can lead to significant negative outcomes across many areas of life. Recently, mindfulness-based interventions (MBIs) have been identified as potentially effective tools for improved pain management among adolescents living with pain. This study aimed to explore the experience of adolescents who participated in an eight-week mindfulness group adapted for adolescents with chronic pain (MBI-A), and obtain their feedback and suggestions on group structure and content. A mixed method design was used employing qualitative data from focus groups and data from a satisfaction questionnaire. Focus group data were transcribed and analyzed using inductive simple descriptive content analysis. Of the total participants (n = 21), 90% (n = 19) provided feedback by completing satisfaction questionnaires and seventeen (n = 17) of those also participated across two focus groups. Analysis of the focus group transcripts uncovered six themes: mindfulness skills, supportive environment, group exercises (likes and dislikes), empowerment, program expectations, and logistics. Participants reported positive experiences in the MBI-A program, including support received from peers and mindfulness skills, including present moment awareness, pain acceptance, and emotion regulation. Group members suggested increasing the number of sessions and being clearer at outset regarding a focus on reduction of emotional suffering rather than physical pain.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742755/

Lessen Fibromyalgia Pain with Mindfulness

Lessen Fibromyalgia Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“You’ve heard the expression “mind over matter,” but did you know that it’s a tried-and-true approach to easing many conditions, including fibromyalgia?” – Madeline Vann

 

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. In today’s Research News article “Mindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693231/ ), Adler-Neal and Zeidan review and summarize the published research literature on the employment of mindfulness training for the relief of fibromyalgia symptoms.

 

They report that “mindfulness interventions . . . are generally premised on (a) developing sustained attention to arising sensory, affective, and cognitive events, (b) recognizing such experiences as momentary and fleeting, and (c) attenuating reactions/judgments to said experiences. Mindfulness training reliably improves catastrophizing, anxiety, depression, mood, and stress. Thus, improvements in mood and cognitive flexibility could lead to greater pain relief by altering the way patients interpret/contextualize pain-related ruminations.”

 

They report that the research finds that mindfulness training, especially if tailored for fibromyalgia, significantly improves fatigue, stress, sleep, pain, pain coping, positive emotions, family stress, loneliness and global well-being in fibromyalgia patients. In addition, these benefits appear to be sustained for at least 2 months after the completion of training. Hence, mindfulness training would appear to be a safe and effective treatment for fibromyalgia.

 

The improvements produced by mindfulness training appear to be mediated by changes in the nervous system. It heightens activity in the brain cortical areas that underlie the cognitional and emotional evaluation of pain and decreased activation of brain thalamic areas that process sensory information. Hence, mindfulness training appears to alter the brain to improve mechanisms underlying attention and emotions and decrease sensory sensitivity to pain. This can deaden pain itself plus improve the non-judgmental and non-reactive awareness of the pain, reducing the suffering of fibromyalgia pain.

 

People with fibromyalgia suffer to an extent where some contemplate suicide. It is wonderful to see that relatively simple and safe mindfulness training can effectively reduce the suffering.

 

So, lessen fibromyalgia pain with mindfulness.

 

“While being mindful did make them more aware of pain or a symptom of their condition, it also helped them be open to something good happening and they had the choice to focus on the good. Many people spoke of trying to negotiate a balance in their feelings,” – Jaqui Long

 

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

 

Adler-Neal, A. L., & Zeidan, F. (2017). Mindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations. Current Rheumatology Reports, 19(9), 59. http://doi.org/10.1007/s11926-017-0686-0

 

Abstract

Purpose of Review

Fibromyalgia is a disorder characterized by widespread pain and a spectrum of psychological comorbidities, rendering treatment difficult and often a financial burden. Fibromyalgia is a complicated chronic pain condition that requires a multimodal therapeutic approach to optimize treatment efficacy. Thus, it has been postulated that mind-body techniques may prove fruitful in treating fibromyalgia. Mindfulness meditation, a behavioral technique premised on non-reactive sensory awareness, attenuates pain and improves mental health outcomes. However, the impact of mindfulness meditation on fibromyalgia-related outcomes has not been comprehensively characterized. The present review delineates the existing evidence supporting the effectiveness and hypothesized mechanisms of mindfulness meditation in treating fibromyalgia-related outcomes.

Recent Findings

Mindfulness-based interventions premised on cultivating acceptance, non-attachment, and social engagement may be most effective in decreasing fibromyalgia-related pain and psychological symptoms. Mindfulness-based therapies may alleviate fibromyalgia-related outcomes through multiple neural, psychological, and physiological processes.

Summary

Mindfulness meditation may provide an effective complementary treatment approach for fibromyalgia patients, especially when combined with other reliable techniques (exercise; cognitive behavioral therapy). However, characterizing the specific analgesic mechanisms supporting mindfulness meditation is a critical step to fostering the clinical validity of this technique. Identification of the specific analgesic mechanisms supporting mindfulness-based pain relief could be utilized to better design behavioral interventions to specifically target fibromyalgia-related outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693231/

Improve Chronic Back Pain with Mindfulness and Cognitive Therapy

Improve Chronic Back Pain with Mindfulness and Cognitive Therapy

 

By John M. de Castro, Ph.D.

 

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

 

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.

 

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.

 

In today’s Research News article “Mindfulness-based stress reduction and cognitive-behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069124/ ), Turner and colleagues recruited adults suffering from chronic low back pain and randomly assigned them to either receive usual care, or 8 weeks, 2 hours per day, of Mindfulness-Based Stress Reduction (MBSR), or Cognitive Behavioral Therapy (CBT). The therapies were supplemented with home practice. They were measured before and after treatment and at 26 and 52 weeks later, for mindfulness, back pain bothersomeness, pain duration, pain frequency, pain catastrophizing, pain acceptance, and pain self-efficacy.

 

They found that before treatment the higher the levels of pain catastrophizing the lower the levels of mindfulness, pain acceptance, and pain self-efficacy. Following treatment both MBSR and CBT produced significant decreases in pain catastrophizing and increases in mindfulness, pain self-efficacy and pain acceptance that remained significant a year later. Hence, both Mindfulness-Based Stress Reduction (MBSR), or Cognitive Behavioral Therapy (CBT) produced significant improvements in the ability of the patients to adjust and cope with low back pain.

 

These results are interesting as MBSR and CBT are quite different treatments. MBSR consists of a combination of meditation, yoga, and body scan practices that are designed to improve mindfulness and reduce stress On the other hand, CBT is designed to assess and alter aberrant thought process that underlie catastrophizing and pain amplification. So, it would seem that the two therapies may work by different mechanisms but end up producing the same result. This would predict that their combination would be even more effective. On the other hand, it is also possible that they both improve mindfulness and this in turn produces the improvements. In which case their combination would only be as effective as each alone. It remains to be seen if Mindfulness-Based Cognitive Therapy (MBCT) would be even more effective for treating chronic low back pain.

 

Regardless, both MBSR and CBT appear to help relieve the suffering of patients with chronic low back pain. So, improve chronic back pain with mindfulness and cognitive therapy.

 

 

Mindfulness-based stress reduction (MBSR) practices like yoga and meditation have also been found to improve chronic lower back pain and its physical limitations and can provide patients with ongoing pain management skills,” – Susan McQuillan

 

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

 

Turner, J. A., Anderson, M. L., Balderson, B. H., Cook, A. J., Sherman, K. J., & Cherkin, D. C. (2016). Mindfulness-based stress reduction and cognitive-behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain, 157(11), 2434–2444. http://doi.org/10.1097/j.pain.0000000000000635

 

Abstract

Cognitive-behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit chronic pain patients by increasing mindfulness and pain acceptance. However, little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR versus CBT. In a randomized controlled trial comparing MBSR, CBT, and usual care (UC) for adults aged 20-70 years with chronic low back pain (CLBP) (N = 342), we examined (1) baseline relationships among measures of catastrophizing, self-efficacy, acceptance, and mindfulness; and (2) changes on these measures in the 3 treatment groups. At baseline, catastrophizing was associated negatively with self-efficacy, acceptance, and 3 aspects of mindfulness (non-reactivity, non-judging, and acting with awareness; all P-values <0.01). Acceptance was associated positively with self-efficacy (P < 0.01) and mindfulness (P-values < 0.05) measures. Catastrophizing decreased slightly more post-treatment with MBSR than with CBT or UC (omnibus P = 0.002). Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks (omnibus P = 0.001). In both the entire randomized sample and the sub-sample of participants who attended ≥6 of the 8 MBSR or CBT sessions, differences between MBSR and CBT at up to 52 weeks were few, small in size, and of questionable clinical meaningfulness. The results indicate overlap across measures of catastrophizing, self-efficacy, acceptance, and mindfulness, and similar effects of MBSR and CBT on these measures among individuals with CLBP.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069124/

Produce Lasting Improvement in Fibromyalgia with Yoga

Produce Lasting Improvement in Fibromyalgia with Yoga

 

By John M. de Castro, Ph.D.

 

“For the nearly 10 million people who suffer from this condition, the thought of any movement can be overwhelming. What makes yoga perfect though is that it can be adapted for each person’s individual needs. Additionally, yoga’s ability to calm the mind and reduce stress may also serve to reduce the main trigger of fibromyalgia attacks, as well as slowly loosen cramped muscles.” – Liz Rosenblum

 

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. 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.

 

Yoga is both an exercise and a mindfulness practice. So, it would make sense to investigate the effectiveness of yoga practice in treating fibromyalgia. Indeed, in a previous study, Carson and colleagues (Insert Link to Prior study) found that, yoga practice produced significant improvements in overall fibromyalgia symptoms. These findings need to be replicated and follow-up needs to be performed to establish the duration of the benefits. In today’s Research News article “Follow-up of Yoga of Awareness for Fibromyalgia: Results at 3 Months and Replication in the Wait-list Group.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568073/, Carson and colleagues follow up their previous study (Insert Link to Prior study) to replicate their findings and investigate whether the benefits last.

 

They recruited adult women who were diagnosed with fibromyalgia for at least a year. They were randomly assigned to receive either yoga practice or be on a wait-list control condition. The Yoga for Awareness training occurred in a group setting for 2 hours, once a week for 8 weeks. Participants were also encouraged to practice at home for 20-40 minutes, 5 to 7 days per week. Yoga for Awareness sessions consisted of yoga stretching poses, mindfulness meditation, breathing exercises, presentations on the application of yogic principles to optimal coping, and group discussions. Participants were measured before and after training for fibromyalgia symptoms and disability, including myalgic tender points, strength deficits, and balance deficits, and pain coping including acceptance, catastrophizing, and adaptive and maladaptive strategies. In addition, daily diaries were maintained of “pain, fatigue, emotional distress, and vigor, along with success at coping via acceptance and relaxation strategies.” In this follow-up study, the wait-list control was provided the yoga training for 8 weeks and the previous yoga group was followed for durability of the symptom relief.

 

They found that after treating the previous control group, like with the previous study, there were significant improvements in overall fibromyalgia symptoms and its impact, including pain, fatigue, stiffness, sleep problems, depression, anxiety, memory problems, tenderness, balance, environmental sensitivity, and strength. There were even improvements in the strategies that the patients used to cope with the pain, including increased engagement with the pain, pain problem solving, reappraisal and decreased pain catastrophizing, self-isolation, and disengagement. The daily diaries also revealed significant improvements as a result of yoga practice including reduced pain, fatigue, emotional distress and increased vigor, relaxation, and success with acceptance. The improvements were significantly related to the amount of home practice with the greater the number of days per week that yoga was practiced at home the greater the improvements in overall fibromyalgia symptoms. They also found that the group treated in the previous study maintained their improvements in fibromyalgia symptoms, functional deficits, and coping abilities with no benefit showing a significantly lessened benefit.

 

Hence, they were able to replicate their prior findings, demonstrating that they were not a one-time event, and they were able to demonstrate that the benefits last at least for 3 months after the end of formal treatment. This is important as fibromyalgia lasts a lifetime. So, having lasting benefit is a prerequisite for a treatment. Yoga practice appears to fulfill these prerequisites and is a safe and effective treatment for fibromyalgia.

 

So, produce lasting improvement in fibromyalgia with yoga.

 

“Yoga’s ability to shift the nervous system out of the stress response and into the relaxation response is vital to people whose central nervous systems are sensitive and naturally hyped way up. It also acts directly on the very muscles where fibromyalgia pain occurs.” – Catherine Guthrie

 

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

 

Carson, J. W., Carson, K. M., Jones, K. D., Mist, S. D., & Bennett, R. M. (2012). Follow-up of Yoga of Awareness for Fibromyalgia: Results at 3 Months and Replication in the Wait-list Group. The Clinical Journal of Pain, 28(9), 804–813. http://doi.org/10.1097/AJP.0b013e31824549b5

 

Abstract

Objectives

Published preliminary findings from a randomized-controlled trial suggest that an 8-week Yoga of Awareness intervention may be effective for improving symptoms, functional deficits, and coping abilities in fibromyalgia. The primary aims of this study were to evaluate the same intervention’s posttreatment effects in a wait-list group and to test the intervention’s effects at 3-month follow-up in the immediate treatment group.

Methods

Unpaired t tests were used to compare data from a per protocol sample of 21 women in the immediate treatment group who had completed treatment and 18 women in the wait-list group who had completed treatment. Within-group paired t tests were performed to compare posttreatment data with 3-month follow-up data in the immediate treatment group. The primary outcome measure was the Fibromyalgia Impact Questionnaire Revised (FIQR). Multilevel random-effects models were also used to examine associations between yoga practice rates and outcomes.

Results

Posttreatment results in the wait-list group largely mirrored results seen at posttreatment in the immediate treatment group, with the FIQR Total Score improving by 31.9% across the 2 groups. Follow-up results showed that patients sustained most of their posttreatment gains, with the FIQR Total Score remaining 21.9% improved at 3 months. Yoga practice rates were good, and more practice was associated with more benefit for a variety of outcomes.

Discussion

These findings indicate that the benefits of Yoga of Awareness in fibromyalgia are replicable and can be maintained.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568073/

Reduce Opioid Treated Low Back Pain with Meditation

Reduce Opioid Treated Low Back Pain with Meditation

 

By John M. de Castro, Ph.D.

 

“When your focus is on the pain, obviously that increases the pain. For people who meditate, their muscle tension and heart rate drops, their respiration slows and breaths gets deeper. All those things have impact on the pain.” – Jane Ehrman

 

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. 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. These include reducing pain catastrophizing. Indeed, mindfulness practices have been shown to be safe and  beneficial in pain management in general and yoga and mindfulness has been shown to specifically improve back pain. Since opiates are frequently used to treat chronic low back pain, there is a need to study the combination of long-term opiate treatment and meditation practice.

 

In today’s Research News article “Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063022/, Zgierska and colleagues recruited adult patients with chronic low back pain who had been treated for at least 3 months with relatively high doses (at least 30 mg/day) of opiates for pain. The patients were randomly assigned to receive meditation practice in combination with Cognitive Behavioral Therapy or to a wait-list control condition. The treatment consisted of 2-hour sessions once a week for 8 weeks of Cognitive Behavioral Therapy (CBT) for identifying and modifying unhealthy thought patterns concerning their pain (e.g. catastrophizing) and additionally mindfulness practices including breath meditation, loving-kindness meditation, body scan and mindful movement practices. Patients were also prescribed to practice meditation at home for at least 30 minutes, 6 days per week. Opiate medications were continued throughout testing. Patients were measured before and after treatment a half a year later for mindfulness, pain intensity, pain acceptance and coping, pain sensitivity to thermal stimuli, disability, opiate dose, and inflammatory biomarkers.

 

They found that the meditation group had a sustained decrease in unpleasantness and pain sensitivity to thermal stimuli (experimentally induced pain) and an 8% reduction in everyday pain intensity while the wait-list control group had an 8% increase in pain. The decrease in pain was greater for patients who consistently meditated at home compared to inconsistent meditators. In addition, the greater the increase in mindfulness in the meditation group, the greater the decrease in disability. No patients withdrew from the study suggesting that the treatment was acceptable and valued.

 

The intervention employed a combination of meditation with Cognitive Behavioral Therapy (CBT). So, it cannot be determined whether meditation, CBT, or their combination produced the benefits for the patients. Nevertheless, the results clearly demonstrated that the treatment was very effective in reducing pain and sensitivity to pain in patients with chronic low back pain who are under treatment with relatively high doses of opiates. It is quite striking that the effects were so large given the high doses of opiates in use and underscores the efficacy of the treatment. This suggests that perhaps the opioids had lost a degree of effectiveness with these patients and meditation training could replace the lost pain relief. So, meditation and CBT can effectively reduce pain even in patients taking opiates.

 

So, reduce opioid treated low back pain with 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

 

Zgierska, A. E., Burzinski, C. A., Cox, J., Kloke, J., Stegner, A., Cook, D. B., … Bačkonja, M. (2016). Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial. Pain Medicine: The Official Journal of the American Academy of Pain Medicine, 17(10), 1865–1881. http://doi.org/10.1093/pm/pnw006

 

Abstract

Objective. To assess benefits of mindfulness meditation and cognitive behavioral therapy (CBT)-based intervention for opioid-treated chronic low back pain (CLBP).

Design. 26-week parallel-arm pilot randomized controlled trial (Intervention and Usual Care versus Usual Care alone).

Setting. Outpatient.

Subjects. Adults with CLBP, prescribed ≥30 mg/day of morphine-equivalent dose (MED) for at least 3 months.

Methods. The intervention comprised eight weekly group sessions (meditation and CLBP-specific CBT components) and 30 minutes/day, 6 days/week of at-home practice. Outcome measures were collected at baseline, 8, and 26 weeks: primary-pain severity (Brief Pain Inventory) and function/disability (Oswestry Disability Index); secondary-pain acceptance, opioid dose, pain sensitivity to thermal stimuli, and serum pain-sensitive biomarkers (Interferon-γ; Tumor Necrosis Factor-α; Interleukins 1ß and 6; C-reactive Protein).

Results. Thirty-five (21 experimental, 14 control) participants were enrolled and completed the study. They were 51.8 ± 9.7 years old, 80% female, with severe CLBP-related disability (66.7 ± 11.4), moderate pain severity (5.8 ± 1.4), and taking 148.3 ± 129.2 mg/day of MED. Results of the intention-to-treat analysis showed that, compared with controls, the meditation-CBT group reduced pain severity ratings during the study (P = 0.045), with between-group difference in score change reaching 1 point at 26 weeks (95% Confidence Interval: 0.2,1.9; Cohen’s d = 0.86), and decreased pain sensitivity to thermal stimuli (P< 0.05), without adverse events. Exploratory analyses suggested a relationship between the extent of meditation practice and the magnitude of intervention benefits.

Conclusions. Meditation-CBT intervention reduced pain severity and sensitivity to experimental thermal pain stimuli in patients with opioid-treated CLBP.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063022/

Improve Fibromyalgia with Yoga Practice

Improve Fibromyalgia with Yoga Practice

 

By John M. de Castro, Ph.D.

 

“If you are suffering from fibromyalgia, it can be hard to get yourself moving, but movement and exercise are key ways to help manage and minimize pain. Practicing yoga daily can help. Yoga targets not only the body but also the mind. You can access multiple benefits by using yoga for fibromyalgia pain.” – Pain Doctor

 

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 produce 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. Yoga is both an exercise and a mindfulness practice. So, it would make sense to investigate the effectiveness of yoga practice in treating fibromyalgia.

 

In today’s Research News article “A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568071/, Carson and colleagues recruited adult women who were diagnosed with fibromyalgia for at least a year. They were randomly assigned to receive either yoga practice or be on a wait-list control condition. The Yoga for Awareness training occurred in a group setting for 2 hours, once a week for 8 weeks. Participants were also encouraged to practice at home for 20-40 minutes, 5 to 7 days per week. Yoga for Awareness sessions consisted of yoga stretching poses, mindfulness meditation, breathing exercises, presentations on the application of yogic principles to optimal coping, and group discussions. Participants were measured before and after training for fibromyalgia symptoms and disability, including myalgic tender points, strength deficits, and balance deficits, and pain coping including acceptance, catastrophizing, and adaptive and maladaptive strategies. In addition, daily diaries were maintained of “pain, fatigue, emotional distress, and vigor, along with success at coping via acceptance and relaxation strategies.”

 

They found that, in comparison to baseline and the wait-list condition, yoga practice produced significant improvements in overall fibromyalgia symptoms and its impact, including pain, fatigue, stiffness, sleep problems, depression, anxiety, memory problems, tenderness, balance, environmental sensitivity, and strength. There were even improvements in the strategies that the patients used to cope with the pain, including increased engagement with the pain, pain problem solving, reappraisal and decreased pain catastrophizing, self-isolation, and disengagement. The daily diaries also revealed significant improvements as a result of yoga practice including reduced pain, fatigue, emotional distress and increased vigor, relaxation, and success with acceptance. The improvements were significantly related to the amount of home practice with the greater the number of days per week that yoga was practiced at home the greater the improvements in overall fibromyalgia symptoms.

 

These results represent highly clinically significant improvements in fibromyalgia produced by just 8 weeks of yoga practice. The observed improvements were broad, covering a wide range of symptoms, and impactful, with relatively large improvements. These are exciting results as fibromyalgia produces great suffering and impairment in the lives of the patients. Yoga practice is generally safe and acceptable to the patients and appears to be very effective. Further research is needed especially research including males and an active control, such as another aerobic exercise. But, the results are so promising that they suggest that yoga practice should be included in the standard treatment package for fibromyalgia.

 

So, improve fibromyalgia with yoga practice.

 

“Although yoga has been practiced for millennia, only recently have researchers begun to demonstrate yoga’s effects on persons suffering from persistent pain. The Yoga of Awareness program stands in contrast to previous multimodal interventions with [fibromyalgia] patients in that it integrates a wide spectrum of yoga-based techniques — postures, mindfulness meditation, breathing exercises, application of yogic principles to optimal coping, and group discussions.” – James Carson

 

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

 

Carson, J. W., Carson, K. M., Jones, K. D., Bennett, R. M., Wright, C. L., & Mist, S. D. (2010). A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain, 151(2), 530–539. http://doi.org/10.1016/j.pain.2010.08.020

 

Abstract

A mounting body of literature recommends that treatment for fibromyalgia (FM) encompass medications, exercise and improvement of coping skills. However, there is a significant gap in determining an effective counterpart to pharmacotherapy that incorporates both exercise and coping. The aim of this randomized controlled trial was to evaluate the effects of a comprehensive yoga intervention on FM symptoms and coping. A sample of 53 female FM patients were randomized to the 8-week Yoga of Awareness program (gentle poses, meditation, breathing exercises, yoga-based coping instructions, group discussions) or to wait-listed standard care. Data were analyzed by intention to treat. At post-treatment, women assigned to the yoga program showed significantly greater improvements on standardized measures of FM symptoms and functioning, including pain, fatigue, and mood, and in pain catastrophizing, acceptance, and other coping strategies. This pilot study provides promising support for the potential benefits of a yoga program for women with FM.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568071/

Improve Fibromyalgia with Qigong Practice

Improve Fibromyalgia with Qigong Practice

 

By John M. de Castro, Ph.D.

 

“the mindful, meditative state that you reach through qigong releases neurochemical and immunological messengers that improve healing and reduce pain.” – Mary Lynch

 

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.

 

Many studies have linked fibromyalgia with depression. In fact, people with fibromyalgia are up to three times more likely to be depressed at the time of their diagnosis than someone without fibromyalgia. In addition, the stress from pain and fatigue can cause anxiety and social isolation. As a result, many patients experience intense anger regarding their situation. The emotions are understandable, but can act to amplify the pain. Hence, there is a great need to develop safe and effective treatments for the torment of fibromyalgia.

 

Mindfulness practices have been shown to be effective in reducing pain from fibromyalgia. This may occur directly by reducing pain or indirectly by reducing emotions or both. In today’s Research News article “Qigong and Fibromyalgia circa 2017.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590073/, Sawynok and Lynch review and summarize the published research literature on the use of Qigong practice for the treatment of fibromyalgia. They review 6 randomized controlled trials and 9 other less controlled studies.

 

They report that the research reflects consistent positive benefits of Qigong practice with medium-to-large effect sizes. These include significant reductions pain, and improvements in sleep, the impact of fibromyalgia on their ability to conduct their lives, physical well-being, and mental, cognitive, function. These benefits were manifest after 6–8 weeks of practice, and were sustained at 4–6 months. Hence, Qigong practice appears to be a safe and effective treatment for the physical and psychological symptoms of fibromyalgia.

 

Qigong is a gentle practice, completely safe, can be used by anyone, including the elderly and sickly, is inexpensive to administer, is convenient as it 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, Qigong appears to be an almost ideal treatment for fibromyalgia.

 

So, improve fibromyalgia with qigong practice.

 

“When our bodies are chronically uncomfortable we tend to disconnect from them. Qigong invites us to connect our breath, feelings and body sensations.” – Laurie Hope

 

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

 

Sawynok, J., & Lynch, M. E. (2017). Qigong and Fibromyalgia circa 2017. Medicines, 4(2), 37. http://doi.org/10.3390/medicines4020037

 

Abstract

Qigong is an internal art practice with a long history in China. It is currently characterized as meditative movement (or as movement-based embodied contemplative practice), but is also considered as complementary and alternative exercise or mind–body therapy. There are now six controlled trials and nine other reports on the effects of qigong in fibromyalgia. Outcomes are related to amount of practice so it is important to consider this factor in overview analyses. If one considers the 4 trials (201 subjects) that involve diligent practice (30–45 min daily, 6–8 weeks), there are consistent benefits in pain, sleep, impact, and physical and mental function following the regimen, with benefits maintained at 4–6 months. Effect sizes are consistently in the large range. There are also reports of even more extensive practice of qigong for 1–3 years, even up to a decade, indicating marked benefits in other health areas beyond core domains for fibromyalgia. While the latter reports involve a limited number of subjects and represent a self-selected population, the marked health benefits that occur are noteworthy. Qigong merits further study as a complementary practice for those with fibromyalgia. Current treatment guidelines do not consider amount of practice, and usually make indeterminate recommendations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590073/

Improve Fibromyalgia with Tai Chi

Improve Fibromyalgia with Tai Chi

 

By John M. de Castro, Ph.D.

 

“Compared with patients who received wellness education and stretching exercises, those who practiced tai chi saw their fibromyalgia become much less severe. They also slept better, felt better, had less pain, had more energy, and had better physical and mental health.” – Chenchen Wang

 

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. Drugs and lifestyle changes are recommended but produce only limited symptomatic relief but also can produce unwanted side effects. Alternatively, mindfulness practices have been shown to be effective in reducing pain from fibromyalgia. Tai Chi is an ancient mindfulness practice involving slow prescribed movements. It is gentle and 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. In addition, Tai Chi  has been shown to reduce pain in patients with spinal cord injury. Hence, Tai Chi may be an excellent treatment for the symptoms of fibromyalgia.

 

In today’s Research News article “A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571653/, Jones and colleagues recruited fibromyalgia sufferers and randomly assigned them to either practice Tai Chi or receive education on fibromyalgia from physicians, dieticians, and counselors for 90 minutes, twice a week, for 12 weeks. Homework and home practice was also prescribed. The participants were measured before and after the 12-week treatment period for fibromyalgia impact, including fatigue, morning tiredness, stiffness, depression, anxiety, work ability, and physical function

 

They found that the Tai Chi group in comparison to baseline and the education group had significant decreases in fibromyalgia impact, pain, sleep quality, self-efficacy, functional mobility, and balance. There were also significant reductions in pain, and improvements in sleep quality, self-efficacy, functional mobility, and balance. Importantly, none of the participants dropped out from the Tai Chi group. Hence, Tai Chi was found to be well tolerated and acceptable, and to produce clinically significant improvements in the symptoms of fibromyalgia.

 

Tai Chi can significantly improve the suffering from fibromyalgia while being acceptable for practice for patients in pain. It has no known negative side effects, is inexpensive and convenient to practice, and can be practiced alone or in groups. It appears to not only improve the psychological symptoms that can be produced by other mindfulness practices, but can also improve physical mobility including balance. Hence, Tai Chi would appear to be a nearly ideal treatment for fibromyalgia, either alone or in combination with other treatments.

 

So, improve fibromyalgia with Tai Chi.

 

“Aside from reductions in pain, patients in the tai chi group reported improvements in mood, quality of life, sleep, self-efficacy and exercise capacity. The potential efficacy and lack of adverse effects now make it reasonable for physicians to support patients’ interest in exploring these types of exercises, even if it is too early to take out a prescription pad and write ‘tai chi,’” – Gloria Yeh

 

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

 

Jones, K. D., Sherman, C. A., Mist, S. D., Carson, J. W., Bennett, R. M., & Li, F. (2012). A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients. Clinical Rheumatology, 31(8), 1205–1214. http://doi.org/10.1007/s10067-012-1996-2

 

Abstract

Previous researchers have found that 10-form Tai chi yields symptomatic benefit in patients with fibromyalgia (FM). The purpose of this study was to further investigate earlier findings and add a focus on functional mobility. We conducted a parallel-group randomized controlled trial FM-modified 8-form Yang-style Tai chi program compared to an education control. Participants met in small groups twice weekly for 90 min over 12 weeks. The primary endpoint was symptom reduction and improvement in self-report physical function, as measured by the Fibromyalgia Impact Questionnaire (FIQ), from baseline to 12 weeks. Secondary endpoints included pain severity and interference (Brief Pain Inventory (BPI), sleep (Pittsburg sleep Inventory), self-efficacy, and functional mobility. Of the 101 randomly assigned subjects (mean age 54 years, 93 % female), those in the Tai chi condition compared with the education condition demonstrated clinically and statistically significant improvements in FIQ scores (16.5 vs. 3.1, p=0.0002), BPI pain severity (1.2 vs. 0.4, p=0.0008), BPI pain interference (2.1 vs. 0.6, p=0.0000), sleep (2.0 vs. −0.03, p=0.0003), and self-efficacy for pain control (9.2 vs. −1.5, p=0.0001). Functional mobility variables including timed get up and go (−.9 vs. −.3, p=0.0001), static balance (7.5 vs. −0.3, p= 0.0001), and dynamic balance (1.6 vs. 0.3, p=0.0001) were significantly improved with Tai chi compared with education control. No adverse events were noted. Twelve weeks of Tai chi, practice twice weekly, provided worthwhile improvement in common FM symptoms including pain and physical function including mobility. Tai chi appears to be a safe and an acceptable exercise modality that may be useful as adjunctive therapy in the management of FM patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571653/

Improve Opiate Relief of Low Back Pain with Mindfulness

Improve Opiate Relief of Low Back Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“I’ve been doing research on back pain for 30 years. The biggest revolution has been the understanding that it’s not just a physical problem with physical solutions. It’s a biopsychosocial problem.” – Daniel Cherkin

 

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.

 

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 have been few attempts to study the combination of opiate treatment with mindfulness training for the treatment of chronic low back pain. In today’s Research News article “Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991566/, Zgierska and colleagues examine their combination. They recruited patients with chronic low back pain who have been taking daily opiates for at least 3 months and randomly assigned them to either continue opiate treatment or to continue it in combination with mindfulness training. Mindfulness training consisted of once a week for 8 weeks, 2-hour sessions with training in breath meditation, walking meditation, loving kindness meditation, and body scan. Participants were also required to practice at home. Before and after treatment and 18 weeks later the patients were measured for pain severity, physical function (disability), and opioid intake and side effects. After treatment, they also completed measures of adherence to the treatment protocol and satisfaction with the treatment.

 

They found that there were significant decreases in pain severity and pain sensitivity in the mindfulness treatment group at the 18-week follow-up. No adverse events were reported and opioid use declined slightly albeit not significantly. None of the participants withdrew from the study and there was a 91% adherence to treatment protocol rate. Additionally, participants were satisfied with the intervention and generally planned to continue practice.

 

These results are very exciting and suggest that mindfulness training is an acceptable, safe, and effective supplement to opioid treatment for pain relief in chronic back pain patients. Given that the patients were already on pain killers, this was a remarkable effect of mindfulness training. It is thought that mindfulness training reduces pain by interrupting the patients’ psychological reactions to pain. Mindfulness is known to improve emotion regulation, and reduce stress effects, fear, worry, and anxiety all of which can amplify pain. By eliminating these factors that magnify the pain, mindfulness practice reduces the patients’ overall pain level.

 

So, improve opiate relief of low back pain with mindfulness.

 

“We are accumulating evidence that meditation’s effects on pain can be realized with very short training. A fast-acting, non-pharmacological, inexpensive treatment for chronic pain? That might be a pill everyone can swallow.” – Stephani Sutherland

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Zgierska, A. E., Burzinski, C. A., Cox, J., Kloke, J., Singles, J., Mirgain, S., … Bačkonja, M. (2016). Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy. Journal of Alternative and Complementary Medicine, 22(8), 610–620. http://doi.org/10.1089/acm.2015.0314

 

Abstract

Objective: Although mindfulness meditation (MM) is increasingly used for chronic pain treatment, limited evidence supports its clinical application for opioid-treated chronic low back pain (CLBP). The goal of this study was to determine feasibility, acceptability, and safety of an MM-based intervention in patients with CLBP requiring daily opioid therapy.

Design: 26-week pilot randomized controlled trial comparing MM-based intervention, combined with usual care, to usual care alone.

Setting: Outpatient.

Patients: Adults with CLBP treated with ≥30 mg of morphine-equivalent dose (MED) per day for 3 months or longer.

Interventions: Targeted MM-based intervention consisted of eight weekly 2-hour group sessions and home practice (30 minutes/d, 6 days/wk) during the study. “Usual care” for opioid-treated CLBP was provided to participants by their regular clinicians.

Outcome measures: Feasibility and acceptability of the MM intervention were assessed by adherence to intervention protocol and treatment satisfaction among experimental participants. Safety was evaluated by inquiry about side effects/adverse events and opioid dose among all study participants.

Results: Thirty-five participants enrolled during the 10-week recruitment period. The mean age (±standard deviation) was 51.8 ± 9.7 years; the patients were predominantly female, with substantial CLBP-related pain and disability, and treated with 148.3 ± 129.2 mg of MED per day. All participants completed baseline assessments; none missed both follow-up assessments or withdrew. Among experimental participants (n = 21), 19 attended 1 or more intervention sessions and 14 attended 4 or more. They reported, on average, 164.0 ± 122.1 minutes of formal practice per week during the 26-week study and 103.5 ± 111.5 minutes of brief, informal practice per week. Seventeen patients evaluated the intervention, indicating satisfaction; their qualitative responses described the course as useful for pain management (n = 10) and for improving pain coping skills (n = 8). No serious adverse events or safety concerns occurred among the study participants.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991566/

Reduce Pain in Children with Mind-Body Practices

Reduce Pain in Children with Mind-Body Practices

 

By John M. de Castro, Ph.D.

 

“Guided imagery is a meditative process that uses visualization and imagination to bring awareness to the mind-body connection. Children can easily access this healing process because they’re naturally imaginative. By relaxing into a vivid story they gain tools to deal with stress, pain or difficult feelings.” – Catherine Gillespie-Lopes

 

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. Sadly, about a quarter to a third of children experience chronic pain. It has to be kept in mind that pain is an important signal that there is something wrong or that damage is occurring. This signals that some form of action is needed to mitigate the damage. This is an important signal that is ignored at the individual’s peril. So, in dealing with pain, it’s important that pain signals not be blocked or prevented. They need to be perceived. But, methods are needed to mitigate the psychological distress produced by chronic pain.

 

The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and prescription opioid overdoses kill more than 14,000 people annually. The use of drugs in children is even more complicated and potentially directly harmful or could damage the developing brain. So, there is a great need to find safe and effective ways to lower the psychological distress and improve children’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. These include meditationyogatai chi, qigong, biofeedback, progressive muscle relaxation, guided imagery, hypnosis, acupuncture, and deep breathing exercises. 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. But there is very little systematic study of the application of these practices for the treatment of chronic pain in children.

 

In today’s Research News article “A Mind–Body Approach to Pediatric Pain Management.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483625/, Brown and colleagues review and summarize the published research literature on the use of mind-body techniques to treat pain in children. They found that there is clear evidence from the research that yoga practice and acupuncture are effective in the treatment of pain in both adults and children. On the other hand, they found that meditation, mindfulness training, and hypnosis are effective for treating pain in adults, but that there is a void of research for its application in children.

 

Hence the published research literature is encouraging. Where there have been studies, mind-body practices have been found to safely and effectively reduce chronic pain in both adults and children. A great advantage of these treatments is that they have little or no side effects other than positive ones and are thus a promising safe alternative to the use of dangerous drugs. But, there is obviously a need for much more research on the effectiveness of mind-body techniques for chronic pain in children.

 

So, reduce pain in children with mind-body practices.

 

“Mindfulness provides a more accurate perception of pain . . . For instance, you might think that you’re in pain all day. But bringing awareness to your pain might reveal that it actually peaks, valleys and completely subsides. One of Goldstein’s clients believed that his pain was constant throughout the day. But when he examined his pain, he realized it hits him about six times a day. This helped to lift his frustration and anxiety.” –  Margarita Tartakovsky

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Brown, M. L., Rojas, E., & Gouda, S. (2017). A Mind–Body Approach to Pediatric Pain Management. Children, 4(6), 50. http://doi.org/10.3390/children4060050

 

Abstract

Pain is a significant public health problem that affects all populations and has significant financial, physical and psychological impact. Opioid medications, once the mainstay of pain therapy across the spectrum, can be associated with significant morbidity and mortality. Centers for Disease and Control (CDC) guidelines recommend that non-opioid pain medications are preferred for chronic pain outside of certain indications (cancer, palliative and end of life care). Mindfulness, hypnosis, acupuncture and yoga are four examples of mind–body techniques that are often used in the adult population for pain and symptom management. In addition to providing significant pain relief, several studies have reported reduced use of opioid medications when mind–body therapies are implemented. Mind–body medicine is another approach that can be used in children with both acute and chronic pain to improve pain management and quality of life.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483625/