Pain

Increase Quality of Life and Decrease Weight of Patients with Diabetes with Tai Chi

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Increase Quality of Life and Decrease Weight of Patients with Diabetes with Tai Chi

 

By John M. de Castro, Ph.D.

 

“a regular tai chi exercise program may help lower blood glucose levels, allowing people with diabetes to better control their disease.” – Lindsey Getz

 

Diabetes is a major health issue. It is estimated that 30 million people in the United States have diabetes and the numbers are growing. Type 2 Diabetes results from a resistance of tissues, especially fat tissues, to the ability of insulin to promote the uptake of glucose from the blood. As a result, blood sugar levels rise producing hyperglycemia. Diabetes is the 7th leading cause of death in the United States. In addition, diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes.

 

Type 2 diabetes is largely preventable. One of the reasons for the increasing incidence of Type 2 Diabetes is its association with overweight and obesity which is becoming epidemic in the industrialized world. A leading cause of this is a sedentary life style. Current treatments for Type 2 Diabetes focus on diet, exercise, and weight control. Recently, mindfulness practices have been shown to be helpful in managing diabetes. Tai Chi is mindfulness practice and a gentle exercise that has been found to improve the symptoms of Type 2 Diabetes. The research is accumulating. So, it is reasonable to examine what has been learned.

 

In today’s Research News article “Effect of Tai Chi on Quality of Life, Body Mass Index, and Waist-Hip Ratio in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851054/ ) Qin and colleagues review, summarize, and perform a meta-analysis of the published research studies of the effectiveness of Tai Chi practice in the treatment of Type 2 Diabetes. They found 18 published research studies, 15 of which were randomized controlled studies.

 

They report that the published research found that patients with Type 2 Diabetes who practiced Tai Chi had significant improvements in their quality of life including physical function, pain, overall health, vitality, social function, emotional function, and mental health dimensions. The research also found that Tai Chi practice produced significant reductions in body size as reflected in the waist-hip ration and the body mass index (BMI), but the improvements were equivalent to that produced by other aerobic exercises.

 

These are important findings as Type 2 Diabetes is so impactful on the health and longevity of large numbers of patients. The results suggest that Tai Chi practice reduces body size which is very important in improving metabolic and glucose control. As a consequence, it greatly improves the quality of life of the patients. It appears from the research that the exercise component of Tai Chi practice is important for the improvements as other aerobic exercises produce similar effects.

 

Some advantages of Tai Chi practice include the facts that it is not strenuous, involves slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion. It can also be practiced without professional supervision and in groups making it inexpensive to deliver and fun to engage in. This makes Tai Chi practice an excellent means to improve the physical and psychological symptoms experienced by patients with Type 2 Diabetes.

 

So, increase quality of life and decrease weight of patients with diabetes with Tai Chi.

 

“Tai Chi exercises can improve blood glucose levels and improve the control of type 2 diabetes and immune system response.” – Anna Sophia McKenney

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Qin, J., Chen, Y., Guo, S., You, Y., Xu, Y., Wu, J., Liu, Z., Huang, J., Chen, L., & Tao, J. (2021). Effect of Tai Chi on Quality of Life, Body Mass Index, and Waist-Hip Ratio in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Frontiers in endocrinology, 11, 543627. https://doi.org/10.3389/fendo.2020.543627

 

Abstract

Background

Type 2 diabetes mellitus (T2DM) is a worldwide public health concern with high morbidity and various progressive diabetes complications that result in serious economic expenditure and social burden. This systematic review aims to evaluate the effect of Tai Chi on improving quality of life (QoL), body mass index (BMI) and waist-hip ratio (WHR) in patients with T2DM.

Method

A systematic review and meta-analysis was performed following PRISMA recommendation. Four English databases and three Chinese databases were searched. The PEDro scale was used to assess the methodological quality of including studies. Study inclusion criteria: randomized controlled trials (RCTs) and quasi-experimental studies were included, patients with T2DM that adopted Tai Chi as intervention and QoL, BMI and/or WHR as outcome measurements.

Results

Eighteen trials were included. The aggregated results of seven trials showed that Tai Chi statistically significantly improved QoL measured by the SF-36 on every domains (physical function: MD = 7.73, 95% confidence interval (CI) = 1.76 to 13.71, p = 0.01; role-physical function: MD = 9.76, 95% CI = 6.05 to 13.47, p < 0.001; body pain: MD = 8.49, 95% CI = 1.18 to 15.8, p = 0.02; general health: MD = 9.80, 95% CI = 5.77 to 13.82, p < 0.001; vitality: MD = 6.70, 95% CI = 0.45 to 12.94, p = 0.04; social function: MD = 9.1, 95% CI = 4.75 to 13.45, p < 0.001; role-emotional function: MD = 7.88, 95% CI = 4.03 to 11.72, p < 0.001; mental health: MD = 5.62, 95% CI = 1.57 to 9.67, p = 0.006) and BMI (MD = −1.53, 95% CI = −2.71 to −0.36, p < 0.001) compared with control group (wait list; no intervention; usual care; sham exercise).

Conclusion

Tai Chi could improve QoL and decrease BMI for patients with T2DM, more studies are needed to be conducted in accordance with suggestions mentioned in this review.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851054/

 

Improve Brain Function and Mental Health in Chronic Pain Patients with Mindfulness

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Improve Brain Function and Mental Health in Chronic Pain Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“With the ACT approach, learning to let go of behaviors, memories, thoughts, and emotions creates space to explore new experiences, including acceptance of chronic pain sensations.” – Rosemary Black

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

 

Hence, it is important to find an effective method to treat Chronic pain. There is an accumulating volume of research findings to demonstrate that mindfulness practices, in general, are effective in treating pain. Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

Pain experiences are processed in the nervous system. So, it’s likely that mindfulness practices somehow alter the brain’s processing of pain. So, it makes sense to study the how Acceptance and Commitment Therapy (ACT) may affect the brain to improve the mental health of chronic pain patients.

 

In today’s Research News article “Neural Mechanisms of Acceptance and Commitment Therapy for Chronic Pain: A Network-Based fMRI Approach.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892587/ ) Aytur and colleagues recruited with musculoskeletal pain who did not abuse opioids. They completed 2 sessions per week for 4 weeks of Acceptance and Commitment Therapy (ACT). Before and after therapy they were measured for acceptance, chronic pain acceptance, quality of life, pain interference, and depression. Brain systems were measured before and after therapy with functional Magnetic Resonance Imaging (fMRI).

 

They found that in comparison to baseline after Acceptance and Commitment Therapy (ACT) the participants had significant increases in acceptance, chronic pain acceptance, quality of life and significant decreases in pain interference, and depression. In the fMRIs they also observed significant decreases in activation and connectivity in the Default Mode Network (DMN), Salience Network (SN), and Frontal-Parietal Network (FPN) networks of the brain. In addition, they observed that changes in the connectivity between these networks were correlated with decreases in depression and pain interference, and increases in quality of life.

 

These are interesting results that need to be interpreted with caution as there wasn’t a control, comparison condition present opening the findings up to alternative confounded interpretations. But the results replicate previous findings with controlled designs that Acceptance and Commitment Therapy (ACT) produces improvements in depression, pain, and quality of life. So, the improvements observed in the present study are likely due to causal effects of ACT.

 

These results also show that the psychological improvements produced by Acceptance and Commitment Therapy (ACT) are related to changes in the activity and connectivity within and between significant brain networks. This suggests that these neural alterations may underly the improvements in mental health of chronic pain patients produced by ACT. It remains for future studies to unravel the cause effect relationships.

 

So, improve brain function and mental health in chronic pain patients with mindfulness.

 

“ACT can help us to break out of that box that we have created for ourselves. To understand that the key to living with our condition is not to limit our lives and miss out on experiences, but instead to face things head on and be dedicated to working with our pain and doing things that bring us joy. ACT’s goal is not necessarily to reduce the pain but to help you to live your life with it, to feel more confident in engaging in activities that you might have otherwise swayed away from.” – Ann-Marie D’arcy-Sharpe

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Aytur, S. A., Ray, K. L., Meier, S. K., Campbell, J., Gendron, B., Waller, N., & Robin, D. A. (2021). Neural Mechanisms of Acceptance and Commitment Therapy for Chronic Pain: A Network-Based fMRI Approach. Frontiers in human neuroscience, 15, 587018. https://doi.org/10.3389/fnhum.2021.587018

 

Abstract

Over 100 million Americans suffer from chronic pain (CP), which causes more disability than any other medical condition in the United States at a cost of $560–$635 billion per year (Institute of Medicine, 2011). Opioid analgesics are frequently used to treat CP. However, long term use of opioids can cause brain changes such as opioid-induced hyperalgesia that, over time, increase pain sensation. Also, opioids fail to treat complex psychological factors that worsen pain-related disability, including beliefs about and emotional responses to pain. Cognitive behavioral therapy (CBT) can be efficacious for CP. However, CBT generally does not focus on important factors needed for long-term functional improvement, including attainment of personal goals and the psychological flexibility to choose responses to pain. Acceptance and Commitment Therapy (ACT) has been recognized as an effective, non-pharmacologic treatment for a variety of CP conditions (Gutierrez et al., 2004). However, little is known about the neurologic mechanisms underlying ACT. We conducted an ACT intervention in women (n = 9) with chronic musculoskeletal pain. Functional magnetic resonance imaging (fMRI) data were collected pre- and post-ACT, and changes in functional connectivity (FC) were measured using Network-Based Statistics (NBS). Behavioral outcomes were measured using validated assessments such as the Acceptance and Action Questionnaire (AAQ-II), the Chronic Pain Acceptance Questionnaire (CPAQ), the Center for Epidemiologic Studies Depression Scale (CES-D), and the NIH Toolbox Neuro-QoLTM (Quality of Life in Neurological Disorders) scales. Results suggest that, following the 4-week ACT intervention, participants exhibited reductions in brain activation within and between key networks including self-reflection (default mode, DMN), emotion (salience, SN), and cognitive control (frontal parietal, FPN). These changes in connectivity strength were correlated with changes in behavioral outcomes including decreased depression and pain interference, and increased participation in social roles. This study is one of the first to demonstrate that improved function across the DMN, SN, and FPN may drive the positive outcomes associated with ACT. This study contributes to the emerging evidence supporting the use of neurophysiological indices to characterize treatment effects of alternative and complementary mind-body therapies.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892587/

 

Self-centeredness Moderates the Effect of Mindfulness on Psychological Health

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Improve Physical Function in Chronic Pain Patients with Mind-Body Practice

 

By John M. de Castro, Ph.D.

 

“mind-body practices like tai chi, yoga, mindfulness and cognitive-behavioral therapy can all relieve lower back pain effectively.” – Wayne Jonas

 

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

 

There is an accumulating volume of research findings that demonstrate that mindfulness practices, in general, are effective in treating 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 pain.  Other mind-body  practices such as Tai Chi  improves spinal health and reduces pain. Since mind body practices involve exercise, it would seem reasonable to look at the effectiveness of mind-body practices in improving physical function and relieving pain in chronic pain patients.

 

In today’s Research News article “Mind-Body Activity Program for Chronic Pain: Exploring Mechanisms of Improvement in Patient-Reported, Performance-Based and Ambulatory Physical Function.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872894/ )  Greenberg and colleagues recruited patients with chronic musculoskeletal pain and randomly assigned them to 10-week mind-body physical activity programs either with or without a Fitbit activity monitor. The programs consisted of 10 weekly 90-minute sessions teaching mindfulness, deep breathing, pain-specific cognitive behavioral skills, physical restoration skills, and education on the disability spiral. They were measured before and after training for physical function, disability, walking distance, and accelerometer-based steps, kinesiophobia (fear of movement due to pain), pain resilience, mindfulness, and pain catastrophizing.

 

Using multilevel linear modelling, they found that compared to baseline, after treatment, there were significant increases in walking distance, step count, pain resilience and mindfulness, and a significant decrease in kinesiophobia and disability. Mediation analysis revealed that the improvement in disability was due to increases in pain resilience and mindfulness and decreases in kinesiophobia. For the walk test, only decreases in kinesiophobia mediated the improvement.

 

It should be noted that there wasn’t a control condition as both groups received the mind-body physical activity program. So, it is possible that confounds such as placebo effects and time-based healing may be operative. So, conclusions must be reached with caution. That being said, the results suggest that mind-body physical activity program improves physical function in chronic pain patients. The improvements are associated with increases in mindfulness, and pain resilience and decreases in kinesiophobia. But these variables only appear to mediate the effects of the training with regard to disability.

 

Mindfulness has been well documented to improve the disability of chronic pain patients. It is not surprising that the ability to be resilient in the face of pain and the lowering the fear of moving with pain are also helpful. Chronic pain makes life miserable for the patients and the effectiveness of the mind-body physical activity program in improving physical ability is helpful to some extent in decreasing the disability resulting from the pain and reducing the patient’s suffering.

 

So, improve physical function in chronic pain patients with mind-body practice.

 

“The mind, emotions and attention play an important role in the experience of pain. In patients with chronic pain, stress, fear and depression can amplify the perception of pain. Mind-body approaches act to change a person’s mental or emotional state or utilise physical movement to train attention or produce mental relaxation.” – Craig Hassed

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Greenberg, J., Mace, R. A., Bannon, S. M., Kulich, R. J., & Vranceanu, A. M. (2021). Mind-Body Activity Program for Chronic Pain: Exploring Mechanisms of Improvement in Patient-Reported, Performance-Based and Ambulatory Physical Function. Journal of pain research, 14, 359–368. https://doi.org/10.2147/JPR.S298212

 

Abstract

Background

Improving physical function among patients with chronic pain is critical for reducing disability and healthcare costs. However, mechanisms underlying improvement in patient-reported, performance-based, and ambulatory physical function in chronic pain remain poorly understood.

Purpose

To explore psychosocial mediators of improvement in patient-reported, performance-based, and objective/accelerometer-measured physical function among participants in a mind-body activity program.

Methods

Individuals with chronic pain were randomized to one of two identical 10-week mind-body activity interventions aimed at improving physical function with (GetActive-Fitbit; N=41) or without (GetActive; N=41) a Fitbit device. They completed self-reported (WHODAS 2.0), performance-based (6-minute walk test), and objective (accelerometer-measured step-count) measures of physical function, as well as measures of kinesiophobia (Tampa Kinesiophobia Scale), mindfulness (CAMS-R), and pain resilience (Pain Resilience Scale) before and after the intervention. We conducted secondary data analyses to test mediation via mixed-effects modeline.

Results

Improvements in patient-reported physical function were fully and uniquely mediated by kinesiophobia (Completely Standardized Indirect Effect (CSIE)=.18; CI=0.08, 0.30; medium-large effect size), mindfulness (CSIE=−.14; CI=−25, −.05; medium effect size) and pain resilience (CSIE=−.07; CI=−.16, −.005; small-medium effect size). Improvements in performance-based physical function were mediated only by kinesiophobia (CSIE=−.11; CI=−23, −.008; medium effect size). No measures mediated improvements in objective (accelerometer measured) physical function.

Conclusion

Interventions aiming to improve patient-reported physical function in patients with chronic pain may benefit from skills that target kinesiophobia, mindfulness, and pain resilience, while those focused on improving performance-based physical function should target primarily kinesiophobia. More research is needed to understand mechanisms of improvement in objective, accelerometer-measured physical function.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872894/

 

Reduce Migraine Symptoms with Yoga or Physical Therapy

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Reduce Migraine Symptoms with Yoga or Physical Therapy

 

By John M. de Castro, Ph.D.

 

“Overall, yoga improved the cardiac autonomic balance. Disturbances in the autonomic nervous system and in the regulation of the circulatory system are associated with migraines. If balance is restored, the likelihood of a migraine is reduced.” – Debra Sullivan

 

Migraine headaches are a torment far beyond the suffering of a common headache. It is an intense throbbing pain usually unilateral, focused on only one side of the head and lasts from 4 hours to 3 days. They are actually a collection of neurological symptoms. Migraines often include: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face. Migraines are the 8th most disabling illness in the world. While most sufferers experience attacks once or twice a month, about 4% have chronic daily headaches. Migraines are very disruptive to the sufferer’s personal and work lives as most people are unable to work or function normally when experiencing a migraine.

 

There is no known cure for migraine headaches. Treatments are targeted at managing the symptoms. Prescription and over-the-counter pain relievers are frequently used. There are a number of drug and drug combinations that appear to reduce the frequency of migraine attacks. These vary in effectiveness but unfortunately can have troubling side effects and some are addictive. Behaviorally, relaxation, exercise, and sleep appear to help lower the frequency of migraines. Mindfulness practices have been shown to reduce stress and improve relaxation. So, they may be useful in preventing migraines. Indeed, it has been shown that mindfulness practice can reduce headache pain. Yoga is both a mindfulness practice and an exercise. It has also been shown to help reduce pain. Hence, it may be effective in treating migraines.

 

In today’s Research News article “Study of Additive Effect of Yoga and Physical Therapies to Standard Pharmacologic Treatment in Migraine.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846311/ ) Mehta and colleagues recruited adult patients diagnosed with migraine headaches and randomly assigned them to either standard care or to receive standard care plus either yoga training or physical therapy. They were trained and then practiced at home daily for 3 months. Before training, at 1 and 2-months during training, and after training they were measured for headache pain and headache frequency and headache impact.

 

They found that all three groups had significant reductions in migraine frequency, severity (pain), and impact on life. Both yoga and physical therapy reduced frequency and impact on life to a significantly greater extent than standard care.

 

These findings suggest that either yoga or physical therapy when added to standard care for migraine headache produces significant additional improvements in the symptoms of migraine headaches. The fact that yoga and physical therapy did not differ in effectiveness suggests that the physical exercise provided by yoga is the reason for yoga’s effectiveness. These findings suggest that yoga practice or physical therapy should be added to the standard care for patients with Migraine headaches.

 

So, reduce migraine symptoms with yoga or physical therapy.

 

“Yoga’s postures, deep breathing and meditation . . . could be very helpful in both treating migraine and fighting the disability associated with migraine.” – American Migraine Foundation

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Mehta, J. N., Parikh, S., Desai, S. D., Solanki, R. C., & G. Pathak, A. (2021). Study of Additive Effect of Yoga and Physical Therapies to Standard Pharmacologic Treatment in Migraine. Journal of Neurosciences in Rural Practice, 12(1), 60–66. https://doi.org/10.1055/s-0040-1718842

 

Abstract

Objective  We aimed to evaluate and compare the effectiveness of physical and yoga therapies as an adjuvant therapy along with standard pharmacologic treatment in patients with migraine.

Materials and Methods  A total of 61 consenting patients diagnosed to have migraine were randomized into three groups to receive either standard treatment alone, physical therapy along with standard treatment, or yoga therapy along with standard treatment. The respective adjuvant intervention was taught to the respective group of patients and they were advised to perform it daily for 3 months with weekly telephonic reminders and review of their activity logs. Outcome measures assessed were headache frequency, Short-Form McGill Pain Questionnaire (SF-MPQ), and Headache Impact Test-6 (HIT-6) at recruitment and once every month for 3 months.

Statistical Analysis  Statistical analysis of the study was done by using Stata 14.1 software. All the descriptive statistics, paired t -test was used to compare the difference between pre and postintervention values of headache frequency, SF-MPQ, and HIT-6 score within all the three groups. Analysis of variance test and post hoc test were used to compare the differences between all groups for outcome measures ( p < 0.05).

Results  Headache frequency and the visual analog scale before intervention compared during each month intervals for 3 months in all the three groups were significantly decreased in all the three groups ( p < 0.005). Yoga or physical therapy as an adjuvant to standard treatment leads to a higher reduction in headache frequency and severity. Sensory and affective pain ratings of SF-MPQ and HIT-6 also showed a significant improvement at 1 to 3 months of treatment compared with baseline in all the three groups.

Conclusion  Either physical or yoga therapy as an adjuvant to standard pharmacologic treatment may further improve the quality of life and reduce headache frequency in patients with migraine.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846311/

 

Reduce Opioid-Treated Pain and Opioid Dosage with Mindfulness

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Reduce Opioid-Treated Pain and Opioid Dosage with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mind-body therapies — including meditation, cognitive behavioral therapy and hypnosis — were associated with improvements in pain and reduced opioid doses.” – Erin Michael

 

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

 

There is an accumulating volume of research findings that demonstrate that mindfulness practices, in general, are effective in treating pain. What is not known is the most effective mind-body treatments for chronic pain. There are a large variety of mind-body therapies including meditation, hypnosis, relaxation, guided imagery, therapeutic suggestion, and Cognitive Behavioral Therapy (CBT). It is not known which are the most effective for reducing pain and opioid use in patients with chronic pain who are being treated with opioids.

 

In today’s Research News article “Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830441/ ) Garland and colleagues review, summarize, and perform a meta-analysis of the published randomized controlled trials of the effectiveness of mind-body techniques for opioid-treated pain. They identified 60 published trials.

 

They report that the published research found that the studies that used Mind-Body Therapies produced significant reductions in pain outcomes and opioid use. This was true for studies that employed meditation, hypnosis, or Cognitive Behavioral Therapy (CBT), with the largest effect sizes found for meditation. Suggestion, imagery, and relaxation were all found to be less effective.

 

Hence, the published randomized controlled trials support the use of Mind-Body Therapies for the treatment of patients with chronic pain who are being treated with opioids. Meditation, hypnosis, or Cognitive Behavioral Therapy (CBT) are particularly effective in both treating pain and reducing opioid use. This is compatible with other results that mindfulness meditation has been repeatedly shown to reduce pain and improve recovery from opioid addiction.

 

Meditation, hypnosis, or Cognitive Behavioral Therapy (CBT) have a common property of changing the patient’s thought patterns associated with their pain and thereby alter their relationship with the pain. These thought patterns such as worry, rumination, and catastrophizing tend to amplify the physical pain. Reducing these tendencies can eliminate the amplification and thereby reduce the experienced pain. With less pain, less opioids are needed to control it.

 

So, reduce opioid-treated pain and opioid dosage with mindfulness.

 

“Using mindfulness, meditation, hypnosis, therapeutic suggestion, and cognitive behavior therapy, in addition to opioid treatment of acute or chronic pain, provides an additional benefit to patients by reducing pain scores. Some of these interventions will decrease the duration or amount of opioid needed.” – Sumi Sexton

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Garland, E. L., Brintz, C. E., Hanley, A. W., Roseen, E. J., Atchley, R. M., Gaylord, S. A., Faurot, K. R., Yaffe, J., Fiander, M., & Keefe, F. J. (2019). Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis. JAMA internal medicine, 180(1), 91–105. Advance online publication. https://doi.org/10.1001/jamainternmed.2019.4917

 

Key Points

Question

Are mind-body therapies (ie, meditation, hypnosis, relaxation, guided imagery, therapeutic suggestion, and cognitive behavioral therapy) associated with pain reduction and opioid-related outcome improvement among adults using opioids for pain?

Findings

In this systematic review and meta-analysis of 60 randomized clinical trials with 6404 participants, mind-body therapies were associated with improved pain (Cohen d = −0.51; 95% CI, −0.76 to −0.27) and reduced opioid dose (Cohen d = −0.26; 95% CI, −0.44 to −0.08).

Meaning

Practitioners should be aware that mind-body therapies may be associated with moderate improvements in pain and small reductions in opioid dose.

Abstract

Importance

Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients.

Objective

To evaluate the association of MBTs with pain and opioid dose reduction in a diverse adult population with clinical pain.

Data Sources

For this systematic review and meta-analysis, the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases were searched for English-language randomized clinical trials and systematic reviews from date of inception to March 2018. Search logic included (pain OR analgesia OR opioids) AND mind-body therapies. The gray literature, ClinicalTrials.gov, and relevant bibliographies were also searched.

Study Selection

Randomized clinical trials that evaluated the use of MBTs for symptom management in adults also prescribed opioids for clinical pain.

Data Extraction and Synthesis

Independent reviewers screened citations, extracted data, and assessed risk of bias. Meta-analyses were conducted using standardized mean differences in pain and opioid dose to obtain aggregate estimates of effect size with 95% CIs.

Main Outcomes and Measures

The primary outcome was pain intensity. The secondary outcomes were opioid dose, opioid misuse, opioid craving, disability, or function.

Results

Of 4212 citations reviewed, 60 reports with 6404 participants were included in the meta-analysis. Overall, MBTs were associated with pain reduction (Cohen d = −0.51; 95% CI, −0.76 to −0.26) and reduced opioid dose (Cohen d = −0.26; 95% CI, −0.44 to −0.08). Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and cognitive behavioral therapy (n = 7) interventions. Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d = −0.70), hypnosis (Cohen d = −0.54), suggestion (Cohen d = −0.68), and cognitive behavioral therapy (Cohen d = −0.43) but not for other MBTs. Although most meditation (n = 4 [80%]), cognitive-behavioral therapy (n = 4 [57%]), and hypnosis (n = 12 [63%]) studies found improved opioid-related outcomes, fewer studies of suggestion, guided imagery, and relaxation reported such improvements. Most MBT studies used active or placebo controls and were judged to be at low risk of bias.

Conclusions and Relevance

The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse. Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830441/Importance

Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients.

Change the Brain to Improve Chronic Pain with Mindfulness

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Change the Brain to Improve Chronic Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“we should consider one’s level of mindfulness when calculating why and how one feels less or more pain.” – Fadel Zeidan

 

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

 

There is an accumulating volume of research findings that demonstrate that mindfulness practices, in general, are effective in treating pain. Pain experiences are processed in the nervous system. The nervous system changes in response to how it is used and how it is stimulated in a process called neuroplasticity. Highly used areas grow in size, metabolism, and connectivity. So, the nervous system changes in response to chronic pain. Mindfulness practices in general are known to produce neuroplastic changes in the structure and activity of the brain. So, it’s likely that mindfulness practices somehow alter the brain’s processing of pain.

 

Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT 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 “Network Analysis of Induced Neural Plasticity Post-Acceptance and Commitment Therapy for Chronic Pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823706/ ) Meier and colleagues recruited adult female patients who were diagnosed with chronic musculoskeletal pain. They were provided a 4-week group program of Acceptance and Commitment Therapy (ACT). It met twice a week for 90 minutes. They were measured before and after ACT for pain intensity, pain interference, anxiety, depression, sleep, quality of life, and cognitive ability. ACT was previously found to improve these symptoms of chronic pain.

 

They also had their brains scanned with functional Magnetic Resonance Imaging (f-MRI). The researchers examined the functional connectivity in 4 brain systems; the pain network, default mode network, frontoparietal network, and salience network. They found that after Acceptance and Commitment Therapy (ACT) there were significant reductions in functional connectivity within all four networks.

 

Previous work revealed that the chronic pain patients had very high levels of connectivity in these 4 networks. This hyperconnectivity was interpreted as a neuroplastic change in the brain produced by chronic pain. The present findings that Acceptance and Commitment Therapy (ACT) reduces this connectivity suggest that ACT normalizes the connectivity in these networks, making it easier for the patients to cope with their pain. This, in turn, improves their mood and quality of life.

 

So, change the brain to improve chronic pain with mindfulness.

 

“Mindfulness meditation can be used as a tool to create more awareness of the sensation of pain itself, without the judgment or resistance, and the affective and cognitive evaluation that we often project upon it. When we impose a litany of negativity upon our pain, it only becomes worse, and potentially elicits other difficulties including depression and anxiety. When we become more aware of what we are actually experiencing, without the overlay of our judgment, the overall perception of pain is reduced.” – Jennifer Wolkin

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Meier, S. K., Ray, K. L., Waller, N. C., Gendron, B. C., Aytur, S. A., & Robin, D. A. (2020). Network Analysis of Induced Neural Plasticity Post-Acceptance and Commitment Therapy for Chronic Pain. Brain sciences, 11(1), 10. https://doi.org/10.3390/brainsci11010010

 

Abstract

Chronic musculoskeletal pain is a costly and prevalent condition that affects the lives of over 50 million individuals in the United States. Chronic pain leads to functional brain changes in those suffering from the condition. Not only does the primary pain network transform as the condition changes from acute to persistent pain, a state of hyper-connectivity also exists between the default mode, frontoparietal, and salience networks. Graph theory analysis has recently been used to investigate treatment-driven brain network changes. For example, current research suggests that Acceptance and Commitment Therapy (ACT) may reduce the chronic pain associated hyper-connectivity between the default mode, frontoparietal, and salience networks, as well as within the salience network. This study extended previous work by examining the associations between the three networks above and a meta-analytically derived pain network. Results indicate decreased connectivity within the pain network (including left putamen, right insula, left insula, and right thalamus) in addition to triple network connectivity changes after the four-week Acceptance and Commitment Therapy intervention.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823706/

 

Movement-Based Therapies are Affective for Rehabilitation from Disease

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Movement-Based Therapies are Affective for Rehabilitation from Disease

 

By John M. de Castro, Ph.D.

 

“Tai chi is often described as “meditation in motion,” but it might well be called “medication in motion.” There is growing evidence that this mind-body practice, which originated in China as a martial art, has value in treating or preventing many health problems.” – Havard Health

 

Mindful movement practices such as yoga and Tai Chi and Qigong have been used for centuries to improve the physical and mental health and well-being of practitioners. But only recently has the effects of these practices come under scientific scrutiny. This research has been accumulating. So, it makes sense to pause and examine what has been learned about the effectiveness of these practice for rehabilitation from disease.

 

In today’s Research News article “Movement-Based Therapies in Rehabilitation.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476461/ ) Phuphanich and colleagues review and summarize the published research studies of the effects of mindful movement practices on rehabilitation from disease.

 

They report that published research has found that yoga practice reduces fatigue, sleep disturbances, depression, and anxiety and improves the immune system in cancer patients. Yoga has been found to be an effective treatment for mental health issues such as anxiety, depression, and post-traumatic stress disorder (PTSD). Yoga has been found to reduce pain levels, fear avoidance, stress, and sleep disturbance and increases self-efficacy and quality of life in chronic pain patients. Yoga has been found to improve the symptoms of traumatic brain injury, stroke, spinal cord injury, Parkinson disease, dementia, multiple sclerosis, epilepsy, and neuropathies. In addition, yoga has been found to improve systolic and diastolic blood pressures, heart rate, respiratory rate, waist circumference, waist/hip ratio, cholesterol, triglycerides, hemoglobin A1c, and insulin resistance in cardiopulmonary diseases.

 

They report that the published research has found that Tai Chi and Qigong practices reduce falls in the elderly. Tai Chi and Qigong has been found to reduce pain levels and increase quality of life in chronic pain patients. In addition, there is evidence that Tai Chi and Qigong practices improves depression, anxiety, posttraumatic stress disorder, sleep disturbance, schizophrenia, rheumatoid arthritis, spinal cord injury, traumatic brain injury, and immune disorders.

 

These are remarkable findings. The range of disorders that are positively affected by yoga, Tai Chi, and Qigong practices is breathtaking. These practices are also safe and can be widely implemented at relatively low cost and can be performed alone or in groups and at home or in a therapeutic setting. This suggests that these practices should be routinely implemented for rehabilitation from disease.

 

So,  movement-based therapies are affective for rehabilitation from disease.

 

“Being mindful through any physical activity can not only improve performance in the activity such as yoga, tennis, swimming, etc, but it can also increase flexibility, confidence in movement and generate a sense of body and mind connection that has the potential for improving your overall sense of well-being.“- Anupama Kommu

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Phuphanich, M. E., Droessler, J., Altman, L., & Eapen, B. C. (2020). Movement-Based Therapies in Rehabilitation. Physical medicine and rehabilitation clinics of North America, 31(4), 577–591. https://doi.org/10.1016/j.pmr.2020.07.002

 

Abstract

Movement therapy refers to a broad range of Eastern and Western mindful movement-based practices used to treat the mind, body, and spirit concurrently. Forms of movement practice are universal across human culture and exist in ancient history. Research demonstrates forms of movement therapy, such as dance, existed in the common ancestor shared by humans and chimpanzees, approximately 6 million years ago. Movement-based therapies innately promote health and wellness by encouraging proactive participation in one’s own health, creating community support and accountability, and so building a foundation for successful, permanent, positive change.

Key Points – Movement-based therapies

  • Decrease fear avoidance and empower individuals to take a proactive role in their own health and wellness.
  • Can benefit patients of any ability; practices are customizable to the individual’s needs and health.
  • Are safe, cost-effective, and potent adjunct treatments used to supplement (not replace) standard care.
  • Deliver patient-centered, integrative care that accounts for the physical, psychological, social, and spiritual aspects of health and illness.
  • Have diverse, evidence-based benefits, including reduction in pain, stress, and debility, and improvements in range of motion, strength, balance, coordination, cardiovascular health, physical fitness, mood, and cognition.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476461/

 

Control Chronic Pain with Mindfulness

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Control Chronic Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness is not like traditional painkillers, which are intended to dull or eliminate pain. While many experts recommend mindfulness-based practices to manage pain, the goal of those practices is typically not to remove pain entirely, but to change your relationship with it so that you are able to experience relief and healing in the middle of uncomfortable physical sensations.” – Andrea Uptmor

 

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

 

There is an accumulating volume of research findings that demonstrate that mindfulness practices, in general, are effective in treating pain. Mindfulness appears to work by changing how the patient relates to pain rather than actually reducing or eliminating the pain. Cognitive Behavioral Therapy (CBT) is directed to change thought patterns and has also been shown to be an effective therapy for chronic pain. What is not known is the most effective treatment for chronic pain. The evidence has been accumulating. So, it makes sense to step back and summarize what has been learned.

 

In today’s Research News article “Differential efficacy between cognitive-behavioral therapy and mindfulness-based therapies for chronic pain: Systematic review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753033/ ) Pardos-Gascón and colleagues review and summarize the published randomized clinical trials of the effectiveness of mindfulness-based and cognitive-behavioral treatments for chronic pain. They identified 18 published randomized clinical trials.

 

They report that the published studies found that mindfulness-based treatments produced significant reductions in symptoms and impact of the pain on the patients’ lives for patients with fibromyalgia, low back pain, and headache. There were few studies that compared mindfulness-based treatment to Cognitive Behavioral Therapy (CBT) but the few that did, did not find significant differences in effectiveness. It is clear that more direct comparisons are needed. Regardless, mindfulness-based treatments are effective for chronic pain.

 

So, control chronic pain with mindfulness.

 

“Daily mindfulness practice can be helpful for people living with chronic pain because sometimes there are negative or worrisome thoughts about the pain. These thoughts are normal, and can affect mood and increase pain. Being able to focus on relaxing the body, noticing the breath and body sensations as being there just as they are, can help manage pain, as well as reduce depression and anxiety symptoms.” – Andrea Neckar

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Pardos-Gascón, E. M., Narambuena, L., Leal-Costa, C., & van-der Hofstadt-Román, C. J. (2021). Differential efficacy between cognitive-behavioral therapy and mindfulness-based therapies for chronic pain: Systematic review. International journal of clinical and health psychology : IJCHP, 21(1), 100197. https://doi.org/10.1016/j.ijchp.2020.08.001

 

Abstract

Background/Objective: To assess the differential efficacy between mindfulness-based interventions and cognitive-behavioral Therapy (CBT) on chronic pain across medical conditions involving pain. Method: ProQuest, Science Direct, Google Scholar, Pubmed, and Embase databases were searched to identify randomized clinical trials. Measurements of mindfulness, pain, mood, and further miscellaneous measurements were included. Results: 18 studies met the inclusion criteria (fibromyalgia, n = 5; low back pain, n = 5; headache/migraine, n = 4; non-specific chronic pain, n = 4). In fibromyalgia, mindfulness based stress reduction (MBSR) was superior to the usual care and Fibroqol, in impact and symptoms. In low back pain, MBSR was superior to the usual care, but not to CBT, in physical functionality and pain intensity. There were no studies on differential efficacy between mindfulness and CBT for headache and non-specific chronic pain, but Mindfulness interventions were superior to the usual care in these syndromes. Conclusions: Mindfulness interventions are superior to usual cares in all diagnoses, but it is not possible to conclude their superiority over CBT. Comparisons between mindfulness interventions are scarce, with MBSR being the most studied. In central sensitization syndromes, variables associated with pain tend to improve with treatment. More research is needed to differentiate diagnosis and intervention.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753033/

 

Improve the Mental Health of Chronic Pain Patients with Mindfulness Training Over the Internet.

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Improve the Mental Health of Chronic Pain Patients with Mindfulness Training Over the Internet.

 

 

By John M. de Castro, Ph.D.

 

“Daily mindfulness practice can be helpful for people living with chronic pain because sometimes there are negative or worrisome thoughts about the pain. These thoughts are normal, and can affect mood and increase pain. Being able to focus on relaxing the body, noticing the breath and body sensations as being there just as they are, can help manage pain, as well as reduce depression and anxiety symptoms.” – Amanda Necker

 

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

 

There is an accumulating volume of research findings that demonstrate that mindfulness practices, in general, are effective in treating pain. A therapeutic technique that contains mindfulness training and Cognitive Behavioral Therapy (CBT) is Acceptance and Commitment Therapy (ACT). It focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

Acceptance and Commitment Therapy (ACT) requires a scheduled program of sessions with a trained therapist. This results in costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. As an alternative, mindfulness training over the internet have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. In addition, research has indicated that mindfulness training online can be effective for improving the health and well-being of the participants.

 

In today’s Research News article “Internet-delivered acceptance and commitment therapy (iACT) for chronic pain-feasibility and preliminary effects in clinical and self-referred patients.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327284/ ) Rickardsson and colleagues recruited chronic pain patients and provided them with 10 weeks of 4 times per week 15 minute programmed Acceptance and Commitment Therapy (ACT) delivered via the internet. Therapists interacted with the individual participants via text once a week for 12 weeks. They were measured before and after training and at 3 and 12-month follow-ups for pain interference, psychological flexibility, value orientation, quality of life, pain intensity, insomnia, anxiety, and depression.

 

They found that following treatment there were significant improvements in pain interference, psychological inflexibility, value progress, value obstruction, QoL, depressive symptoms, pain intensity, anxiety and insomnia. These improvements were maintained at the 3 and 12-month follow-ups.

 

This was a pilot study without a comparison condition. As such, it must be interpreted with caution. But the results suggest that Acceptance and Commitment Therapy (ACT) can be effectively delivered via the internet with the suggestion that it produced lasting improvements in the psychological health of the chronic pain patients. The internet delivery is important as it allows for convenient, cost-effective, mass delivery of the program. This makes it a particularly desirable therapeutic method for the treatment of patients with chronic pain.

 

So, improve the mental health of chronic pain patients with mindfulness training over the internet.

 

“Mindfulness can help you . . . to reduce the suffering associated with pain without necessarily reducing the severity of the pain itself. It can also help you approach your pain with less fear and more acceptance, allowing you to live life fully, even though you have pain.” – Andrea Uptmor

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Rickardsson, J., Zetterqvist, V., Gentili, C., Andersson, E., Holmström, L., Lekander, M., Persson, M., Persson, J., Ljótsson, B., & Wicksell, R. K. (2020). Internet-delivered acceptance and commitment therapy (iACT) for chronic pain-feasibility and preliminary effects in clinical and self-referred patients. mHealth, 6, 27. https://doi.org/10.21037/mhealth.2020.02.02

 

Abstract

Background

Acceptance and commitment therapy (ACT) is an evidence-based treatment to improve functioning and quality of life (QoL) for chronic pain patients, but outreach of this treatment is unsatisfactory. Internet-delivery has been shown to increase treatment access but there is limited evidence regarding feasibility and effectiveness of web-based ACT for chronic pain. The aim of the study was to evaluate and iterate a novel internet-delivered ACT program, iACT, in a clinical and a self-referred sample of chronic pain patients. The intervention was developed in close collaboration with patients. To enhance learning, content was organized in short episodes to promote daily engagement in treatment. In both the clinical and self-referred samples, three critical domains were evaluated: (I) feasibility (acceptability, practicality and usage); (II) preliminary efficacy on pain interference, psychological inflexibility, value orientation, QoL, pain intensity, anxiety, insomnia and depressive symptoms; and (III) potential treatment mechanisms.

Methods

This was an open pilot study with two samples: 15 patients from a tertiary pain clinic and 24 self-referred chronic pain participants, recruited from October 2015 until January 2017. Data were collected via an online platform in free text and self-report measures, as well as through individual oral feedback. Group differences were analyzed with Chi square-, Mann-Whitney U- or t-test. Preliminary efficacy and treatment mechanism data were collected via self-report and analyzed with multilevel linear modeling for repeated measures.

Results

Feasibility: patient feedback guided modifications to refine the intervention and indicated that iACT was acceptable in both samples. User insights provided input for both immediate and future actions to improve feasibility. Comprehensiveness, workability and treatment credibility were adequate in both samples. Psychologists spent on average 13.5 minutes per week per clinical patient, and 8 minutes per self-referred patient (P=0.004). Recruitment rate was 24 times faster in the self-referred sample (24 patients in 1 month, compared to 15 patients in 15 months, P<0.001) and the median distance to the clinic was 40 km in the clinical sample, and 426 km in the self-referred sample (P<0.001). Preliminary effects: post-assessments were completed by 26 participants (67%). Significant effects of time were seen from pre- to post-treatment across all outcome variables. Within group effect sizes (Cohen’s d) at post-treatment ranged from small to large: pain interference (d=0.64, P<0.001), psychological inflexibility (d=1.43, P<0.001), value progress (d=0.72, P<0.001), value obstruction (d=0.42, P<0.001), physical QoL (d=0.41, P=0.005), mental QoL (d=0.67, P=0.005), insomnia (d=0.31, P<0.001), depressive symptoms (d=0.47, P<0.001), pain intensity (d=0.78, P=0.001) and anxiety (d=0.46, P<0.001). Improvements were sustained at 1-year follow-up. Psychological inflexibility and value progress were found to be potential treatment mechanisms.

Conclusions

The results from the present study suggests that iACT was feasible in both the clinical and the self-referred sample. Together with the positive preliminary results on all outcomes, the findings from this feasibility study pave the way for a subsequent large randomized efficacy trial.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327284/

 

Improve Chronic Low Back Pain with Mindfulness

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Improve Chronic Low Back Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“meditation and cognitive behavioral therapy often work better than pain meds and other medical treatments for chronic back pain.” – Nancy Shute

 

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. Mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back pain. The research has been accumulating and it is useful to summarize what has been learned.

 

In today’s Research News article “A Systematic Review of Mindfulness Practices for Improving Outcomes in Chronic Low Back Pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735497/ ) Smith and Langen review, and summarize the effectiveness of Mindfulness-Based Stress Reduction (MBSR) for the relief of chronic low back pain. MBSR is generally delivered as an 8-week program including training in meditation, body scan, and yoga along with group discussion and daily home practice.

 

They identified 12 published research studies. They report that the published studies found that Mindfulness-Based Stress Reduction (MBSR) significantly reduced pain severity and improved the quality of life of patients with chronic low back pain. These improvements were still present at long-term follow-up. Hence, mindfulness training appears to a safe and effective treatment for the symptoms of chronic low back pain.

 

Mindfulness-Based Stress Reduction (MBSR) is a complex of different practices. It is not known which of the components or which combination of components is necessary and sufficient to produce the pain reductions and quality of life improvement. But meditation practice by itself has been shown to reduce perceived pain and quality of life and yoga practice alone has also been shown to reduce perceived pain and quality of life. So, all of the components may be effective. It is not known, however, if their effects are additive so that the combination of practices produces greater benefits than the individual practices alone. This remains for future research to investigate.

 

So, improve chronic low back pain with mindfulness.

 

“meditation may help change the individual’s relationship to pain and other experiences, rather than focusing on changing the content of the experience itself (which, of note, may not be possible), and has the potential to uncouple the physical experience of pain from pain-related suffering.” –  Aleksandra Zgierska

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Smith, S. L., & Langen, W. H. (2020). A Systematic Review of Mindfulness Practices for Improving Outcomes in Chronic Low Back Pain. International journal of yoga, 13(3), 177–182. https://doi.org/10.4103/ijoy.IJOY_4_20

 

Abstract

Background:

Chronic pain is a serious public health problem that affects people of all ages and backgrounds. Mindfulness-based stress reduction (MBSR) techniques offer an accessible treatment modality for chronic pain patients that may complement or replace pharmacological treatment. This article reviews the literature on the efficacy of MBSR training in patients with back chronic pain syndromes for the outcomes of pain measures, quality of life (QOL), mental health, and mindfulness.

Methods:

A systemized search was conducted in September of 2018 for studies published between 2008 and 2018 on mindfulness and chronic low back pain. Out of 50 articles on mindfulness and chronic pain, 12 empirical studies were selected for the inclusion in this review.

Results:

Subjective pain scores and QOL improved for chronic pain patients after mindfulness interventions, compared to control groups, in most of the studies reviewed. Limitations of the studies reviewed included the varied pain measurement instruments, the small sample sizes, and the inability to blind participants to MBSR intervention.

Conclusions:

MBSR interventions show significant improvements in chronic pain patients for pain measures, QOL, and mental health.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735497/