Improve Arthritis Depression, Pain, and Disability with Mindfulness

July 23, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“People in pain often react automatically to [what’s going on]. “You think I feel pain, and then the body tightens and you have a flurry of other thoughts like Pain is ruining my life. Mindfulness allows you to notice this distress as it happens and to intentionally step back, shifting awareness to the body and adjusting it in a way that can bring ease.” – Steven Rosenzweig

Arthritis is a chronic disease that most commonly affects the joints. Depending on the type of arthritis symptoms may include pain, stiffness, swelling, redness, and decreased range of motion. It affects an estimated 52.5 million adults in the United States. It is associated with aging as arthritis occurs in only 7% of adults ages 18–44, while 30% adults ages 45–64 are affected, and 50% of adults ages 65 or older. Due to complications associated with arthritis, the lifespan for people with RA may be shortened by 10 years.

The pain, stiffness, and lack of mobility associate with arthritis produce fatigue and markedly reduce the quality of life of the sufferers. It can have very negative psychological effects diminishing the individual’s self-image and may lead to depression, isolation, and withdrawal from friends and social activities. It even affects the individual’s physical appearance. As the quality of life deteriorates the individual can feel a loss of control and become anxious about the future. Stress can build and influence the individual’s attitude toward life and can lead to frustration, anger, and hopelessness. The physical disability produced by arthritis, reduces the individual’s ability to function at work and may require modifications of work activities. This can lead to financial difficulties. The normal chores at home may take much longer to accomplish and the individual may need the help of a relative or caregiver. Hence, it can produce stress on the entire family system.

There are no cures for arthritis. Treatments are primarily symptomatic, including weight loss, exercise, braces, pain relievers, anti-inflammatory drugs, and corticosteroids. Recently, mindfulness practices have been found to be effective in coping with the symptoms of arthritis. In today’s Research News article “Chronic pain experience on depression and physical disability: The importance of acceptance and mindfulness-based processes in a sample with rheumatoid arthritis.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1277531588937431/?type=3&theater

or below, Costa and colleagues studied the relationship between mindfulness, acceptance, disability, and depression in adult rheumatoid arthritis sufferers. They measure them for mindfulness, pain, pain acceptance, health impact of arthritis, depression, anxiety, and stress.

They found, not surprisingly, that the greater the level of pain the greater the levels of disability and depression. Higher levels of both mindfulness, especially the non-reacting facet of mindfulness, and acceptance were found to be associated with lower levels of pain, disability and depression. Performing a mediational analysis, Costa and colleagues found that the effects of pain on depression were reduced by both acceptance and non-reacting while pain’s effects on disability was reduced by only acceptance.

The results show that being non-reactinge and accepting of experience were associated with lower levels of arthritis symptoms, with acceptance associated with lower levels of both depression and physical disability and mindful non-reacting to experience associated with lower levels of depression. Depression is amplified by rumination about past pain and worry about future pain. Mindfulness focuses the individual on the present moment and thereby reduces worry and rumination. This, to some extent explains, mindfulness’ association with lower depression. Accepting the situation is also important for pain management, as fighting against pain amplifies the pain. As a result, acceptance can reduce attempts to control the pain and thereby reduce the experience of pain and the resultant symptoms of depression and physical disability.

So, improve arthritis depression, pain, and disability with mindfulness and acceptance.

“mindfulness training, which teaches people to push away troublesome thoughts, helped improve well-being in people with rheumatoid arthritis and similar diseases. Patients . . . who received the training didn’t have less pain compared to those who didn’t, but they coped better, were less tired and showed less stress. “Yes, they still have pain, but they are able to manage their pain in more constructive ways,” – Randy Dotinga

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

Joana Costa, José Pinto-Gouveia, and João Marôco. Chronic pain experience on depression and physical disability: The importance of acceptance and mindfulness-based processes in a sample with rheumatoid arthritis. J Health Psychol, 1359105316649785, first published on June 15, 2016

Abstract

The mediating effect of acceptance and mindfulness in the relationship between pain, depression, and physical disability was examined in 55 rheumatoid arthritis patients. Results showed that the relationship between pain and depression was mediated by both nonreact and acceptance. By contrast, the relationship between pain and physical disability was mediated by acceptance but not by nonreact. This study provides evidences that the influence of these processes is different on depression and on physical disability. These findings support models that take both general measures of mindfulness and content-specific measures of acceptance into account when conceptualizing rheumatoid arthritis. Theoretical and clinical implications are discussed.

ACT for Chronic Pain

July 19, 2016 psyjdc 2 Comments

By John M. de Castro, Ph.D.

“meditation practice is the best ongoing foundation for working with pain: Mindfulness practice is a wonderful opportunity to do just that. It helps to shift the locus of control from the outside (“this is happening to me and there is nothing I can do about it”) to the inside (“this is happening to me but I can choose how I relate to it”).” – Christiane Wolf

We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. But, for a wide swath of humanity pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. Chronic pain accompanies a number of conditions. The most common form of chronic pain is low back pain affecting between 6% to 15% of the population. Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. In the U.S., osteoarthritis affects 14% of adults over 25 years of age and 34% of those over 65. Fibromyalgia is a mysterious disorder whose causes are unknown. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. It is very common affecting over 5 million people in the U.S., about 2% of the population.

Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating a number of physical and psychological disorders. 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.

In today’s Research News article “Acceptance as a Mediator for Change in Acceptance and Commitment Therapy for Persons with Chronic Pain?” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1274906459199944/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748004/

Cederberg and colleagues investigate the effectiveness of Acceptance and Commitment Therapy (ACT) in the treatment of chronic pain and to identify potential intermediaries; factors that are altered by ACT that are responsible for improved pain tolerance. They randomly assigned chronic pain patients to either receive ACT or relaxation therapy targeted to pain. The patients were measured before after treatment and again 6 and 12 months later for acceptance of chronic pain, pain intensity, satisfaction with life, physical functioning, anxiety, and depression.

They found that the patients receiving ACT had significant improvements in of acceptance of chronic pain, pain intensity, satisfaction with life, and physical functioning, while the relaxation group did not. Both groups showed reductions in anxiety, and depression. These effects were for the most part still present 12 months after the completion of treatment. They performed a sophisticated statistical analysis to identify whether the effects of ACT on acceptance, anxiety, or depression were responsible for the effects on physical functioning and satisfaction with life. They found that acceptance of pain was responsible for ACT’s effects on physical functioning, but not satisfaction with life.

These results are exciting and important demonstrating a mindfulness based treatment, Acceptance and Commitment Therapy (ACT), is effective in improving the ability of chronic pain patients to function and their satisfaction with life, and reducing their pain, anxiety, and depression. They further demonstrate that acceptance of pain is the important variable underlying the improvement in physical functioning. This underlines the importance of acceptance which is a predominant component of ACT. These results strongly suggest that ACT is an excellent, long-lasting, and safe treatment for people suffering with chronic pain.

So, ACT for chronic pain

“This perspective provides a new way to relate to distressing thoughts and emotions so they can be accepted as natural rather than avoided. In a similar way, patients are encouraged to re-engage in previously avoided valued activities¹⁰. Importantly, a therapeutic focus on strategies that reduce avoidance through increased acceptance have proved useful for people with chronic pain.” – Michael Hogan

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

Cederberg, J. T., Cernvall, M., Dahl, J., von Essen, L., & Ljungman, G. (2016). Acceptance as a Mediator for Change in Acceptance and Commitment Therapy for Persons with Chronic Pain? International Journal of Behavioral Medicine, 23, 21–29. http://doi.org/10.1007/s12529-015-9494-y

Abstract

Background: Cognitive behavior therapy (CBT) is considered effective for chronic pain, but little is known about active treatment components. Although acceptance correlates with better health outcomes in chronic pain patients, no study has examined its mediating effect in an experimental design.

Purpose: The aim of the present study is to investigate acceptance as a mediator in acceptance and commitment therapy (ACT), a third wave CBT intervention, for chronic pain.

Method: A bootstrapped cross product of coefficients approach was used on data from a previously published RCT evaluating ACT for chronic pain. To address the specificity of acceptance as a mediator, anxiety and depression were also tested as mediators. Outcome variables were satisfaction with life and physical functioning. Two change scores, pre-assessment to 6-month follow-up (n = 53) and pre-assessment to 12-month follow-up (n = 32), were used.

Results: Acceptance was found to mediate the effect of treatment on change in physical functioning from pre-assessment to follow-up at 6 months. Further, a trend was shown from pre-assessment to follow-up at 12 months. No indirect effect of treatment via acceptance was found for change in satisfaction with life.

Conclusion: This study adds to a small but growing body of research using mediation analysis to investigate mediating factors in the treatment of chronic pain. In summary, the results suggest that acceptance may have a mediating effect on change in physical functioning in ACT for persons with chronic pain. However, given the small sample size of the study, these findings need to be replicated.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748004/

Improve Low Back Pain with Yoga

July 5, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Achy back? Give yoga a go. Multiple studies have shown the power of the ancient practice, which emphasizes stretching, strength, and flexibility, to relieve back soreness. In fact, several studies have found that yoga can even trump usual care for back pain when it comes to improving back function.” – Annie Hauser

Acute pain in all forms is a signal that there is something wrong that needs immediate attention. Chronic pain, on the other hand signals the presence of physical issues that are more difficult to address. Chronic pain is particularly difficult as it is not only a torment but is highly disruptive to the sufferer’s life, decreasing the ability to engage in everyday activities and lowering the quality of life. One source of chronic pain, low back pain, is ubiquitous. It is estimated that 80% of the population will experience back pain sometime during their lives. It is the leading cause of disability worldwide and affects between 6% to 15% of the population.

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. The therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years. Obviously, there is a need for effective treatments for low back pain that are low cost and don’t have troublesome side effects.

Mindfulness training has shown promise in the treatment of a variety of pain conditions, including low back pain. Yoga practice is both a physical and a mindfulness training that under supervised conditions is effective for a variety of physical and psychological conditions, especially musculoskeletal problems including low back pain. There have been a variety of studies of the application of yoga for low back pain but they are highly variable in technique, postures employed, included components of practice, patient groups, and follow-up. So, there is a need for a rigorous review and summarization of these studies to ascertain the overall effectiveness of yoga practice for low back pain.

In today’s Research News article “Yoga as a treatment for chronic low back pain: A systematic review of the literature.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1265126300177960/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878447/

Chang and colleagues review and summarize the published research on the application of yoga practice for low back pain. They found that the literature provides documented, scientific, controlled evidence that supports the conclusion that yoga practice when properly administered reduces pain and disability in patients with chronic low back pain. In addition, since postures once learned can be practiced at home, yoga provides a more cost effective long-term for back pain than physical therapy, spinal manipulation, physical therapy, and acupuncture.

These results are very promising and suggest that yoga practice is an excellent treatment for low back pain. Yoga, however, is not without risks. Back pain can be exacerbated and even disc herniation is possible. So, it is important that, at least in its initial stages, yoga practice be administered and supervised by a knowledgeable certified professional. It is important to also recognize that yoga practice has many psychological, physical, and spiritual benefits beyond relief of low back pain. So, yoga should not be evaluated with only one physical issue in mind, but should be looked upon as not only relieving symptoms but also having holistic benefits, improving the practitioner’s health and well-being.

So, improve low back pain with yoga.

“An estimated 84 percent of people may experience low back pain. If you’ve ever felt it yourself, you know that the most basic, daily movements can be challenging. Suddenly sitting, standing, and bending seem like advanced yoga postures. Back pain is actually one of the most common reasons that people visit the doctor. Fortunately, new studies are supporting yoga’s efficacy and many individuals are turning to the practice for help.” – Jennifer Carter Avgerinos

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

Chang, D. G., Holt, J. A., Sklar, M., & Groessl, E. J. (2016). Yoga as a treatment for chronic low back pain: A systematic review of the literature. Journal of Orthopedics & Rheumatology, 3(1), 1–8.

Abstract

Objectives: Chronic low back pain (CLBP) affects millions of people worldwide, and appears to be increasing in prevalence. It is associated not only with pain, but also with increased disability, psychological symptoms, and reduced quality of life. There are various treatment options for CLBP, but no single therapy stands out as being the most effective. In the past 10 years, yoga interventions have been studied as a CLBP treatment approach. The objective of this paper is to review the current literature supporting the efficacy of yoga for CLBP.

Methods: A literature search through the beginning of 2015 was conducted in Pub Med for randomized control trials addressing treatment of CLBP with yoga.

Results: In this review we evaluate the use of yoga as a treatment for CLBP. Specifically we evaluate how yoga impacts physical functioning and disability, pain, and associated psychological symptoms. We also evaluate possible mediators of the effect of yoga and the safety of yoga.

Discussion: With few exceptions, previous studies and the recent randomized control trials (RCTs) indicate that yoga can reduce pain and disability, can be practiced safely, and is well received by participants. Some studies also indicate that yoga may improve psychological symptoms, but these effects are currently not as well established.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878447/

Relieve Chronic Pain with Tai Chi

June 2, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Tai Chi has demonstrated usefulness in the prevention and treatment of certain problems such as back pain. Importantly, Tai Chi is non-invasive, relatively inexpensive, and gentle on the spine, so many people with back pain are starting to try it as an adjunct to (or sometimes instead of) traditional medical approaches to manage back pain. Furthermore, Tai Chi does not require any expensive equipment and can be practiced anywhere.” – Robert Humphreys

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. It affects more Americans than diabetes, heart disease and cancer combined. It is a significant public health problem as it’s the number one cause of disability and costs U.S. society an estimated $560-$635 billion annually. Quite frequently opioids are prescribed for chronic pain and prescription opioid overdoses kill more than 14,000 people annually.

Chronic pain accompanies a number of conditions. The most common form of chronic pain is low back pain affecting between 6% to 15% of the population. Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. In the U.S., osteoarthritis affects 14% of adults over 25 years of age and 34% of those over 65. Fibromyalgia is a mysterious disorder whose causes are unknown. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. It is very common affecting over 5 million people in the U.S., about 2% of the population.

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 reduce stress responses and anxiety, and to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. So, it would seem reasonable to project that mindfulness practices would be helpful in pain management. Indeed, these practices have been shown to be safe and beneficial in pain management. Both Yoga and mindfulness has been shown to specifically improve back pain. Gentle movements of the joints with exercise appears to be helpful in the treatment of osteoarthritis. This suggests that alternative and complementary practices that involve gentle movements may be useful 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. So, it would seem reasonable to look further into the effectiveness of alternative and complementary practices in treating osteoarthritis.

In today’s Research News article “Tai Chi for Chronic Pain Conditions: A Systematic Review and Meta-analysis of Randomized Controlled Trials.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1242319075792016/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850460/

Kong and colleagues review the published research literature on the application of the ancient Chinese practice of Tai Chi, a mindful movement practice, on chronic pain. They found that the practice of Tai Chi reduced chronic pain significantly better than control conditions. These included osteoarthritis pain, low back pain, rheumatoid arthritis, and pain from herpes zoster. The results for fibromyalgia pain were not significant. Hence, they found that tai chi practice was a safe and effective treatment for most forms of chronic pain.

These are excellent results. They’re particularly encouraging as tai chi is a safe and very gentle practice that is applicable for all age groups including the elderly. It can also be practiced anywhere and after some initial instruction, without formal classes. In China it is frequently practiced either alone or in groups in public parks. But, it can also be practiced at home. So, it’s very inexpensive. Its safety, effectiveness, affordability, and convenience make tai chi practice an outstanding choice for the treatment of chronic pain.

So, relieve chronic pain with tai chi.

“Tai Chi is a form of exercise that has recently been gaining popularity as a way to relieve and/or manage back pain and neck pain. It is often easy to associate Tai Chi with groups of people in parks or gyms moving slowly and deliberately in synchronization. These people are using the same Tai Chi principles and movements created in ancient China and still practiced all around the world as a healing exercise.” – Robert Humphreys

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Kong, L. J., Lauche, R., Klose, P., Bu, J. H., Yang, X. C., Guo, C. Q., … Cheng, Y. W. (2016). Tai Chi for Chronic Pain Conditions: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Scientific Reports, 6, 25325. http://doi.org/10.1038/srep25325

Abstract

Several studies reported that Tai Chi showed potential effects for chronic pain, but its role remains controversial. This review assessed the evidence regarding the effects of Tai Chi for chronic pain conditions. 18 randomized controlled trials were included in our review. The aggregated results have indicated that Tai Chi showed positive evidence on immediate relief of chronic pain from osteoarthritis (standardized mean difference [SMD], −0.54; 95% confidence intervals [CI], −0.77 to −0.30; P < 0.05). The valid duration of Tai Chi practice for osteoarthritis may be more than 5 weeks. And there were some beneficial evidences regarding the effects of Tai Chi on immediate relief of chronic pain from low back pain (SMD, −0.81; 95% CI, −1.11 to −0.52; P < 0.05) and osteoporosis (SMD, −0.83; 95% CI, −1.37 to −0.28; P = 0.003). Therefore, clinicians may consider Tai Chi as a viable complementary and alternative medicine for chronic pain conditions.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850460/

Reduce Pain by Accepting it Mindfully

May 14, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“They were able to have a sense of personal control over their migraines. It really makes us wonder if an intervention like meditation can change the way people interpret their pain.” – Rebecca Erwin Wells

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. The most common type of headache is the tension headache with 80 to 90 percent of the population suffering from tension headaches at least some time in their lives. The second most common type of headache is the migraine headache. Around 16 to 17 percent of the population complains of migraines. It is the 8th most disabling illness in the world with more than 90% of sufferers unable to work or function normally during their migraine. American employers lose more than $13 billion each year as a result of 113 million lost work days due to migraine.

There are a wide variety of drugs that are prescribed for chronic headache pain with varying success. Most tension headaches can be helped by taking pain relievers such as aspirin, naproxen, acetaminophen, or ibuprofen. A number of medications can help treat and prevent migraines and tension headaches, including 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. 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, reducing worry and catastrophizing can reduce headache pain. In addition, mindfulness improves self-efficacy, the belief that the individual can adapt to and handle headache pain. In addition, mindfulness training also has been shown to alter not only what is thought, but also how thoughts are processed. Central to this cognitive change is mindfulness and acceptance. By mindfully viewing pain as a present moment experience it can be experienced just as it is and by accepting it, the individual stops fighting against the pain which can amplify the pain.

It is not known whether it is the changes in the what or how, or both, of thoughts that is responsible for mindfulness training’s efficacy in treating headache pain. In today’s Research News article “The mediating role of pain acceptance during mindfulness-based cognitive therapy for headache.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1229081490449108/?type=3&theater

or see below

Day and Thorn investigate this question. They randomly assigned headache patients to receive either 8-weeks of Mindfulness Based Cognitive Therapy (MBCT) or treatment as usual as a wait-list control condition. Before and again after treatment measurements were obtained of pain, pain acceptance, pain catastrophizing, and pain self-efficacy.

They found, as has previously been shown, that the MBCT training significantly reduced the level of pain and pain catastrophizing, and increased the levels of pain self-efficacy and pain acceptance. Day and Thorn then went on to use a sophisticated statistical technique to assess whether the change in pain produced by mindfulness training was due to the changes in the what or how about thinking. They found that only the how aspect of thought, pain acceptance, significantly mediated the effect. Neither of the what aspects of thought, pain catastrophizing nor pain self-efficacy, were significantly related to the mindfulness training effects on pain.

These results are very interesting and potentially important. They suggest that mindfulness training reduces headache pain by altering how pain is thought about, increasing acceptance of the pain. Acceptance is defined as the “conscious willingness to stay in direct contact with experience.” This may operate by reducing the individual’s attempts to counteract the pain. Since, fighting against the pain can actually increase the level of pain, accepting the pain interferes with this amplifying process, thus lowering the pain level experienced. It is interesting that neither the pain catastrophizing nor pain self-efficacy were significant mediators as they have long been thought to be important mechanisms of mindfulness’ effectiveness for pain management. But, it is clear that how pain is thought about, in particular, the acceptance of pain, is the key.

So, reduce pain by accepting it mindfully.

“Awareness transforms emotional pain just as it transforms the pain that we attribute more to the domain of body sensations. When we are immersed in emotional pain, if we pay close attention, we will notice that there is always an overlay of thoughts and a plethora of different feelings about the pain we are in, so here too the entire constellation of what we think of as emotional pain can be welcomed in and held in awareness.” – Jon Kabat-Zinn

CMCS – Center for Mindfulness and Contemplative Studies

Study Summary

Day MA, Thorn BE. The mediating role of pain acceptance during mindfulness-based cognitive therapy for headache. Complement Ther Med. 2016 Apr;25:51-4. doi: 10.1016/j.ctim.2016.01.002. Epub 2016 Jan 13.

Highlights

Pain acceptance was a significant mediator of the MBCT-pain interference relation.
Specifically, activity engagement emerged as the critical component of acceptance.
Pain catastrophizing and self-efficacy did not meet criteria for mediation.
This is the first study to show acceptance is a key mediator of MBCT for headache.

Abstract

Objectives: This study aimed to determine if mindfulness-based cognitive therapy (MBCT) engenders improvement in headache outcomes via the mechanisms specified by theory: (1) change in psychological process, (i.e., pain acceptance); and concurrently (2) change in cognitive content, (i.e., pain catastrophizing; headache management self-efficacy).

Design: A secondary analysis of a randomized controlled trial comparing MBCT to a medical treatment as usual, delayed treatment (DT) control was conducted. Participants were individuals with headache pain who completed MBCT or DT (N = 24) at the Kilgo Headache Clinic or psychology clinic. Standardized measures of the primary outcome (pain interference) and proposed mediators were administered at pre- and post-treatment; change scores were calculated. Bootstrap mediation models were conducted.

Results: Pain acceptance emerged as a significant mediator of the group-interference relation (p < .05). Mediation models examining acceptance subscales showed nuances in this effect, with activity engagement emerging as a significant mediator (p < .05), but pain willingness not meeting criteria for mediation due to a non-significant pathway from the mediator to outcome. Criteria for mediation was also not met for the catastrophizing or self-efficacy models as neither of these variables significantly predicted pain interference.

Conclusions: Pain acceptance, and specifically engagement in valued activities despite pain, may be a key mechanism underlying improvement in pain outcome during a MBCT for headache pain intervention. The theorized mediating role of cognitive content factors was not supported in this preliminary study. A large, definitive trial is warranted to replicate and extend the findings in order to streamline and optimize MBCT for headache.

Mitigate Pain with Mindfulness

April 28, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“It turns out, the human mind does not simply feel pain, it also processes the information that it contains. It teases apart all of the different sensations to try to find their underlying causes so that you can avoid further pain or damage to the body. In effect, the mind zooms in on your pain for a closer look as it tries to find a solution to your suffering. This ‘zooming-in’ amplifies pain.” – Danny Penman

Postherpetic neuralgia is a complication of shingles, which is caused by the chickenpox virus, a form of herpes virus. It affects between 10%-20% of shingles sufferers. It affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear. It produces pain that has been described as burning, sharp and jabbing, or deep and aching, that lasts for over 3 months. Patients report extreme sensitivity to touch such that even the feel of clothing is very uncomfortable. Sometimes it is also accompanied with itching or numbness. Postherpetic neuralgia pain is difficult to cope with and can thus lead to depression, fatigue, sleep problems, loss of appetite, and difficulty with concentration. The risk of acquiring postherpetic neuralgia increase with age and primarily afflict people over 60. There’s no cure, but treatments can ease symptoms. For most people, postherpetic neuralgia improves over time. But, it is an extremely uncomfortable and disruptive disorder and new and better treatments are needed.

Mindfulness training has been shown to effectively reduce pain from a number of different conditions. So, it is reasonable to explore whether mindfulness training could be an effective treatment for postherpetic neuralgia. In today’s Research News article “Mindfulness meditation in older adults with postherpetic neuralgia: a randomized controlled pilot study.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1218626534827937/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488325/

Meize-Grochowski and colleagues randomly assigned elderly patients (55-90 years of age) with postherpetic neuralgia to either a 6-weeks of 20-minute daily meditation or to a wait-list control condition. They found that at the end of the 6-weeks the meditation group had a significant decrease in neuropathic pain, total pain, and affective pain and improved physical functioning compared to baseline and control participants.

These results are encouraging. But, it should be recognized that this was a very small pilot study and needs to be replicated in a much larger clinical trial. Regardless, the results suggest that meditation may be a safe and effective treatment for postherpetic neuralgia, decreasing pain and improving functioning in life. This adds to the growing list of pain conditions that respond positively to mindfulness techniques. It suggests that mindfulness training may be a universally effective treatment for chronic pain.

Mindfulness training may be effective for pain by focusing attention on the present moment and thereby reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. So, reducing worry and catastrophizing should reduce pain. In addition, negative emotions are associated with pain and amplify it. Mindfulness may ne effective for pain because it increases positive emotions and decreases negative ones. Finally, mindfulness has been shown to change how pain is processed in the brain reducing the intensity of pain signals in the nervous system.

Regardless of the mechanism, it is clear that meditation is a safe and effective treatment for postherpetic neuralgia. So, mitigate pain with mindfulness.

“What we want to do as best as we can is to engage with the pain just as it is. It’s not about achieving a certain goal – like minimizing pain – but learning to relate to your pain differently.” – Elisha Goldstein

CMCS – Center for Mindfulness and Contemplative Studies

Study Summary

Meize-Grochowski, R., Shuster, G., Boursaw, B., DuVal, M., Murray-Krezan, C., Schrader, R., … Prasad, A. (2015). Mindfulness meditation in older adults with postherpetic neuralgia: a randomized controlled pilot study. Geriatric Nursing (New York, N.Y.), 36(2), 154–160. http://doi.org/10.1016/j.gerinurse.2015.02.012

Abstract

This parallel-group, randomized controlled pilot study examined daily meditation in a diverse sample of older adults with postherpetic neuralgia. Block randomization was used to allocate participants to a treatment group (n = 13) or control group (n = 14). In addition to usual care, the treatment group practiced daily meditation for six weeks. All participants completed questionnaires at enrollment in the study, two weeks later, and six weeks after that, at the study’s end. Participants recorded daily pain and fatigue levels in a diary, and treatment participants also noted meditation practice. Results at the .10 level indicated improvement in neuropathic, affective, and total pain scores for the treatment group, whereas affective pain worsened for the control group. Participants were able to adhere to the daily diary and meditation requirements in this feasibility pilot study.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488325/

Improve Surgery Recovery with Yoga

April 25, 2016November 23, 2021 psyjdc Leave a comment

Improve Surgery Recovery with Yoga

By John M. de Castro, Ph.D.

“Yoga is a holistic approach to wellness. We already know the many benefits of yoga. Apart from yoga, even intensive stretching may improve chronic lower back pain and reduce your dependence on medication drugs. Patients have shown to benefit immensely from yoga after their back surgery. Research shows that 12 weeks of yoga can actually improve back function and reduce symptoms in people with chronic back pain.” – Jasmine Bilimoria

Yoga practice has been shown to have a myriad of beneficial effects on physical and psychological well-being and it can help the individual heal from physical or mental illness or injury. In India, it is a common and acceptable practice to include yoga and other ayurvedic practices along with modern medical techniques in treating patients. This provides an opportunity to investigate the effects of these alternative practices on healing and recovery after a large array of medical interventions.

In today’s Research News article “From 200 BC to 2015 AD: an integration of robotic surgery and Ayurveda/Yoga”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756240/

Khan and colleagues investigate the effects of a package of alternative treatments including yoga, yogic breathing techniques, and massage on patients’ recovery after modern minimally invasive robotic thoracic surgery for a variety of conditions. They compared groups who received the additional treatments to those who did not. Yoga practices commenced shortly after surgery and were taught for as long as they were in the hospital (mean stay of 2.1 days). The patients were encouraged to continue practice at home after release from the hospital.

They found that the yoga practices group reported high satisfaction with the practices, less pain and use pain killing medications, less wound drainage, and less lung collapse. Hence, the yoga practices were effective in reducing pain and promoting recovery. These are interesting findings that these practices can improve recovery after surgery. This can have positive benefits for the patients and reduce hospital stays and overall treatment costs, making it attractive to the medical professions.

Since, this study was performed in India, where these practices are highly acceptable to the population, it remains to be demonstrated if they would be similarly effective in western countries. In addition, the yoga practices included a package of practices including postures, breathing, and massage. As a result, it cannot be determined which of these components, or which combinations of components, were required for effectiveness. Finally, since another active treatment or placebo control was not included in the study, it is impossible to determine if the effectiveness on recovery from surgery was due to the yogic practices or to a variety of contaminants including subject expectancy effects, demand characteristics, or experimenter bias. It remains for future research to verify the results under more controlled circumstances.

Regardless, the results are encouraging and provide the rationale to continue investigating the use of yogic practices to promote recovery after surgery.

“Yoga can be a great way to heal from surgery. However, as with any exercise after surgery, make sure you take it slow and do not push yourself. The best yoga for after surgery is Hatha yoga, which is very gentle and can be done very slowly. Hatha yoga focuses on a series of asanas done slowly and with deep breathing. If done properly, it is unlikely that it will do you any harm after the surgery.” – YogaWiz

CMCS – Center for Mindfulness and Contemplative Studies

Study Summary

Khan, A. Z., & Pillai, G. G. (2016). From 200 BC to 2015 AD: an integration of robotic surgery and Ayurveda/Yoga. Journal of Thoracic Disease, 8(Suppl 1), S84–S92. http://doi.org/10.3978/j.issn.2072-1439.2016.01.74

Abstract

BACKGROUND: Among the traditional systems of medicine practiced all over the world, Ayurveda and Yoga has a documented history dating back to beyond 200 BC. Robotic and video assisted thoracic surgery (VATS) is an invention of the 21(st) century. We aim to quantify the effects of integration of Ayurveda and Yoga on patients undergoing minimally invasive robotic and VATS.

METHODS: Four hundred and fifty-four patients undergoing VATS and robotic thoracic surgery were introduced to a pre and postoperative protocol ofYoga therapy, mediation and oil massages. Yoga exercises included Pranayam, Anulom Vilom, and Oil Massages included Urotarpan. Preoperative and postoperative respiratory functions were recorded. Patient satisfaction questionnaire were noted. Statistical comparison was made to control group undergoing minimally invasive thoracic surgery without integrative medicine. Only one patient refused to undergo Ayurveda therapy and was deleted from the group.

RESULTS: Acceptability was high among all patients. Preoperative training led to implementation as early as 6 hours post surgery. Pulmonary function test showed significant improvement. All patients suggested an improvement in satisfaction score. Pain score were less in study patients. Quicker mobilization led to early discharge and drain removal. Chronic pain was prevented in patients having oil massages over the healed wound sites.

CONCLUSIONS: Integration of Ayurveda, Yoga and minimally invasive robotic and VATS is acceptable to Indian patients and gives better clinical results and higher patient satisfaction.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756240/

Improve Tension Headaches with Mindfulness

April 23, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Stress is a known trigger for headaches, and mindfulness is a known combatant against stress. Several studies have shown that mindfulness meditation can curb stress responses” – Mandy Oaklander

The most common medical ailment is headaches. They affect about 16.5% of the population of the U.S., approximately 45 million Americans each year. Over eight million seek out medical attention for headaches each year. The most common type of headache is the tension headache. It is estimated that 80 to 90 percent of the population suffer from tension headaches at least some time in their lives, about 69% of males and 88% of females. They come in two categories. Episodic headaches appear occasionally, while chronic headaches occur more than 15 times per month. Headaches are associated with personal and societal burdens of pain, disability, damaged quality of life and financial cost.

Tension headaches are generally treated with over the counter analgesics. Opiates, or narcotics, are rarely used because of their side effects and potential for dependency. To prevent tension headaches antidepressants or muscle relaxers are sometimes prescribed. Some individuals learn to employ a non-drug method to prevent or reduce tension headaches by learning what causes the headaches and trying to avoid those triggers. Finally, recently it has been shown that mindfulness techniques are generally helpful with coping with pain and specifically can be effective for headache relief. These include Mindfulness Based Stress Reduction (MBSR). Hence, it makes sense to further investigate the relationship of MBSR with stress reduction and tension headache relief.

In today’s Research News article “Effects of mindfulness-based stress reduction on perceived stress and psychological health in patients with tension headache”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755092/

Omidi and colleagues randomly assigned tension headache sufferers to either a treatment as usual (TAU) group, treated with antidepressant medication and clinical management, or an MBSR group which received TAU plus 8-weeks of Mindfulness Based Stress Reduction. They found that the MBSR group had significantly lower headache pain and increased mindfulness, while the treatment as usual group had no significant change in either.

These results are impressive and demonstrate that MBSR training may be an effective treatment for tension headache when combined with treatment as usual. Because MBSR contains three primary components; body scan, meditation, and yoga, it is not possible to discern which component or which combination of components were responsible for the improvement in headache pain. It is also not possible to discern if MBSR might be effective alone without the associated treatment as usual.

MBSR is structured to reduce stress and has been empirically shown to significantly reduce both the physiological and psychological responses to stress. Since tension headaches are primarily produced by stress and migraine headaches are frequently triggered by stress, it would seem reasonable to conclude that the stress reduction contributed to the effectiveness of MBSR for chronic headaches. Mindfulness training, by focusing attention on the present moment has also 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, reducing worry and catastrophizing should reduce headache pain. In addition, negative emotions are associated with the onset of headaches. Mindfulness has been shown to increase positive emotions and decrease negative ones. Finally, mindfulness has been shown to change how pain is processed in the brain reducing the intensity of pain signals in the nervous system.

Regardless of the mechanism, it is clear that MBSR is a safe and effective treatment for tension headaches. So, improve tension headaches with mindfulness.

“In the pain studies, people with chronic pain such as headaches, back pain, neck pain and fibromyalgia who participated in the Mindfulness-Based Stress Reduction Clinic reported a dramatic reduction in the average level of pain during the eight-week training period and for at least four years following the treatment.” – Mindful Living

CMCS – Center for Mindfulness and Contemplative Studies

Study Summary

Omidi, A., & Zargar, F. (2015). Effects of mindfulness-based stress reduction on perceived stress and psychological health in patients with tension headache. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences, 20(11), 1058–1063. http://doi.org/10.4103/1735-1995.172816

Abstract

Background: Programs for improving health status of patients with illness related to pain, such as headache, are often still in their infancy. Mindfulness-based stress reduction (MBSR) is a new psychotherapy that appears to be effective in treating chronic pain and stress. This study evaluated efficacy of MBSR in treatment of perceived stress and mental health of client who has tension headache.

Materials and Methods: This study is a randomized clinical trial. Sixty patients with tension type headache according to the International Headache Classification Subcommittee were randomly assigned to the Treatment As Usual (TAU) group or experimental group (MBSR). The MBSR group received eight weekly classmates with 12-min sessions. The sessions were based on MBSR protocol. The Brief Symptom Inventory (BSI) and Perceived Stress Scale (PSS) were administered in the pre- and posttreatment period and at 3 months follow-up for both the groups.

Results: The mean of total score of the BSI (global severity index; GSI) in MBSR group was 1.63 ± 0.56 before the intervention that was significantly reduced to 0.73 ± 0.46 and 0.93 ± 0.34 after the intervention and at the follow-up sessions, respectively (P < 0.001). In addition, the MBSR group showed lower scores in perceived stress in comparison with the control group at posttest evaluation. The mean of perceived stress before the intervention was 16.96 ± 2.53 and was changed to 12.7 ± 2.69 and 13.5 ± 2.33 after the intervention and at the follow-up sessions, respectively (P < 0.001). On the other hand, the mean of GSI in the TAU group was 1.77 ± 0.50 at pretest that was significantly reduced to 1.59 ± 0.52 and 1.78 ± 0.47 at posttest and follow-up, respectively (P < 0.001). Also, the mean of perceived stress in the TAU group at pretest was 15.9 ± 2.86 and that was changed to 16.13 ± 2.44 and 15.76 ± 2.22 at posttest and follow-up, respectively (P < 0.001).

Conclusion: MBSR could reduce stress and improve general mental health in patients with tension headache.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755092/

Improve Arthritis with Massage, Yoga, and Tai Chi

April 11, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Osteoarthritis is a degenerative joint disease which can lead to pain and swelling of your joints. Yoga is a great complimentary practice to help overcome knee osteoarthritis relief, as you’re strengthening and loosening your joints, and improving your overall well being.” – Minakshi Welukar

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 is not localized to the cartilage alone but involves the whole joint, including articular cartilage, meniscus, ligament, and peri-articular muscle. It is painful and disabling. While age is a major risk factor for osteoarthritis of the knee, young people are not immune. It effects 5% of adults over 25 years of age and 12% of those over 65. 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. So, it would seem reasonable to look further into the effectiveness of alternative and complementary practices in treating knee osteoarthritis.

In today’s Research News article “Knee osteoarthritis pain in the elderly can be reduced by massage therapy, yoga and tai chi: A review”

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Tiffany Field reviews the literature on the application of three alternative and complementary practices, massage therapy, yoga, and tai chi, for the treatment of treating knee osteoarthritis. She reports that the literature finds fairly consistently that massage can help to relieve pain. It appears that pressure massage, involving skin displacement if more effective than light massage. She further reports that yoga practice has been routinely found to reduce pain and relieve accompanying depression and sleep problems in arthritis sufferers. Yoga practice appears to produce better results than simple light exercise. Finally, she reports that the ancient Chinese gentle slow movement practice of Tai Chi significantly decreased knee pain and improved movement characteristics including stride length, stride frequency and gait speed.

The results of the reviewed studies are encouraging that massage therapy, and yoga and tai chi practices are effective in treating knee osteoarthritis. Yoga and tai chi have other characteristics that recommend them. They are both safe practices with very few, if any, adverse effects and importantly, they both can be practiced conveniently and inexpensively in groups or alone at home, thus allowing their widespread affordable application to sufferers. In addition, both yoga and tai chi practices have been shown to have a large number of other physical and psychological benefits. So, they would seem to be excellent alternative and complementary practices for the treatment of knee osteoarthritis.

So, improve arthritis with massage, yoga, and tai chi.

“Research suggests that a tailored yoga practice can help reduce pain and improve function in patients with knee osteoarthritis. Potential mechanisms include strengthening, improving flexibility, and altering gait biomechanics.” – Richa Mishra

CMCS – Center for Mindfulness and Contemplative Studies

Study Summary

Field T. Knee osteoarthritis pain in the elderly can be reduced by massage therapy, yoga and tai chi: A review. Complement Ther Clin Pract. 2016 Feb;22:87-92. doi: 10.1016/j.ctcp.2016.01.001. Epub 2016 Jan 14. Review.

Highlights

Massage therapy reduces knee osteoarthritis pain in the elderly.
Yoga reduces knee osteoarthritis pain in the elderly.
Tai chi reduces knee osteoarthritis pain in the elderly.

Abstract

Background and methods: This is a review of recently published research, both empirical studies and meta-analyses, on the effects of complementary therapies including massage therapy, yoga and tai chi on pain associated with knee osteoarthritis in the elderly.

Results: The massage therapy protocols have been effective in not only reducing pain but also in increasing range of motion, specifically when moderate pressure massage was used and when both the quadriceps and hamstrings were massaged. The yoga studies typically measured pain by the WOMAC. Most of those studies showed a clinically significant reduction in pain, especially the research that focused on poses (e.g. the Iyengar studies) as opposed to those that had integrated protocols (poses, breathing and meditation exercises). The tai chi studies also assessed pain by self-report on the WOMAC and showed significant reductions in pain. The tai chi studies were difficult to compare because of their highly variable protocols in terms of the frequency and duration of treatment.

Discussion: Larger, randomized control trials are needed on each of these therapies using more standardized protocols and more objective variables in addition to the self-reported WOMAC pain scale, for example, range-of-motion and observed range-of-motion pain. In addition, treatment comparison studies should be conducted so, for example, if the lower-cost yoga and tai chi were as effective as massage therapy, they might be used in combination with or as supplemental to massage therapy. Nonetheless, these therapies are at least reducing pain in knee osteoarthritis and they do not seem to have side effects.

Mindfully Control Back Pain

April 8, 2016 psyjdc 1 Comment

By John M. de Castro, Ph.D.

“MBSR is a practice that can help you “turn the volume down” on the perception of back pain by teaching you to look into the pain, and being with the experience and not resisting it so much. Looking into our emotional reactivity to it. Focusing on the present, rather than being bitter about the past or worried about the future about your back pain, helps you take ownership of the situation (i.e., accept your pain), and ultimately, find creative solutions for pain relief. It trains you to be in control of your mind, not for your mind to control you.” – Mark Neenan
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 and addiction. 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.

In today’s Research News article “Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients”

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Braden and colleagues investigate the effectiveness of a 4-week program of Mindfulness Based Stress Reductions (MBSR) for the treatment of low back pain. They randomly assigned patients with chronic low back pain to either an MBSR or reading control group. They found that only the MBSR group reported a significant decrease in low back pain and the somatic-affective aspects of depression following the MBSR training. In addition, they performed functional magnetic imaging of the brains of the patients, both before and after training, during a task designed to induce emotions. They found that after MBSR training there was increased activity in response to emotions in the subgenual Anterior Cingulate Cortex and the ventrolateral Prefrontal Cortex. Both of these areas have been associated with emotion regulation processing.

Hence the results suggest that a 4-week MBSR training program can be effective for the relief of low back pain and the improvement in emotions. The results suggest that the improvements may have been due to changes in brain processing of emotions produced by the MBSR training. Unfortunately, at a one year follow up the reductions in pain and depression were not maintained. This suggests that an abbreviated program of 4 weeks of MBSR (the standard program is 8-weeks) may be able to improve the patients but not sufficient to produce lasting effects. It remains to be shown if the standard 8-week program can produce more lasting effects. Regardless, the findings provide support for further research into the utility of MBSR training for the treatment of chronic low back pain.

So, mindfully control back pain.

“Mindfulness soothes the circuits that amplify secondary pain and you can see this process happening in a brain scanner. In effect, mindfulness teaches you how to turn down the volume control on your pain. And as you do so, any anxiety, stress and depression that you may be feeling begins to melt away too. Your body can then relax and begin to heal.” – Danny Penman

CMCS – Center for Mindfulness and Contemplative Studies

Study Summary

Braden BB, Pipe TB, Smith R, Glaspy TK, Deatherage BR, Baxter LC. Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients. Brain Behav. 2016 Feb 16:e00443. [Epub ahead of print]

Abstract

INTRODUCTION: Mindfulness-based stress reduction (MBSR) reduces depression, anxiety, and pain for people suffering from a variety of illnesses, and there is a growing need to understand the neurobiological networks implicated in self-reported psychological change as a result of training. Combining complementary and alternative treatments such as MBSR with other therapies is helpful; however, the time commitment of the traditional 8-week course may impede accessibility. This pilot study aimed to (1) determine if an abbreviated MBSR course improves symptoms in chronic back pain patients and (2) examine the neural and behavioral correlates of MBSR treatment.

METHODS: Participants were assigned to 4 weeks of weekly MBSR training (n = 12) or a control group (stress reduction reading; n = 11). Self-report ratings and task-based functional MRI were obtained prior to, and after, MBSR training, or at a yoked time point in the control group.

RESULTS: While both groups showed significant improvement in total depression symptoms, only the MBSR group significantly improved in back pain and somatic-affective depression symptoms. The MBSR group also uniquely showed significant increases in regional frontal lobe hemodynamic activity associated with gaining awareness to changes in one’s emotional state.

CONCLUSIONS: An abbreviated MBSR course may be an effective complementary intervention that specifically improves back pain symptoms and frontal lobe regulation of emotional awareness, while the traditional 8-week course may be necessary to detect unique improvements in total anxiety and cognitive aspects of depression.