Improve Chronic Neck Pain with Yoga

Improve Chronic Neck Pain with Yoga

 

By John M. de Castro, Ph.D.

 

“yoga may be an effective treatment for people dealing with chronic neck pain, and that it may also result in improved psychological effects.” – Nicole Joseph

 

We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. But, for many, pain is a constant in their lives. The most common forms of chronic pain are back and neck pain. Neck pain is the number three cause of chronic pain; affecting more than a quarter of Americans.

There is a myriad of causes for chronic neck pain, including something as simple as improper positioning while sleeping, or even sitting or standing with bad posture. It can also occur due to injuries, accidents, heavy lifting or other spinal issues.

 

Just as there are many different causes there are also a plethora of treatments for neck pain. The most common is the use of drugs, including over –the-counter pain relievers and at times opiates. These are helpful but have limited effectiveness and opiates can lead to addiction and even death. Sometimes the pain can lead to surgical interventions that can be costly and are not always effective. So, alternative treatments such as acupuncture have also been used with some success. Physical therapy and chiropractic care have also been shown to be effective. Mindfulness practices, in general, are effective in treating pain and specific practices such as yoga can 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 neck pain for many individuals.

 

There has been a considerable amount of research on the effects of yoga practice on chronic neck pain. So, it makes sense to step back and summarize what has been discovered. In today’s Research News article “Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407933/ ), Li and colleagues review, summarize, and perform a meta-analysis of the 10 published randomized controlled trials of the application of yoga practice for chronic neck pain.

 

They report that the published research found that yoga practice significantly reduced neck pain and neck pain related disability in comparison to other exercises except Pilates which produced an equivalent relief of pain and disability. These studies also found that yoga practice significantly improved the range of motion in the neck, the physical and mental quality of life, anxiety, and depression. They summarized only on short-term studies. But there were 3 studies that found significant improvements in the chronic neck pain patients that were still present 3 month later.

 

Hence, the published controlled research studies found that yoga practice was safe and effective for the treatment of chronic neck pain with suggestions that the benefits are long lasting. These are very promising results that suggest that yoga practice should be recommended for the treatment of patients with chronic neck pain, relieving the pain and disability, improving motion, quality of life, and mood.

 

So, improve chronic neck pain with yoga.

 

“yoga might enhance both the toning of muscles and releasing of muscle tension. Relaxation responses, therefore, could reduce stress related muscle tension and modify neurobiological pain perception. . .  lyengar yoga can be a safe and effective treatment option for chronic neck pain.” – Science Daily

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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Study Summary

 

Li, Y., Li, S., Jiang, J., & Yuan, S. (2019). Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis. Medicine, 98(8), e14649.

 

Abstract

Background:

Chronic nonspecific neck pain (CNNP) has a high prevalence and is more common among younger people. Clinical practice suggests that yoga is effective in relieving chronic pain.

Objectives:

This meta-analysis aimed to quantitatively summarize the efficacy of yoga for treating CNNP.

Data sources:

We searched for trials in the electronic databases from their inception to January 2019. English databases including PubMed, MEDLINE, Cochrane Library, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and Ind Med; Chinese databases including China National Knowledge Infrastructure (CNKI), WanFang Database, and VIP Information. We also conducted a manual search of key journals and the reference lists of eligible papers to identify any potentially relevant studies we may have missed. We placed no limitations on language or date of publication.

Study eligibility criteria:

We included only randomized controlled trials (RCTs) and q-RCTs evaluating the effects of yoga on patients with CNNP. The primary outcomes for this review were pain and disability, and the secondary outcomes were cervical range of motion (CROM), quality of life (QoL), and mood.

Participants and interventions:

Trails that examined the clinical outcomes of yoga intervention in adults with CNNP compared with those of other therapies except yoga (e.g., exercise, pilates, usual care, et al) were included.

Study appraisal and synthesis methods:

Cochrane risk-of-bias criteria were used to assess the methodological quality, and RevMan 5.3 software was used to conduct the meta-analysis.

Results:

A total of 10 trials (n = 686) comparing yoga and interventions other than yoga were included in the meta-analysis. The results show that yoga had a positive effects on neck pain intensity (total effect: SMD = −1.13, 95% CI [−1.60, −0.66], Z = 4.75, P < .00001), neck pain-related functional disability (total effect: SMD = −0.92, 95% CI [−1.38, −0.47], Z = 3.95, P < .0001), CROM (total effect: SMD = 1.22, 95% CI [0.87, 1.57], Z = 6.83, P < .00001), QoL (total effect: MD = 3.46, 95% CI [0.75, 6.16], Z = 2.51, P = .01), and mood (total effect: SMD = −0.61, 95% CI [−0.95, −0.27], Z = 3.53, P = .0004).

Conclusions and implications of key findings:

It was difficult to make a comprehensive summary of all the evidence due to the different session and duration of the yoga interventions, and the different outcome measurement tools in the study, we draw a very cautious conclusion that yoga can relieve neck pain intensity, improve pain-related function disability, increase CROM, improve QoL, and boost mood. This suggests that yoga might be an important alternative in the treatment of CNNP.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407933/

 

Reduce Pain Catastrophizing and Pain with Mindfulness

Reduce Pain Catastrophizing and Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

People often increase the pain experience by adding to the physical sensations with a host of thoughts and feelings, like catastrophizing the pain or trying to suppress and ignore the pain. Mindfulness is a practice of attending to pain — or body sensations — and thoughts and feelings with that present-moment attention in an accepting and curious manner.” – Susan Smalley

 

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. Some of the effects of mindfulness practices are to alter thought processes, changing what is thought about. In terms of pain, mindfulness training, by focusing attention on the present moment has been shown to reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. So, mindfulness may reduce worry and catastrophizing and thereby reduce fibromyalgia pain.

 

In today’s Research News article “Interactive effects of pain catastrophizing and mindfulness on pain intensity in women with fibromyalgia.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198401/ ), Dorado and colleagues recruited adult women suffering with fibromyalgia and had them complete questionnaires measuring mindfulness, pain, pain catastrophizing and fibromyalgia interference in daily activities and keeping a 7-day diary of their daily levels of pain and pain catastrophizing. They then examined predictors of the daily pain intensity and pain catastrophizing.

 

They found a strong positive relationship between pain catastrophizing and pain intensity indicating that the higher the daily levels of catastrophizing the greater the levels of pain. They also found that the higher the levels of mindfulness the lower the levels of daily pain catastrophizing and daily levels of pain. They found that this relationship was modified by facets of mindfulness. In particular, the greater the observing facet of mindfulness the smaller the relationship between daily pain catastrophizing and daily pain intensity. On the other hand, when the mindfulness facets of non-judging and acting with awareness were high then the greater the daily levels of catastrophizing the greater the levels of pain.

 

These relationships suggest that observing mindfully tends to mitigate the relationship of catastrophizing to pain while mindfully non-judging and acting with awareness tends to amplify the relationship. But, overall, mindfulness tends to be associated with lower catastrophizing. It has been shown in other work that mindfulness tends to lower fibromyalgia pain, The present study suggests that it may do so by reducing pain catastrophizing. Even though mindfulness, in general lowers pain and catastrophizing not judging the situation and acting toward it with awareness can actually heighten the effects of catastrophizing on pain.

 

It should be kept in mind that these results are correlational and conclusions about causation cannot be made. In addition, the results are complicated suggesting complex relationships between mindfulness and daily pain and catastrophizing levels. This indicates that further research is needed especially work in which mindfulness is altered by training and then observing the effects of this change on pain levels and catastrophizing and their relationships with each other.

 

So, reduce pain catastrophizing and pain with mindfulness.

 

When pain is consistently part of your day, you can start to dwell on it. You may feel stress and anxiety about the pain you’re feeling now, as well as pain that may occur in the future. Mindfulness may lead to changes in the brain that provide benefits for those with fibromyalgia.” – Peggy Pletcher

 

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

 

Dorado, K., Schreiber, K. L., Koulouris, A., Edwards, R. R., Napadow, V., & Lazaridou, A. (2018). Interactive effects of pain catastrophizing and mindfulness on pain intensity in women with fibromyalgia. Health psychology open, 5(2), 2055102918807406. doi:10.1177/2055102918807406

 

Abstract

The objective of this study was to examine the association between facets of trait mindfulness, pain catastrophizing, and pain severity in a sample of patients with fibromyalgia. Patients with fibromyalgia completed validated baseline and diary assessments of clinical pain, mindfulness, and pain catastrophizing. Multilevel modeling analyses indicated that the daily association between catastrophizing and pain intensity was moderated by certain mindfulness facets. Our findings suggest that various aspects of mindfulness may interact differently with pain and catastrophizing, which may have implications for the design and testing of interventions targeting mindfulness and catastrophizing in fibromyalgia patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198401/

 

Meditation’s Reduction of Pain is Independent of Brain Opioid Systems

Meditation’s Reduction of Pain is Independent of Brain Opioid Systems

 

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. Opioids act on a system in the brain that contains receptors that respond to these drugs. 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. It is not known whether meditations effects on pain are mediated by the same system that responds to opioids.

 

In today’s Research News article “Enhancement of Meditation Analgesia by Opioid Antagonist in Experienced Meditators.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162167/  ), May and colleagues recruited adult experienced meditators who were free of chronic pain and not taking opioid drugs. They were measured for pain responses to an electric shock delivered to the ring finger of the non-dominant hand. They rated the level of pain on a 10-point scale. The participants first rated pain under normal conditions and later while meditating. Those participants who demonstrated a 15% or more reduction in pain while meditating (meditation analgesia) participated in the second half of the experiment. Half the participants received a saline injection and half an injection of Naloxone (an opioid receptor blocker) and repeated the pain testing while meditating. In the next session the participants received either the saline or Naloxone injection that they did not receive in the first session. So, all participants received both saline and Naloxone injections and were tested for their pain sensitivity.

 

They found in the initial test that 85% of the participants demonstrated a 15% or more reduction in pain while meditating (meditation analgesia). This high rate suggests that meditation routinely produces a reduced experience of pain in experienced meditators. In the second phase they found that meditation analgesia was not only not reduced by Naloxone injection but actually significant increased, with larger reductions in both pain intensity and pain unpleasantness to the electric shock after Naloxone injection than after saline injections.

 

The opioid system of the brain is a well-established pain processing system. Its function is blocked by Naloxone. So, the reduction in pain produced by meditation was not affected by disrupting the opioid system. So, meditation analgesia must not be due to changes in this opioid system. It must be processed by a different system in the brain. The increase in meditation analgesia after Naloxone was a surprise, for which there is no viable explanation at this time. Hence, meditation reduces pain sensitivity and does so independent of the brain system that responds to opiates.

 

So, meditation reduces pain sensitivity independent of brain opioid systems.

 

Mindfulness meditation is believed to be a viable alternative to drugs when it comes to pain management. Although research is still in the beginning phases, pilot studies focusing on the benefits of mindfulness have shown promising outcomes for patients suffering from chronic ailments such as fibromyalgia, back pain, migraines, etc.” – Mindworks

 

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

 

May, L. M., Kosek, P., Zeidan, F., & Berkman, E. T. (2018). Enhancement of Meditation Analgesia by Opioid Antagonist in Experienced Meditators. Psychosomatic medicine, 80(9), 807-813.

 

ABSTRACT

Objective

Studies have consistently shown that long-term meditation practice is associated with reduced pain, but the neural mechanisms by which long-term meditation practice reduces pain remain unclear. This study tested endogenous opioid involvement in meditation analgesia associated with long-term meditation practice.

Methods

Electrical pain was induced with randomized, double-blind, cross-over administration of the opioid antagonist naloxone (0.15-mg/kg bolus dose, then 0.2-mg/kg per hour infusion dose) with 32 healthy, experienced meditation practitioners and a standardized open monitoring meditation.

Results

Under saline, pain ratings were significantly lower during meditation (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17) than at baseline (pain intensity: 6.86 ±1.04, t(31) = 2.476, p = .019, Cohen’s d= 0.46; pain unpleasantness: 4.96 ±1.75, t(31) = 3.746, p = .001, Cohen’s d = 0.68), confirming the presence of meditation analgesia. Comparing saline and naloxone revealed significantly lower pain intensity (t(31) = 3.12, p = .004, d = 0.56), and pain unpleasantness (t(31) = 3.47, p = .002, d = 0.62), during meditation under naloxone (pain intensity: 5.53 ± 1.54; pain unpleasantness: 2.95 ± 1.88) than under saline (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17). Naloxone not only failed to eliminate meditation analgesia but also made meditation analgesia stronger.

Conclusions

Long-term meditation practice does not rely on endogenous opioids to reduce pain. Naloxone’s blockade of opioid receptors enhanced meditation analgesia; pain ratings during meditation were significantly lower under naloxone than under saline. Possible biological mechanisms by which naloxone-induced opioid receptor blockade enhances meditation analgesia are discussed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162167/

 

Reduce Painful Diabetic Neuropathy with Mindfulness

Reduce Painful Diabetic Neuropathy with Mindfulness

 

By John M. de Castro, Ph.D.

 

Meditation techniques can help people struggling with neuropathy symptoms live through their pain. It can help to lower stress, improve your coping skills, and decrease your pain intensity. Taking a mind-body approach is a noninvasive technique that provides you with more control over your condition.” – Healthline

 

Managing Diabetes can be difficult on the health and quality of life of the patient. In addition, Diabetes can lead to a very painful condition known as diabetic neuropathy. The high blood glucose levels associated with diabetes can damage nerves and result in a burning pain and numbness, particularly from the legs and feet. It affects the majority of long-term diabetes patients. This is not only painful but is also disruptive to the normal life functions of these patients. There are no cures, but diabetic neuropathy can be prevented by blood glucose control in the diabetic patient with a rigorous program of measured diet and exercise. Treatment for diabetic neuropathy usually involves pain management with drugs.

 

Mindfulness practices have been shown to help with pain management and with quality of life in diabetes patients. It is possible, then, that mindfulness practices may be effective in reducing pain and improving quality of life in patients with diabetic neuropathy. In today’s Research News article “Randomized Trial of the Effect of Mindfulness-Based Stress Reduction on Pain-Related Disability, Pain Intensity, Health-Related Quality of Life, and A1C in Patients With Painful Diabetic Peripheral Neuropathy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734176/ ), Nathan and colleagues examined the effectiveness of mindfulness training on reducing pain and improving the quality of life in patients with Painful diabetic peripheral neuropathy (PDPN).

 

They recruited adults with Type II Diabetes and with Painful diabetic peripheral neuropathy (PDPN). The participants were maintained on their usual pharmacological treatments and randomly assigned to a wait-list or to receive an additional 8-week program, once weekly 2.5 hour sessions and home practice, of Mindfulness-Based Stress Reduction (MBSR). The mindfulness program consists of group discussion and training in sitting, walking, and body scan meditations, and yoga practice. They were measured before and after training and 3 months later for pain related disability, pain severity, pain catastrophizing, health related and diabetic neuropathy related quality of life, depression, diabetes self-care, blood sugar reactions, and A1C levels, a measure of long-term blood glucose control.

 

They found that in comparison to baseline and the wait-list control, the participants who received Mindfulness-Based Stress Reduction (MBSR) training had significantly improved scores on all measures including lower pain related disability, pain severity, pain catastrophizing, depression health related and diabetic neuropathy related quality of life, diabetes self-care, blood sugar reactions, and A1C levels. These improvements were maintained at the 3-month follow-up. In addition, there was a high retention rate with 94% of the treated patients completing the 8-week training and the 3-month follow-up.

 

These results are striking and important. Diabetic Neuropathy is a torment for Type II Diabetes patients and mindfulness training was found to markedly improve this condition. It increased quality of life and health and decreased pain and pain associated psychological and physical difficulties. This relief of suffering in important and remarkable and should lead to a recommendation for mindfulness training to be included in the usual care of patients with Painful diabetic peripheral neuropathy (PDPN).

 

So, reduce painful diabetic neuropathy with mindfulness.

 

“When people with diabetes are more mindful – being calmly aware of what is going on around them, inside their bodies and in their minds – they can potentially make healthier lifestyle choices, such as diet, medication and exercise, that help lower their blood glucose. Additionally, stress reduction decreases the amount of stress hormones, such as cortisol, in the blood. When elevated for too long, cortisol can cause anxiety, depression, digestive problems, heart disease, sleep problems, weight gain and memory and concentration problems.” – Diabetes Canada

 

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

 

Nathan, H. J., Poulin, P., Wozny, D., Taljaard, M., Smyth, C., Gilron, I., Sorisky, A., Lochnan, H., … Shergill, Y. (2017). Randomized Trial of the Effect of Mindfulness-Based Stress Reduction on Pain-Related Disability, Pain Intensity, Health-Related Quality of Life, and A1C in Patients With Painful Diabetic Peripheral Neuropathy. Clinical diabetes : a publication of the American Diabetes Association, 35(5), 294-304.

 

Abstract

IN BRIEF Painful diabetic peripheral neuropathy (PDPN) has a large negative impact on patients’ physical and mental functioning, and pharmacological therapies rarely provide more than partial relief. Mindfulness-based stress reduction (MBSR) is a group psychosocial intervention that was developed for patients with chronic illness who were not responding to existing medical treatments. This study tested the effects of community-based MBSR courses for patients with PDPN. Among patients whose PDPN pharmacotherapy had been optimized in a chronic pain clinic, those randomly assigned to treatment with MBSR experienced improved function, better health-related quality of life, and reduced pain intensity, pain catastrophizing, and depression compared to those receiving usual care.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734176/

 

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/