Pain

Relieve Back Pain with Yoga

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Relieve Back Pain with Yoga

 

By John M. de Castro, Ph.D.

 

“This systematic review found strong evidence for short-term effectiveness and moderate evidence for long-term effectiveness of yoga for chronic low back pain in the most important patient-centered outcomes. Yoga can be recommended as an additional therapy to chronic low back pain patients.” – Holger Cramer

 

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 pain. Yoga practice has been shown to have a myriad of health benefits. These include relief of chronic pain. Yoga 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 therapy for chronic low back pain and the structure of the spine.

 

In today’s Research News article “A Randomized Controlled Trial to Assess Pain and Magnetic Resonance Imaging-Based (MRI-Based) Structural Spine Changes in Low Back Pain Patients After Yoga Practice.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1481032081920713/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031167/

Telles and colleagues recruited patients with degenerative intervertebral discs and randomly assigned them to either yoga or treatment as usual waitlist control groups. The yoga group engaged in light exercises and specific physical yoga postures, breathing exercises, and chanting and yoga relaxation techniques, for one hour per day for 3 months. Before and after treatment the participants were measured for pain, anxiety, and spine flexibility. To look at potential structural alteration, the participants’ spines were measured employing Magnetic Resonance Imaging.

 

They found that yoga practice produced a significant reduction in both pain levels and anxiety. There were no significant changes found in spine flexibility or the structure of the spine including nerve compression, endplate changes, and facet joint change. Hence yoga practice was shown to be effective in reducing subjective pain and the anxiety produced by it. This is in line with previous research but it was disappointing not to see changes in spine flexibility or structure. It appears that yoga practice is safe and moderately effective in treating patients with degenerative intervertebral discs.

 

So, relieve back pain with yoga.

 

“Yoga focuses a great deal of attention to developing both balance and flexibility. Improper spinal alignment can cause back pain and decrease range of motion in the spine. Yoga postures focus on elongating the spine and rediscovering the spine’s range of motion. Practicing a few yoga stretches after work can help straighten and strengthen your spine.” – Nicole Carlin

 

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 Twitter @MindfulResearch

 

Study Summary

Telles, S., Bhardwaj, A. K., Gupta, R. K., Sharma, S. K., Monro, R., & Balkrishna, A. (2016). A Randomized Controlled Trial to Assess Pain and Magnetic Resonance Imaging-Based (MRI-Based) Structural Spine Changes in Low Back Pain Patients After Yoga Practice. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, 22, 3238–3247. http://doi.org/10.12659/MSM.896599

 

Abstract

Background:

The present study aimed at determining whether 12 weeks of yoga practice in patients with chronic LBP and MRI-based degenerative changes would result in differences in: (i) self-reported pain, anxiety, and spinal flexibility; and (ii) the structure of the discs or vertebrae.

Material/Methods:

Sixty-two persons with MRI-proven degenerative intervertebral discs (group mean ±S.D., 36.2±6.4 years; 30 females) were randomly assigned to yoga and control groups. However, testing was conducted on only 40 subjects, so only their data are included in this study. The assessments were: self-reported pain, state anxiety, spinal flexibility, and MRI of the lumbosacral spine, performed using a 1.5 Tesla system with a spinal surface column. The yoga group was taught light exercises, physical postures, breathing techniques, and yoga relaxation techniques for 1 hour daily for 3 months. No intervention was given to the control group except for routine medical care. A repeated-measures analysis of variance (ANOVA) with post hoc analyses (which was Bonferroni-adjusted) was used. The Ethics Committee of Patanjali Research Foundation had approved the study which had been registered in the Clinical Trials Registry of India (CTRI/2012/11/003094).

Results:

The yoga group showed a significant reduction in self-reported pain and state anxiety in a before/after comparison at 12 weeks. A few patients in both groups showed changes in the discs and vertebrae at post-intervention assessment.

Conclusions:

Within 12 weeks, yoga practice reduced pain and state anxiety but did not alter MRI-proven changes in the intervertebral discs and in the vertebrae.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031167/

 

Reduce the Psychological Distress Produced by Chronic Pain with Mindfulness

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Reduce the Psychological Distress Produced by Chronic Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“When it comes to chronic pain, the key is learning to live with it rather than vainly trying to avoid or eradicate it; a regular meditation practice is the best ongoing foundation for working with pain.” – Christiane Wolf

 

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 common chronic pain conditions. 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. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the patients ability to cope with the pain. Pain is affected by the mind. The perception of pain can be amplified by the emotional reactions to it and also by attempts to fight or counteract it. Pain perception can be reduced by aerobic exercise and mental states, including placebo effects, attention, and conditioning. Additionally, mindfulness has been shown to reduce both chronic and acute pain and are safe. Mindfulness may be an effective treatment to be used in combination with other treatments. Hence, it is important to study mindfulness practice effects on chronic pain and the psychological distress it produces.

 

In today’s Research News article “A 13-Weeks Mindfulness Based Pain Management Program Improves Psychological Distress in Patients with Chronic Pain Compared with Waiting List Controls.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1473967172627204/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037934/

Andersen and Vægter recruited patients with chronic non-malignant pain who entered a pain clinic for treatment and a control group on the waiting list for treatment at the clinic. Both groups received medical treatment as usual, but the intervention group in addition received a 13-week Mindfulness-Based Cognitive Behavior Therapy (MBCT) program. Therapy was conducted once a week in a 2.5-hour session, combined with homework assignments supported with written and recorded materials. Patients were measured for pain intensity, pain catastrophizing, pain acceptance, anxiety, depression, mindfulness, and psychological distress prior to and after treatment.

 

It was found that the Mindfulness-Based Cognitive Behavior Therapy (MBCT) program produced a significant decrease in depression, anxiety, psychological distress, and pain catastrophizing, and an increase in pain acceptance and mindfulness. There were no significant changes in pain intensity. The change in mindfulness and also in pain acceptance were highly correlated with the reduction in psychological distress. Hence, MBCT reduced the psychological impact of chronic pain without changing the perception of pain. It appears to do so by increasing mindfulness and pain acceptance.

 

These are interesting results that suggest that Mindfulness-Based Cognitive Behavior Therapy (MBCT) is a safe and effective adjunct treatment for patients with chronic pain. The fact that MBCT improved mindfulness is expected as mindfulness training is targeted to do just that. The fact that MBCT also improves pain acceptance is also expected as Cognitive Behavioral Therapy is targeted to do so. In addition, mindfulness training and MBCT have been shown to reduce anxiety, depression, and worry and catastrophizing. So, the results would be expected. But, it is always important to confirm even expected outcomes.

 

So, reduce the psychological distress produced by chronic pain with mindfulness.

 

“It is still early days in terms of understanding why meditation can be so helpful in coping with pain, although the ancient origins of meditation in the different yoga and contemplative traditions suggests that people have known of these benefits for hundreds of years.” – Jean Byrne

 

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 Twitter at @MindfulResearch

 

Study Summary

Andersen, T. E., & Vægter, H. B. (2016). A 13-Weeks Mindfulness Based Pain Management Program Improves Psychological Distress in Patients with Chronic Pain Compared with Waiting List Controls. Clinical Practice and Epidemiology in Mental Health : CP & EMH, 12, 49–58. http://doi.org/10.2174/1745017901612010049

 

Abstract

Background:: Eradication of pain is seldom an option in chronic pain management. Hence, mindfulness meditation has become popular in pain management.

Objective: This pilot study compared the effect of a 13-weeks cognitive behavioural therapy program with integrated mindfulness meditation (CBTm) in patients with chronic non-malignant pain with a control condition. It was hypothesised that the CBTm program would reduce pain intensity and psychological distress compared to the control condition and that level of mindfulness and acceptance both would be associated with the reduction in pain intensity and psychological distress.

Methods: A case-control design was used and data were collected from a convenience sample of 70 patients with chronic non-malignant pain. Fifty patients were consecutively recruited to the CBTm intervention and 20 patients matched waiting list controls. Assessments of clinical pain and psychological distress were performed in both groups at baseline and after 13 weeks.

Results: The CBTm program reduced depression, anxiety and pain-catastrophizing compared with the control group. Increased level of mindfulness and acceptance were associated with change in psychological distress with the exception of depression, which was only associated with change in level of mindfulness. Surprisingly, changes in level of mindfulness did not correlate with changes in acceptance.

Conclusions: The results indicate that different mechanisms are targeted with cognitive behavioural therapy and mindfulness. The finding that changes in level of mindfulness did not correlate with changes in acceptance may indicate that acceptance is not a strict prerequisite for coping with pain related distress.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037934/

 

Reduce Pelvic Pain in Women with Yoga

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By John M. de Castro, Ph.D.

 

“women need to start a relationship with their pelvis, looking at the outside of it, touching the inside of it, talking and listening to it, and loving it. If you are having problems with your pelvic floor, it’s telling you, “Hey, I am here and you’ve been ignoring me and something has to change.” – Leslie Howard

 

Chronic pelvic pain (CPP) is focused in the area below the naval and between the hips and lasts six months or longer. CPP can have multiple causes; a symptom of another disease, or it can be a condition in its own right. Millions of men and women suffer from pelvic floor dysfunction every year. In fact, over 4 million American women under the age of 40 are diagnosed with pelvic pain or incontinence. Despite this staggering figure, people often feel alone, ashamed, and frustrated with the process of being properly diagnosed and treated. There are two strategies to treating chronic pelvic pain (CPP), either treating the symptoms or the underlying cause. Typically, it is treated with drugs and/or hormones, including pain relievers, antibiotics, antidepressants, and birth control pills, with physical or psychological therapy, or even with surgery.

 

Yoga practice has been shown to have a myriad of health benefits. These include relief of chronic pain. So, it makes sense to explore the effectiveness of yoga therapy for CPP in combination with treatment as usual. In today’s Research News article “Effects of yogic intervention on pain scores and quality of life in females with chronic pelvic pain.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1438108362879752/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ijoy.org.in/article.asp?issn=0973-6131;year=2017;volume=10;issue=1;spage=9;epage=15;aulast=Saxena

Saxena and colleagues recruited patients with chronic pelvic pain (CPP) and randomly assigned them to receive either treatment as usual or treatment as usual in combination with yoga therapy. The women were measured for pain levels and quality of life both before and after the 8-weeks of treatment. Yoga therapy occurred 5 times per week for 8 weeks and included deep breathing, chanting, postures, regulated breathing and relaxation, etc.

 

They found that the two groups had equivalent levels of pain before treatment, but after treatment the pain levels of the yoga therapy group were reduced virtually in half while the treatment as usual group was unchanged. In addition, yoga therapy produced significant improvements in the quality of life by about a third for the patients, with increases in the physical, psychological, and social domains of quality of life, and a significant but smaller increase in the environmental domain.

 

These are excellent results that indicate that yoga therapy can produce clinically significant improvements in pain levels and quality of life in patients with chronic pelvic pain (CPP). Since yoga practice is known to strengthen the abdominal muscles, this may be the reason for the improvements. In addition, the contemplative components of yoga therapy are known to improve the individual’s ability to cope with chronic pain and this may also be responsible for the improvements. Regardless, it is clear that yoga therapy is a safe and effective treatment that complements treatment as usual and produces clinically significant improvements in CPP.

 

So, reduce pelvic pain in women with yoga.

 

“The physical postures of yoga can help relieve pain in a number of ways. The most obvious is the ability of a well-rounded yoga practice to lower stress levels. Stress makes muscles more likely to go into spasm, and muscle spasms are an underappreciated contributor to both acute and chronic pain. . . The practice of asana, beyond its ability to induce relaxation, can be an effective way to relieve muscle tightness. In contrast to many other forms of exercise, yoga promotes both strength and flexibility in muscles.” – Timothy McCall

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Saxena R, Gupta M, Shankar N, Jain S, Saxena A. Effects of yogic intervention on pain scores and quality of life in females with chronic pelvic pain. Int J Yoga [serial online] 2017 [cited 2016 Nov 23];10:9-15. Available from: http://www.ijoy.org.in/text.asp?2017/10/1/9/186155

 

Abstract

Context: Chronic pelvic pain (CPP) is a common condition of women of the reproductive age group. It has a negative impact on a woman’s personal health and quality of life (QOL). Practicing yoga has shown numerous benefits in various chronic painful conditions.
Aim: To study the effects of yogic intervention on pain scores and quality of life in females of reproductive age group with CPP, on conventional therapy.
Settings and Design: It is a follow-up, randomized case-control study done in a tertiary care hospital.
Subjects and Methods: Sixty female patients of CPP in the age group of 18-45 years were randomly divided into Group I (n = 30) and Group II (n = 30). Group I received only conventional therapy in the form of NSAIDS and Group II received yoga therapy in the form of asanas, pranayama, and relaxation along with the conventional therapy for 8 weeks. They were assessed twice (pre- and post-treatment) for pain scores through visual analog scale (VAS) score and QOL by the World Health Organization quality of life-BREF (WHOQOL-BREF) questionnaire.
Statistical Analysis Used: Repeated measure ANOVA followed by Tukey’s test. P < 0.05 was considered significant.
Results: After 8 weeks of yogic intervention, Group II patients showed a significant decrease in intensity of pain seen by a decrease in VAS score (P < 0.001) and improvement in the quality of life with a significant increase (P < 0.001) in physical, psychological, social, and environmental domain scores of WHOQOL-BREF.
Conclusions: The practice of yoga causes a reduction in the pain intensity and improves the quality of life in patients with chronic pelvic pain.

http://www.ijoy.org.in/article.asp?issn=0973-6131;year=2017;volume=10;issue=1;spage=9;epage=15;aulast=Saxena

 

Reduce the Pain of Knee Osteoarthritis with Tai Chi

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By John M. de Castro, Ph.D.

 

“tai chi provides benefit by improving muscle strength and coordination, which leads to better joint stability. In addition, the mind-body aspects and breath control promote mental calmness, which may help to break the cycle of arthritis pain.” – Harvard Health

 

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. In the U.S., osteoarthritis affects 14% of adults over 25 years of age and 34% of those over 65.

 

Knee osteoarthritis effects 5% of adults over 25 years of age and 12% of those over 65. It involves the whole joint, including articular cartilage, meniscus, ligament, and peri-articular muscle. 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 appears 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 and mind-body practices in general have been shown to reduce the gene expressions that underlie the inflammatory response which contribute to arthritis. Tai Chi would seem on the surface to be perfect treatment as it involves slow gentle movement of the limbs and mindfulness and has been shown to be beneficial for a wide range of conditions. Indeed, it has been shown to reduce the physical symptoms of knee osteoarthritis. So, it would seem reasonable to look further into the effectiveness of Tai Chi, in treating knee osteoarthritis.

 

In today’s Research News article “A Supplemental Report to a Randomized Cluster Trial of a 20-Week Sun-Style Tai Chi for Osteoarthritic Knee Pain in Elders with Cognitive Impairment.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1426470794043509/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725717/

Tsai and colleagues performed a multicenter randomized controlled trial of the effectiveness of Tai Chi for the treatment of the pain from knee osteoarthritis. They recruited elderly (aged 60 and over) patients with knee osteoarthritis who also had cognitive impairment and randomly assigned them to either practice Tai Chi for 3 40-minute sessions per week for 20 weeks or a control condition that received attention control education on an identical schedule. Before and after training and four times during training the patients were measured for pain, pain behaviors, and analgesic intake.

 

They found over training Tai Chi practice produced a significant reduction in pain and analgesic intake that increased in magnitude over time. There was also a significant reduction in pain behaviors. The effects were not affected by the degree of cognitive impairment. Unfortunately, there was no follow-up evaluation to determine if the effects last beyond the times of active practice. They also did not have another exercise for comparison. So, it can’t be determined if the gentle exercise or the mindfulness properties of Tai Chi were effective.

 

These are interesting results that extend the findings that Tai Chi is an effective treatment for the pain of knee osteoarthritis. They also demonstrated that Tai Chi was effective regardless of cognitive impairment. Since, the ancient gentle practice of Tai Chi is completely safe, can be used with the elderly and sickly, and is inexpensive to administer, it would appear to be an excellent treatment for knee osteoarthritis sufferers.

 

So, reduce the pain of knee osteoarthritis with tai chi.

 

“Tai chi helps patients preserve and improve function by increasing strength, flexibility and coordination while avoiding aggravation of arthritic pain and inflammation. Tai chi is a particularly appealing form of exercise, as it is very low impact and emphasizes balance, coordination and strength. Tai chi is safe and has been shown to reduce falls in the elderly.” – Matthew Hepinstall

 

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Tsai, P.-F., Chang, J. Y., Beck, C., Kuo, Y.-F., Keefe, F. J., & Rosengren, K. (2015). A Supplemental Report to a Randomized Cluster Trial of a 20-Week Sun-Style Tai Chi for Osteoarthritic Knee Pain in Elders with Cognitive Impairment. Complementary Therapies in Medicine, 23(4), 570–576. http://doi.org/10.1016/j.ctim.2015.06.001

 

Abstract

Objective: This was a secondary data analysis of a cluster-randomized clinical trial that tested the efficacy of a 20-week Sun-style Tai Chi (TC) program in reducing pain in community-dwelling elders with cognitive impairment and knee osteoarthritis (OA). The study also examined whether elders’ level of cognitive function was related to the outcomes of the TC program.

Method: Elders (N=55) were recruited from 8 study sites. Each site was randomly assigned to participate in either a 20-week TC or an education program. Verbal report of pain was measured by a Verbal Descriptor Scale (VDS) at Weeks 1, 5, 9, 13, 17 and 21 (designated as Times 1-6). Pain behaviors and analgesic intake were also recorded at Times 1-6.

Results: At post-test, scores on the VDS and observed pain behaviors were significantly better in the TC group than in the control group (p=.008-.048). The beneficial effects of TC were not associated with cognitive ability.

Conclusion: These results suggest that TC can be used as an adjunct to pharmacological intervention to relieve OA pain in elders with cognitive impairment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725717/

 

Help Headaches in Adolescents with Mindfulness

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By John M. de Castro, Ph.D.

 

“Mindfulness meditation is proving to be of significant help in not only reducing migraines or chronic pain, but improvements in mood, outlook on life and illness, increased coping skills, enhanced sense of well-being, changes in perception of pain, higher tolerance of pain, enhanced immune function, less fatigue and stress and better sleep.” – Cynthia Perkins

 

Headaches are the most common disorders of the nervous system. It has been estimated that 47% of the adult population have a headache at least once during the last year. There are a wide variety of drugs that are prescribed for chronic headache pain with varying success. Headaches are treated with pain relievers, ergotamine, blood pressure drugs such as propranolol, verapamil, antidepressants, antiseizure drugs, and muscle relaxants. Drugs, however, can have some problematic side effects particularly when used regularly and are ineffective for many sufferers. So, almost all practitioners consider lifestyle changes that help control stress and promote regular exercise to be an important part of headache treatment and prevention. Avoiding situations that trigger headaches is also vital.

 

Mindfulness training has been shown to be an effective treatment for headache pain in adults. It is not known whether it is also effective for adolescents. Yet, 60% of children and adolescents report headaches, with 20% having frequent or severe headaches. In today’s Research News article “Mindfulness-Based Intervention for Adolescents with Recurrent Headaches: A Pilot Feasibility Study.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1415631915127397/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700163/

Hesse and colleagues study the effectiveness of mindfulness training for recurrent headaches in adolescents. They recruited adolescent females with recurrent headaches. The teens received group mindfulness training once a week for 1 to 1.5 hours for 12 weeks. Before and after training the adolescents recorded their mindfulness practices and headaches, and completed scales measuring headache-related disability, anxiety, depression, and quality of life, while their parents also completed a report of the teens’ quality of life.

 

They found that mindfulness training did not produce any changes in the frequency or severity of headaches, headache-related disability, or anxiety, but a significant reduction in depression and an improvement in acceptance of headache pain. The parents reported that the adolescents had improved physical quality of life. Hence, mindfulness training improved the teen’s depression, quality of life, and acceptance of pain but not the headaches themselves. These are encouraging results that need to be followed up with a large randomized controlled clinical trial. But, they suggest that mindfulness training may be a useful treatment for headache pain in adolescents.

 

Mindfulness practices may be helpful with headache pain by focusing attention on the present moment. This has been shown to reduce worry and catastrophizing which, in turn, reduces depression. Pain is increased by worry about the pain and the expectation of greater pain in the future. So, reducing worry and catastrophizing can reduce headache pain. Mindfulness teaches the individual to view pain as a present moment experience that can be experienced just as it is and accept it. As a result, the individual accepts the pain and stops fighting against it, which can amplify the pain.

 

So, help headaches in adolescents with mindfulness.

 

“Years of research and clinical experience demonstrate that behavioral medicine methods can have a powerful effect on pain, especially when used in conjunction with medical treatment. Behavioral medicine examines and trains an individual to become aware of the power of the mind and emotions on physical health. One potent method for recovering health is meditation.” – Michigan Headache & Neurological Institute

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Hesse, T., Holmes, L. G., Kennedy-Overfelt, V., Kerr, L. M., & Giles, L. L. (2015). Mindfulness-Based Intervention for Adolescents with Recurrent Headaches: A Pilot Feasibility Study. Evidence-Based Complementary and Alternative Medicine : eCAM, 2015, 508958. http://doi.org/10.1155/2015/508958

 

Abstract

Recurrent headaches cause significant burden for adolescents and their families. Mindfulness-based interventions (MBIs) have been shown to reduce stress and alter the experience of pain, reduce pain burden, and improve quality of life. Research indicates that MBIs can benefit adults with chronic pain conditions including headaches. A pilot nonrandomized clinical trial was conducted with 20 adolescent females with recurrent headaches. Median class attendance was 7 of 8 total sessions; average class attendance was 6.10 ± 2.6. Adherence to home practice was good, with participants reporting an average of 4.69 (SD = 1.84) of 6 practices per week. Five participants dropped out for reasons not inherent to the group (e.g., extracurricular scheduling); no adverse events were reported. Parents reported improved quality of life and physical functioning for their child. Adolescent participants reported improved depression symptoms and improved ability to accept their pain rather than trying to control it. MBIs appear safe and feasible for adolescents with recurrent headaches. Although participants did not report decreased frequency or severity of headache following treatment, the treatment had a beneficial effect for depression, quality of life, and acceptance of pain and represents a promising adjunct treatment for adolescents with recurrent headaches.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700163/

 

ACT On-line to Reduce Chronic Pain

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By John M. de Castro, Ph.D.

 

“What kind of therapy is beneficial?  What are the specific components of therapy most applicable to people with chronic pain?  I can tell you that mindfulness, CBT, and ACT based interventions are definitely part of the equation, i.e., they are always helpful.  In fact, mindfulness practice is often a necessary component of healing.” – Howard Schubiner, MD

 

We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. For many, however, pain is a constant in their lives. Chronic pain affects a wide swath of humanity.  At least 100 million adult Americans have common 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 prescription opioid overdoses kill more than 14,000 people annually. Fortunately, there are alternative treatments. Mindfulness and yoga practices have been shown to improve pain. A therapeutic technique that includes mindfulness training called Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating a number of physical and psychological disorders and has been shown to successfully improve acceptance of chronic pain, pain intensity, satisfaction with life, and physical functioning in patients with chronic pain.

 

Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, it teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. At its core, ACT is targeted at increasing psychological flexibility, which is an ability to modify behavior based upon conscious and open contact with thoughts, feelings, and sensory experiences, and in a manner that reflects the individual’s values and goals.

 

An impediment to widespread adoption of various psychotherapy techniques, including ACT, is that they require a trained professional therapist and attendance at scheduled therapy sessions. This can make the treatments expensive and inconvenient. The internet holds great promise to deliver therapy inexpensively and conveniently to large numbers of people spread across wide geographic areas. Mindfulness training has been successfully conducted over the internet with positive benefit. ACT has been successfully has been delivered on-line reducing depression. So, on-line ACT training appears to be a viable method for treatment.

 

In today’s Research News article “Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1369590659731523/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786566/

Trompetter and colleagues investigate the effectiveness of ACT, delivered on-line, to treat chronic pain and what variable might predict the kinds of patients who are most likely to have positive responses to ACT. They recruited patients suffering from chronic pain and randomly assigned them to either receive 12-weeks of on-line ACT treatment or Expressive Writing Treatment or to a waitlist control group. They measured pain and pain interference in daily life before and after treatment and 3 months after the conclusion of treatment. Before treatment they also measured demographic variables, pain intensity, pain disability, psychological distress, and mental health.

 

They found that ACT produced a significant reduction in pain interference in daily life and that this effect was moderated by the psychological well-being of the participants. That is, that participants with high levels of psychological well-being had much greater benefit from ACT than those at lower levels. There were no other significant predictors of benefit. These results suggest that ACT conducted on-line can be effective in reducing the interference from pain in the conduct of the daily lives of chronic pain patients. This is important as on-line presentation can greatly increase the scalability, affordability, and convenience of treatment for the huge numbers of chronic pain patients. The results further indicate that on-line ACT should be used primarily for patients who have moderate to high levels of psychological well-being at the beginning.

 

So, ACT on-line to reduce chronic pain.

 

“Overall, it appears that the cognitive-behavioral approach has a positive effect when combined with active treatments such as medications, physical therapy, and medical treatments for chronic pain clients in treating pain, thoughts about pain, and pain behavior problems.” –  Carrie L. Winterowd

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Trompetter, H. R., Bohlmeijer, E. T., Lamers, S. M. A., & Schreurs, K. M. G. (2016). Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective. Frontiers in Psychology, 7, 353. http://doi.org/10.3389/fpsyg.2016.00353

 

Abstract

The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (in)effective. In this study, we primarily explored for which chronic pain patients web-based Acceptance and Commitment Therapy (ACT) was (in)effective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following either web-based ACT (n = 82), or one of two control conditions [web-based Expressive Writing (EW; n = 79) and Waiting List (WL; n = 77)] were analysed. ACT and EW both consisted of nine modules and lasted nine to 12 weeks. Exploratory linear regression analyses were performed using the PROCESS macro in SPSS. Pain interference at 3-month follow-up was predicted from baseline moderator (characteristics that influence the outcome of specific treatments in comparison to other treatments) and predictor (characteristics that influence outcome regardless of treatment) variables. The results showed that none of the demographic or physical characteristics moderated ACT treatment changes compared to both control conditions. The only significant moderator of change compared to both EW and WL was baseline psychological wellbeing, and pain intensity was a moderator of change compared to EW. Furthermore, higher pain interference, depression and anxiety, and also lower levels of emotional well-being predicted higher pain interference in daily life 6 months later. These results suggest that web-based self-help ACT may not be allocated to chronic pain sufferers experiencing low levels of mental resilience resources such as self-acceptance, goals in life, and environmental mastery. Other subgroups are identified that potentially need specific tailoring of (web-based) ACT. Emotional and psychological wellbeing should receive much more attention in subsequent studies on chronic pain and illness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786566/

 

Lessen a Pain in the Neck with Yoga

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By John M. de Castro, Ph.D.

 

“Many people suffer from neck pain on a regular basis. Stress, poor posture, accidents, and long-stored physiological tension can contribute to a mild stiff neck or even a full-blown muscle spasm of the neck, shoulders, and upper back. When confronted with neck pain, we tend turn to medication or a heating pad for relief. However, there are several yoga poses that have therapeutic effects on the neck as well. The next time you have a twinge of pain, turn yoga poses for relief from neck pain and tension.” – Adam Brady

 

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. Indeed, back pain is the number one cause of disability worldwide. In addition, neck pain is the number three cause of chronic pain; affecting more than a quarter of Americans. People who experience chronic back and neck pain are limited in their daily activities and may compensate in order to walk, run, sit, etc. and the compensatory postures can produce further sometimes different problems.

 

There are a myriad of causes for chronic back and 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. These types of pain are not only a problem for the individual but are also costly for society as they constitute the largest category of medical insurance claims.

 

Just as there are many different causes there are also a plethora of treatments for back and 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. We’ve seen in previous posts that 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 back and neck pain for many individuals.

 

In today’s Research News article “Effects of yoga on chronic neck pain: a systematic review of randomized controlled trials.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1368694369821152/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971133/

Kim summarized the published research literature on the effectiveness of yoga practices for the treatment of neck pain. They could only identify three controlled trials. These trials reported that, in comparison to control conditions, yoga practice significantly reduced neck pain intensity and the functional disabilities resulting from chronic neck pain.

 

Hence, the limited research available suggests that yoga practice is effective in treating chronic neck pain. It should be noted that none of the trials included a placebo control group or an active control. So, it is difficult to make firm conclusions. But, what evidence is available suggests that this ancient practice can be helpful in reducing neck pain and its consequent disabilities. Great care, however, should be taken with yoga practice and proper instruction by a certified yoga teacher should be obtained to prevent further injury.

 

So, lessen of a pain in the neck with yoga.

 

“Hatha is the sanctuary for those suffering every type of pain. It is the foundation for those practicing every type of Yoga.” ~Svatmarama

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Kim, S.-D. (2016). Effects of yoga on chronic neck pain: a systematic review of randomized controlled trials. Journal of Physical Therapy Science, 28(7), 2171–2174. http://doi.org/10.1589/jpts.28.2171

 

Abstract

[Purpose] The aim of this study was to investigate the effectiveness of yoga in the management of chronic neck pain. [Subjects and Methods] Five electronic databases were searched to identify randomized controlled trials (RCTs) of yoga intervention on chronic neck pain. The trials were published in the English language between January 1966 and December 2015. The Cochrane Risk of Bias Tool was used to assess the quality of the trials. [Results] Three trials were identified and included in this review. A critical appraisal was performed on the trials, and the result indicated a high risk of bias. A narrative description was processed because of the small number of RCTs. Neck pain intensity and functional disability were significantly lower in the yoga groups than in the control groups. [Conclusion] Evidence from the 3 randomly controlled trials shows that yoga may be beneficial for chronic neck pain. The low-quality result of the critical appraisal and the small number of trials suggest that high-quality RCTs are required to examine further the effects of yoga intervention on chronic neck pain relief.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971133/

 

Reduce Pain with Meditation Rather Than Drugs

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By John M. de Castro, Ph.D.

 

“For some people with chronic pain, mindful meditation is an appealing pain management option because it has an unusual benefit; it is something that you personally control. Unlike pain medications or medical procedures, meditation is not done to you, it is something you can do for yourself.” – Stephanie Burke

 

Pain can be difficult to deal with, particularly if it’s persistent. But, even short-term pain, acute pain, is unpleasant. Pain, however, 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. Nevertheless, it would be useful to find ways to lower the intensity of perceived pain and improve recovery from painful stimuli. Pain signals are processed in the brain and the state of the brain can alter the perception of pain. Indeed, opioid drugs are very effective pain killers and they work by affecting opioid receptors in the brain that are important in the perception of pain.

 

Pain is affected by the mind. The perception of pain can be amplified by the emotional reactions to it and also by attempts to fight or counteract it. Pain perception can be reduced by aerobic exercise and mental states, including placebo effects, attention, and conditioning. Additionally, contemplative practices have been shown to reduce both chronic and acute pain. It has been shown that exercise and mental states affect pain perception via opioid receptors. Their effects on pain can be prevented by the injection of a drug, naloxone, that blocks opioid receptors. Hence, mental states appear to alter pain perception through effects on the opioid system in the brain. But, it is not known if contemplative practices act in the same way.

 

In today’s Research News article “Mindfulness-Meditation-Based Pain Relief Is Not Mediated by Endogenous Opioids.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1361495810541008/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792946/

Zeidan and colleagues examine the involvement of opioid receptors in the pain reduction produced by meditation practice. They recruited participants who had no experience with meditation and randomly assigned them to four groups. Two groups engaged in meditation for 20 minutes per day for four days, while two groups listened to an audiobook for 20 minutes per day for four days. One meditation group and one no-meditation group received a naloxone injection while the other two groups received injections of a non-active saline solution. Both participants and experimenters were blind as to whether they were receiving naloxone or saline. Before and after injection, participants were tested while meditating or resting for sensitivity to pain induced by heat to the skin. Participants rated their perceived pain to different levels of heat.

 

They found that mindfulness meditation reduced pain perception by 21% and pain unpleasantness by 36% relative to resting controls. This occurred for the meditation groups regardless of whether naloxone or saline was injected. So, the opioid receptor blocking drug naloxone had no effect on the reductions in pain produced by meditation. Hence, meditation, unlike other mental states, appears to reduce pain independent of the opioid pain system in the brain.

 

There are a number of effects of meditation that might underlie the reduction in pain perception. 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. Meditation practices have been shown to reduce stress responses and anxiety, and to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. So, it would seem reasonable that mindfulness practices would be helpful in pain management. In addition, pain is accompanied by, and frequently caused by, inflammation and meditation has been shown to reduce the inflammatory response. This may account for the mindfulness’ effects on the physical aspects of chronic pain.

 

So, reduce pain with meditation rather than drugs.

 

“Meditation teaches patients how to react to the pain. People are less inclined to have the ‘Ouch’ reaction, and are able to control their emotional reaction to pain.” – BRIAN STEINER

 

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Fadel Zeidan, Adrienne L. Adler-Neal, Rebecca E. Wells, Emily Stagnaro, Lisa M. May, James C. Eisenach, John G. McHaffie, Robert C. Coghill. Mindfulness-Meditation-Based Pain Relief Is Not Mediated by Endogenous Opioids. J Neurosci. 2016 Mar 16; 36(11): 3391–3397. doi: 10.1523/JNEUROSCI.4328-15.2016

 

Abstract

Mindfulness meditation, a cognitive practice premised on sustaining nonjudgmental awareness of arising sensory events, reliably attenuates pain. Mindfulness meditation activates multiple brain regions that contain a high expression of opioid receptors. However, it is unknown whether mindfulness-meditation-based analgesia is mediated by endogenous opioids. The present double-blind, randomized study examined behavioral pain responses in healthy human volunteers during mindfulness meditation and a nonmanipulation control condition in response to noxious heat and intravenous administration of the opioid antagonist naloxone (0.15 mg/kg bolus + 0.1 mg/kg/h infusion) or saline placebo. Meditation during saline infusion significantly reduced pain intensity and unpleasantness ratings when compared to the control + saline group. However, naloxone infusion failed to reverse meditation-induced analgesia. There were no significant differences in pain intensity or pain unpleasantness reductions between the meditation + naloxone and the meditation + saline groups. Furthermore, mindfulness meditation during naloxone produced significantly greater reductions in pain intensity and unpleasantness than the control groups. These findings demonstrate that mindfulness meditation does not rely on endogenous opioidergic mechanisms to reduce pain.

SIGNIFICANCE STATEMENT Endogenous opioids have been repeatedly shown to be involved in the cognitive inhibition of pain. Mindfulness meditation, a practice premised on directing nonjudgmental attention to arising sensory events, reduces pain by engaging mechanisms supporting the cognitive control of pain. However, it remains unknown if mindfulness-meditation-based analgesia is mediated by opioids, an important consideration for using meditation to treat chronic pain. To address this question, the present study examined pain reports during meditation in response to noxious heat and administration of the opioid antagonist naloxone and placebo saline. The results demonstrate that meditation-based pain relief does not require endogenous opioids. Therefore, the treatment of chronic pain may be more effective with meditation due to a lack of cross-tolerance with opiate-based medications.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792946/

Reduce Back Pain with Mindfulness

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Image result for back pain

 

By John M. de Castro, Ph.D.

 

“For some people with chronic pain, mindful meditation is an appealing pain management option because it has an unusual benefit; it is something that you personally control. Unlike pain medications or medical procedures, meditation is not done to you, it is something you can 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. 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 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. Mindfulness Based Stress Reductions (MBSR) programs contain both yoga and mindfulness practices. So, it would seem reasonable to project that MBSR practice would improve emotion regulation and thereby be beneficial for back pain.

 

In today’s Research News article “Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1347215058635750/?type=3&theater

or see summary below or view the full text of the study at:

http://jama.jamanetwork.com/article.aspx?articleid=2504811

Cherkin and colleagues recruited a large sample of adults suffering with low back pain. They were then randomly assigned to a treatment as usual group or to groups which received treatment as usual plus 2 hours per week for 8-weeks of either Mindfulness Based Stress Reduction (MBSR) treatment or Cognitive Behavioral Therapy (CBT). Participants were measured before, 4-weeks into, and after treatment at 8, 26, and 52 weeks for back pain, functional related limitations, bothersomeness, depression, anxiety, pain intensity, pain improvement, general physical health, and general mental health.

 

They found that at the primary endpoint of 26 weeks both the MBSR and CBT groups showed statistically significant better clinically meaningful improvements in pain bothersomeness and functional related limitations than the treatment as usual group and these improvements were still present at one-year follow-up. They also found that at 8 and 26 weeks both the MBSR and CBT groups showed statistically significant improvements in depression, anxiety, pain intensity, and global mental health than the treatment as usual group and the improvement in pain intensity was still present at one-year follow-up.

 

These results are excellent and conclusively demonstrate that both Mindfulness Based Stress Reduction (MBSR) treatment and Cognitive Behavioral Therapy (CBT) are far superior to the usual treatment in the improvement of low back pain physical and psychological symptoms. These improvements occurred without any significant adverse effects. The fact that many of the effects were still present a year later is particularly significant and indicate the treatments have lasting effects. Hence, both MBSR and CBT are safe and effective treatments for chronic low back pain.

 

So, reduce back pain with mindfulness.

 

“mindfulness-based stress reduction may be particularly helpful for people because even if their use lapses, they develop a skill they can draw on later when they need it. That suggests that training the mind has potential to change people on a more lasting basis than doing a manipulation of the spine or massage of the back, techniques that may be effective in the short term but lose effects over time. You can practice it by waiting at the bus stop and just breathing.” – Daniel Cherkin

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Daniel C. Cherkin, Karen J. Sherman, Benjamin H. Balderson, Andrea J. Cook, Melissa L. Anderson, Rene J. Hawkes, Kelly E. Hansen, Judith A. Turner. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA. 2016;315(12):1240-1249. doi:10.1001/jama.2016.2323.

 

Abstract

Importance:  Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain.

Objective:  To evaluate the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care.

Design, Setting, and Participants  Randomized, interviewer-blind, clinical trial in an integrated health care system in Washington State of 342 adults aged 20 to 70 years with chronic low back pain enrolled between September 2012 and April 2014 and randomly assigned to receive MBSR (n = 116), CBT (n = 113), or usual care (n = 113).

Interventions:  CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. Usual care included whatever care participants received.

Main Outcomes and Measures:  Coprimary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range, 0-23) and in self-reported back pain bothersomeness (scale, 0-10) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks.

Results:  There were 342 randomized participants, the mean (SD) [range] age was 49.3 (12.3) [20-70] years, 224 (65.7%) were women, mean duration of back pain was 7.3 years (range, 3 months-50 years), 123 (53.7%) attended 6 or more of the 8 sessions, 294 (86.0%) completed the study at 26 weeks, and 290 (84.8%) completed the study at 52 weeks. In intent-to-treat analyses at 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ was higher for those who received MBSR (60.5%) and CBT (57.7%) than for usual care (44.1%) (overall P = .04; relative risk [RR] for MBSR vs usual care, 1.37 [95% CI, 1.06-1.77]; RR for MBSR vs CBT, 0.95 [95% CI, 0.77-1.18]; and RR for CBT vs usual care, 1.31 [95% CI, 1.01-1.69]). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 43.6% in the MBSR group and 44.9% in the CBT group, vs 26.6% in the usual care group (overall P = .01; RR for MBSR vs usual care, 1.64 [95% CI, 1.15-2.34]; RR for MBSR vs CBT, 1.03 [95% CI, 0.78-1.36]; and RR for CBT vs usual care, 1.69 [95% CI, 1.18-2.41]). Findings for MBSR persisted with little change at 52 weeks for both primary outcomes.

Conclusions and Relevance:  Among adults with chronic low back pain, treatment with MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.

http://jama.jamanetwork.com/article.aspx?articleid=2504811

 

Lower Fibromyalgia Pain with Higher Mindfulness

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By John M. de Castro, Ph.D.

 

“Meditation, particular mindfulness techniques, can lead to improvements in pain intensity when compared to standard care for many chronic pain patients. It also may help improve pain-related disability, pain acceptance, feelings of control over the pain, depression, anxiety, and quality of life, immediately after treatment as well as at follow up later on.” – University Health News

 

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, controlling the emotions may reduce the perceived pain. Mindfulness practices have been shown to be effective in reducing pain from fibromyalgia. This may occur directly or indirectly by reducing emotions or both.

 

In today’s Research News article “Fibromyalgia Impact and Mindfulness Characteristics in 4986 People with Fibromyalgia.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1342272192463370/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552195/

Jones and colleagues obtained measures of mindfulness and fibromyalgia impact from a national sample of nearly 5000 fibromyalgia sufferers. They found that the approximately 20% of the sample who meditated had small but statistically lower fibromyalgia impact and symptoms scores than those who did not meditate. They also found that the higher the level of the mindfulness facets of Describing, Non-Reacting, Non-Judging, and Acting with Awareness the lower the fibromyalgia symptoms and the greater the mindfulness facet of Observing the greater the fibromyalgia symptom scores. These relationships still remained significant for all facets regardless of whether a univariate or a multiple regression were employed to document the relationships.

 

These findings confirm with a large national sample and a correlational study what has been previously found that mindfulness improves the symptoms of fibromyalgia. The one exception was with mindfully Observing which was positively correlated with fibromyalgia symptoms. This may have occurred due to a reverse causation such that individuals with more severe fibromyalgia symptoms become more observing of them in the present moment.

 

There are a number of potential explanations for the relationship between high mindfulness and low fibromyalgia symptoms. Mindfulness has been shown to improve emotion regulation which allows the individual to experience the emotions fully but to respond to them in a constructive, productive fashion, thus taking away the amplifying effect of the emotions on pain. Mindfulness training also improves the individual’s ability to focus on the present moment and this has been shown to reduce rumination and catastrophizing which can produce anxiety and depression also amplifying the symptoms. Regardless of the mechanism it is clear the mindfulness can be beneficial in controlling the emotional sequela of fibromyalgia pain.

 

So, lower fibromyalgia pain with higher mindfulness.

 

“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. With mindfulness practice you learn to relate to anxiety differently, with an open curiosity. Learning to do that leads to a reduction in the fear response itself,” – Susan Smalley

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Jones, K. D., Mist, S. D., Casselberry, M. A., Ali, A., & Christopher, M. S. (2015). Fibromyalgia Impact and Mindfulness Characteristics in 4986 People with Fibromyalgia. Explore (New York, N.Y.), 11(4), 304–309. http://doi.org/10.1016/j.explore.2015.04.006

 

Abstract

Context and Objective: A growing body of literature suggests that mindfulness techniques may be beneficial in fibromyalgia. A recent systematic review and meta-analysis of six trials indicated improvement in depressive symptoms and quality of life, calling for increased rigor and use of standardized measures in future trials. The purpose of the study was to examine the relationship between mindfulness [as measured by the Five Facet Mindfulness Questionnaire (FFMQ)] and fibromyalgia impact [as measured by the Revised Fibromyalgia Impact Questionnaire (FIQR)].

Design, Setting, and Participants: A cross-sectional survey was conducted with adults diagnosed with fibromyalgia from a national fibromyalgia advocacy foundation e-mail list.

Results: A total of 4986 respondents represented all 50 states in the United States and 30 countries. FIQR scores demonstrated moderate to severe fibromyalgia with the majority of subjects (59%) scoring ≤60. Scores on the FFMQ subscales ranged from 20.8 to 27.3, with highest scores for the observe subscale. All subscale correlations were small to moderate and indicated that more severe fibromyalgia impact was associated with less mindfulness except in the observe scale (r = .15, P > .000). No clinical or demographics explained as much variance in the FIQR total as any of the mindfulness subscales.

Conclusions: Fibromyalgia patients experience symptoms that may be alleviated by mindfulness interventions. Baseline values for the observe subscale of the FFMQ were unexpectedly high. Further research is needed to know if this may be due to non-mindful observations and should be noted when the FFMQ is used in fibromyalgia clinical trials.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552195/