Pain

Improve Chronic Conditions with Mindfulness Taught over the Internet

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Improve Chronic Conditions with Mindfulness Taught over the Internet

 

By John M. de Castro, Ph.D.

 

“It’s important for people living with health conditions to recognize what they are feeling, instead of trying to push painful thoughts and emotions away, which can actually amplify them. For those living with serious medical conditions, mindfulness can help them accept and respond to difficult feelings, including fear, loneliness and sadness. By bringing mindfulness to emotions (and the thoughts that may underlie them), we can begin to see them more clearly and recognize that they are temporary.” – Shauna Shapiro

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health and particularly with the physical and psychological reactions to stress. The vast majority of the mindfulness training techniques, however, require a certified trained therapist. This results in costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. This makes delivery to individuals in remote locations nearly impossible.

 

As an alternative, applications over the internet and on smartphones have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, eliminating the need to go repeatedly to specific locations, and being available to patients in remote areas. But, the question arises as to the level of compliance with the training and the effectiveness of these internet applications in inducing mindfulness and improving physical and psychological health in chronically ill patients.

 

In today’s Research News article “Digital Characteristics and Dissemination Indicators to Optimize Delivery of Internet-Supported Mindfulness-Based Interventions for People With a Chronic Condition: Systematic Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107686/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123540/  ), Russell and colleagues review and summarize the published research literature on the effectiveness of internet based mindfulness training programs for the treatment of patients with chronic diseases. They identified 10 randomized controlled studies that contained a control group where mindfulness training was performed over the internet. The patients were afflicted with chronic pain in 3 of the studies, and in single studies with fibromyalgia, heart disease, cancer post-treatment, anxiety disorder, major depressive disorder, residual depressive symptoms, and psychosis.

 

They found that internet-based mindfulness interventions in general had significant beneficial effects that improved patient functioning in comparison to the control groups. Half of the studies reported follow-up measurements that reflected persisting benefits. They noted that when measured participant adherence to the programs was in general low.

 

Hence, it appears that internet-based mindfulness interventions are safe and effective treatments for the well-being of patients with chronic diseases. This is potentially very important as these interventions can be administered inexpensively, conveniently, and to large numbers of patients regardless of their locations, greatly increasing the impact of the treatments.

 

There are some caveats. The majority of the participants by far were women and there was no study that compared the efficacy of the internet-based intervention to the comparable face-to-face intervention or another treatment. So, it was recommended that future studies include more males and a comparison to another treatment.

 

So, improve chronic conditions with mindfulness taught over the internet.

 

“MBSR programs might not reverse underlying chronic disease, but they can make it easier to cope with symptoms, improve overall well-being and quality of life and improve health outcomes.” – Monika Merkes

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Russell, L., Ugalde, A., Milne, D., Austin, D., & Livingston, P. M. (2018). Digital Characteristics and Dissemination Indicators to Optimize Delivery of Internet-Supported Mindfulness-Based Interventions for People With a Chronic Condition: Systematic Review. JMIR Mental Health, 5(3), e53. http://doi.org/10.2196/mental.9645

 

Abstract

Background

Internet-supported mindfulness-based interventions (MBIs) are increasingly being used to support people with a chronic condition. Characteristics of MBIs vary greatly in their mode of delivery, communication patterns, level of facilitator involvement, intervention period, and resource intensity, making it difficult to compare how individual digital features may optimize intervention adherence and outcomes.

Objective

The aims of this review were to (1) provide a description of digital characteristics of internet-supported MBIs and examine how these relate to evidence for efficacy and adherence to the intervention and (2) gain insights into the type of information available to inform translation of internet-supported MBIs to applied settings.

Methods

MEDLINE Complete, PsycINFO, and CINAHL databases were searched for studies assessing an MBI delivered or accessed via the internet and engaging participants in daily mindfulness-based activities such as mindfulness meditations and informal mindfulness practices. Only studies using a comparison group of alternative interventions (active compactor), usual care, or wait-list were included. Given the broad definition of chronic conditions, specific conditions were not included in the original search to maximize results. The search resulted in 958 articles, from which 11 articles describing 10 interventions met the inclusion criteria.

Results

Internet-supported MBIs were more effective than usual care or wait-list groups, and self-guided interventions were as effective as facilitator-guided interventions. Findings were informed mainly by female participants. Adherence to interventions was inconsistently defined and prevented robust comparison between studies. Reporting of factors associated with intervention dissemination, such as population representativeness, program adoption and maintenance, and costs, was rare.

Conclusions

More comprehensive descriptions of digital characteristics need to be reported to further our understanding of features that may influence engagement and behavior change and to improve the reproducibility of MBIs. Gender differences in determinants and patterns of health behavior should be taken into account at the intervention design stage to accommodate male and female preferences. Future research could compare MBIs with established evidence-based therapies to identify the population groups that would benefit most from internet-supported programs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123540/

 

Improve Opioid-Treated Chronic Low Back Pain with Mindfulness

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Improve Opioid-Treated Chronic Low Back Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness meditation and CBT-based interventions have the potential to safely reduce pain severity in patients with chronic lower back pain that’s treated with opioids,” – Dr. Aleksandra Zgiersk

 

Low Back Pain is the leading cause of disability worldwide and affects between 6% to 15% of the population. It is estimated, however, that 80% of the population will experience back pain sometime during their lives. The pain interferes with daily living and with work, interfering with productivity and creating absences. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs. These therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years and opiate pain killers are dangerous and can lead to abuse, addiction, and fatal overdoses. Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects.

 

Pain involves both physical and psychological issues. Physically, exercise can be helpful in strengthening the back to prevent or relieve pain. Psychologically, the stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back pain. There is a need to explore the utility of mindfulness training when it is used as a supplement to opioid treatment for chronic low back pain.

 

In today’s Research News article “Cost of Opioid-Treated Chronic Low Back Pain: Findings from a Pilot Randomized Controlled Trial of Mindfulness Meditation-Based Intervention.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836724/ ), Zgierska and colleagues recruited adults with chronic low back pain and were being treated with opioids. They were randomly assigned to either continue with only treatment as usual or receive additional mindfulness training delivered in 8-weekly 2-hour sessions with home practice. They were measured before and after training for pain severity, pain responses to heat, healthcare utilization, productivity loss, medication use, and costs associated with disability and treatment.

 

They found that in comparison to baseline and the treatment as usual control, the patients that received mindfulness training had significantly reduced pain severity and pain response to heat. In addition, the mindfulness group tended to have fewer lost days of work while the control group tended to use more opioid medication. In looking at the economic costs of opioid treatment for low back pain, they found that adding the mindfulness training did not increase overall costs. Hence, mindfulness training appears to additionally relieve chronic low back pain beyond the effects of opioid medication, yet does not cost any more.

 

So, improve opioid-treated chronic low back pain with mindfulness.

 

“Chronic pain is a condition best managed when patients take an active role and . . . . according to the research, mindfulness should now be a part of a multi-disciplinary strategy for those willing to put in the effort.” —Stephani Sutherland

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Zgierska, A. E., Ircink, J., Burzinski, C. A., & Mundt, M. P. (2017). Cost of Opioid-Treated Chronic Low Back Pain: Findings from a Pilot Randomized Controlled Trial of Mindfulness Meditation-Based Intervention. Journal of Opioid Management, 13(3), 169–181. http://doi.org/10.5055/jom.2017.0384

 

Abstract

Objective

Opioid-treated chronic low back pain (CLBP) is debilitating, costly and often refractory to existing treatments. This secondary analysis aims to pilot-test the hypothesis that mindfulness meditation (MM) can reduce economic burden related to opioid-treated CLBP.

Design

26-week unblinded pilot randomized controlled trial, comparing MM, adjunctive to usual-care, to usual care alone.

Setting

Outpatient

Participants

Thirty-five adults with opioid-treated CLBP (≥ 30 morphine-equivalent mg/day) for 3+ months enrolled; none withdrew.

Intervention

8 weekly therapist-led MM sessions and at-home practice.

Outcome Measures

Costs related to self-reported healthcare utilization, medication use (direct costs), lost productivity (indirect costs), and total costs (direct+indirect costs) were calculated for 6-month pre- and post-enrollment periods and compared within and between the groups.

Results

Participants (21 MM; 14 control) were 20% men, age 51.8 ± 9.7 years, with severe disability, opioid dose of 148.3 ± 129.2 morphine-equivalent mg/day, and individual annual income of $18,291 ± $19,345. At baseline, total costs were estimated at $15,497 ± 13,677 (direct: $10,635 ± 9,897; indirect: $4,862 ± 7,298) per participant. Although MM group participants, compared to controls, reduced their pain severity ratings and pain sensitivity to heat-stimuli (p<0.05), no statistically significant within-group changes or between-group differences in direct and indirect costs were noted.

Conclusions

Adults with opioid-treated CLBP experience a high burden of disability despite the high costs of treatment. Although this pilot study did not show a statistically significant impact of MM on costs related to opioid-treated CLBP, MM can improve clinical outcomes and should be assessed in a larger trial with long-term follow-up.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836724/

 

Relieve Depression in Patients with Chronic Pain with Mindfulness-Based Cognitive Therapy (MBCT)

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Relieve Depression in Patients with Chronic Pain with Mindfulness-Based Cognitive Therapy (MBCT)

 

By John M. de Castro, Ph.D.

 

“By developing a routine meditation practice, clients can use the technique whenever they start to feel overwhelmed by negative emotions. When sadness occurs and starts to bring up the usual negative associations that trigger relapse of depression, the client is equipped with tools that will help them replace negative thought patterns with positive.” – Psychology Today

 

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

 

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. There is an accumulating volume of research findings to demonstrate that mind-body therapies have highly beneficial effects on the health and well-being of humans. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain in adults.

 

Chronic pain is often accompanied with depression. The most commonly used mindfulness technique for the treatment of depression is Mindfulness-Based Cognitive Therapy (MBCT).  MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. It is not known, however if MBCT is also effective for the depression accompanying chronic pain.

 

In today’s Research News article “A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients with Chronic Pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020018/ ), De Jong and colleagues recruited adult patients with chronic pain and who were also clinically depressed. They were randomly assigned to either receive an 8-week program of Mindfulness-Based Cognitive Therapy (MBCT) or to a treatment as usual wait list control. The MBCT group met once a week for 2 hours in groups of 7 and also engaged in daily home practice. They were measured before and after training for depression, pain, quality of life, anxiety, and perceptions of improvement.

 

They found that in comparison to baseline and the wait list control group that the participants who received MBCT had a significant decrease in depression but not pain. Hence, MBCT was an effective treatment for depression for patients with chronic pain. It did so by not affecting the levels of pain experienced. So, the effectiveness of MBCT was due to influencing depression directly independent of pain. It should be noted that there was not an active control condition and the sample sizes were small. So, these results need to be replicated in a larger randomized controlled clinical trial with an active control. Regardless, the results are encouraging and extend the types of depressed patients helped by MBCT.

 

So, relieve depression in patients with chronic pain with Mindfulness-Based Cognitive Therapy (MBCT).

 

“Most importantly, I seemed to be developing a whole new relationship with my thoughts. It wasn’t that they’d really changed; they were still the same old wolf- and fire- and death-fearing thoughts, but I could see that they were simply that: thoughts. I did not have to judge them, act on them or indeed do anything very much about them.“ – Julie Myerson

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available at the Contemplative Studies Blog http://contemplative-studies.org/wp/

They are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

De Jong, M., Peeters, F., Gard, T., Ashih, H., Doorley, J., Walker, R., … Mischoulon, D. (2018). A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients with Chronic Pain. The Journal of Clinical Psychiatry, 79(1), 15m10160. http://doi.org/10.4088/JCP.15m10160

 

Abstract

Objective

Chronic Pain (CP) is a disabling illness, often comorbid with depression. We performed a randomized controlled pilot study on mindfulness-based cognitive therapy (MBCT) targeting depression in a CP population.

Methods

Participants with CP lasting ≥ 3 months, DSM-IV Major Depressive Disorder (MDD), Dysthymic Disorder, or Depressive disorder NOS, and a Quick Inventory of Depression scale (QIDS-C16) score ≥ 6 were randomized to MBCT (n = 26) or waitlist (n = 14). We adapted the original MBCT intervention for depression relapse prevention by modifying the psychoeducation and Cognitive Behavioral Therapy (CBT) elements to an actively depressed chronic pain population. We analyzed an intent-to treat (ITT) and a per protocol sample; the per protocol sample included participants in the MBCT group who completed at least 4 out of 8 sessions. The change in the QIDS-C16 and Hamilton Rating Sale for Depression (HRSD17) were the primary outcome measures. Pain, quality of life and anxiety were secondary outcome measures. Data collection took place between January 2012 and July 2013.

Results

Nineteen (73%) participants completed the MBCT program. No significant adverse events were reported in either treatment group. ITT analysis (n=40) revealed no significant differences. Repeated measures ANOVAs for the per protocol sample (n=33) revealed a significant treatment × time interaction (F (1, 31) = 4.67, p = 0.039, η2p = 0.13) for the QIDS-C16, driven by a significant decrease in the MBCT group (t (18) = 5.15, p < 0.001, d = 1.6), but not in the control group (t (13) = 2.01, p = 0.066). The HRSD17 scores did not differ significantly between groups. The study ended before the projected sample size was obtained, which might have prevented effect detection in some outcome measures.

Conclusions

MBCT shows potential as a treatment for depression in individuals with CP, but larger controlled trials are needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020018/

 

Decrease Chronic Pain with HIV Infection with Mindfulness

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Decrease Chronic Pain with HIV Infection with Mindfulness

 

By John M. de Castro, Ph.D.

 

“When it came to processing my HIV diagnosis, meditation offered me a framework for reflection, self-forgiveness, forgiving others and moving toward a place of acceptance.” – Seb Stuart

 

More than 35 million people worldwide and 1.2 million people in the United States are living with HIV infection. In 1996, the advent of the protease inhibitor and the so-called cocktail changed the prognosis for HIV. Since this development a 20-year-old infected with HIV can now expect to live on average to age 69. Hence, living with HIV is a long-term reality for a very large group of people. People living with HIV infection experience a wide array of physical and psychological symptoms which decrease their perceived quality of life. The symptoms include chronic pain, muscle aches, anxiety, depression, weakness, fear/worries, difficulty with concentration, concerns regarding the need to interact with a complex healthcare system, stigma, and the challenge to come to terms with a new identity as someone living with HIV.

 

Mindfulness training has been found to be effective in treating chronic pain conditions. In addition, mindfulness training has been shown to improve psychological well-being, lower depression and strengthen the immune system of patients with HIV infection. Hence it makes sense to examine the ability of mindfulness training to help relieve the chronic pain associated with HIV infection.

 

In today’s Research News article “A Mixed-Methods Pilot Study of Mindfulness Based Stress Reduction for HIV-Associated Chronic Pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005203/ ), George and colleagues recruited  HIV-infected adults who had been experiencing neuropathic and/or musculoskeletal pain for at least 3 months. They were randomly assigned to receive either an 8-week program of Mindfulness-Based Stress Reduction (MBSR) or health education. The MBSR program was comprised of guided meditations, gentle movement exercises, and group discussion. Health education concerned HIV-related pain topics. The participants were measured before and after training and 3 months later for pain intensity, pain interference with activities, HIV symptoms, perceived stress, and autonomic nervous system function.

 

They found that both groups improved modestly on all measures after training. But at the 3-month follow-up the Mindfulness-Based Stress Reduction (MBSR) had a further significant decline in pain intensity while the health education group reverted to pretreatment levels. At the follow-up 79% of the MBSR patients were still practicing which may account for the continued improvements. MBSR is composed of an array of different practices and it cannot be determined here which or which combination of components were necessary and sufficient for the benefits.

Regardless, MBSR appears to help in all areas of HIV symptoms but particularly with HIV-related pain and it is not only lasting but appears to continue producing reductions in pain intensity over time. This is a blessing for the patients as the torment of the pain produces suffering and reduces the quality of their lives.

 

So, decrease chronic pain with HIV infection with mindfulness.

 

“Given the stress-reduction benefits of mindfulness meditation training, these findings indicate there can be health protective effects not just in people with HIV but in folks who suffer from daily stress,” – David Creswell

 

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

 

George, M. C., Wongmek, A., Kaku, M., Nmashie, A., & Robinson-Papp, J. (2017). A Mixed-Methods Pilot Study of Mindfulness Based Stress Reduction for HIV-Associated Chronic Pain. Behavioral Medicine (Washington, D.C.), 43(2), 108–119. http://doi.org/10.1080/08964289.2015.1107525

 

Abstract

Treatment guidelines for chronic pain recommend non-pharmacologic modalities as part of a comprehensive management plan. Chronic pain is common among people living with HIV/AIDS, but there is little data to guide the choice of non-pharmacologic therapies in this complex population. We performed a mixed-methods feasibility study of Mindfulness Based Stress Reduction (MBSR) versus health education control with 32 inner city, HIV-infected participants. Outcome measures included: the Brief Pain Inventory, Perceived Stress Scale, HIV Symptoms Index, autonomic function testing, and audiotaped focus groups. Post-intervention, participants reported modest improvements in pain measures and perceived stress, but no effect of group assignment was observed. At 3-month follow-up, 79% of MBSR participants were still practicing, and pain intensity was improved, whereas in the control group pain intensity had worsened. Qualitative analysis revealed a strong sense of community in both groups, but only MBSR was perceived as useful for relaxation and pain relief.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005203/

 

Improve Pain Tolerance After Athletic Injuries with Mindfulness

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Improve Pain Tolerance After Athletic Injuries with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Meditation is not something that only benefits yogis. Meditation gives athletes the ability to stay calm in the eye of the storm, it improves your ability to ignore distractions, and it has a powerful impact on the state of your nervous systems. All of these elements are significant to recovery time.” – Jennifer Houghton

 

Athletic performance requires the harmony of mind and body. Excellence is in part physical and in part psychological. That is why an entire profession of Sports Psychology has developed. “In sport psychology, competitive athletes are taught psychological strategies to better cope with a number of demanding challenges related to psychological functioning.” They use a number of techniques to enhance performance including mindfulness training. It has been shown to improve attention and concentration and emotion regulation and reduces anxiety and worry and rumination, and the physiological and psychological responses to stress. As a result, mindfulness training has been employed by athletes and even by entire teams to enhance their performance.

 

Athletes, however, often get injured. It has been shown that mindfulness can help with pain management. But, it is not known if mindfulness training can help in dealing with and recovering from severe athletic injuries. In today’s Research News article “Effect of Mindfulness Based Stress Reduction (MBSR) in Increasing Pain Tolerance and Improving the Mental Health of Injured Athletes.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00722/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_650705_69_Psycho_20180524_arts_A ), Mohammed and colleagues examined the ability of a Mindfulness Based Stress Reduction (MBSR) program to reduce the physical and psychological effects of severe athletic injuries.

 

They recruited university athletes who had severe injuries that kept them from participating in their sport for at least 3 months. All athletes received usual care consisting of the standard physiotherapy treatments throughout the study. They were randomly assigned to receive either an additional 8-week program of Mindfulness Based Stress Reduction (MBSR). They met once a week for 90 minutes and were asked to practice at home for 20 minutes per day. MBSR contains meditation, yoga and body scan practices. For this study the practices were adapted to the physical needs and capabilities of the injured athletes. All athletes were measured before and after training for pain tolerance with a cold pressor test, rated their own levels of pain, and completed measures of mindfulness, positive and negative emotions, anxiety, and depression.

 

They found that following training the athletes receiving MBSR training had a significantly greater level of pain tolerance, and mindfulness compared to baseline and the control group. Both groups had significant improvements in mood, especially significant reductions in anxiety and stress. This is a small study and it needs to be repeated with larger groups and an active control condition. But, the results indicate that Mindfulness Based Stress Reduction (MBSR) improves pain tolerance and mindfulness in injured athletes. It has been previously demonstrated that mindfulness training reduces pain perception in general. The present study suggests that it also does so for severely injured athletes. This may be important for the athlete’s recovery from their injuries.

 

It will be interesting to see if the heightened mindfulness produces improved athletic performance when the athletes recover and return to their respective sporting activities. It has been shown that mindfulness training improves athletic performance. But it is not known whether it is effective with athletes returning to competition after serious injury.

 

So, improve pain tolerance after athletic injuries with mindfulness.

 

“Athletes that fall into reactive habits are being mindful when under stress.  They are at the mercy of these destructive habits.  Becoming mindful creates a pause between the stimulus that occurs and the athletes reaction to the event.” – Robert Andrews

 

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

 

Mohammed WA, Pappous A and Sharma D (2018) Effect of Mindfulness Based Stress Reduction (MBSR) in Increasing Pain Tolerance and Improving the Mental Health of Injured Athletes. Front. Psychol. 9:722. doi: 10.3389/fpsyg.2018.00722

 

Abstract

Literature indicates that injured athletes face both physical and psychological distress after they have been injured. In this study, a Mindfulness Based Stress Reduction (MBSR) was utilised as an intervention for use during the period of recovery with injured athletes and, to the best of our knowledge, this is the first study using MBSR as an intervention for this purpose.

Objective: The aim of this research was to investigate the role of MBSR practise in reducing the perception of pain and decreasing anxiety/stress, as well as increasing pain tolerance and mindfulness. An additional aim was to increase positive mood and decrease negative mood in injured athletes.

Methods: The participants comprised of twenty athletes (male = 14; female = 6; age range = 21–36 years) who had severe injuries, preventing their participation in sport for more than 3 months. Prior to their injury, the participants had trained regularly with their University teams and participated in official university championships. Both groups followed their normal physiotherapy treatment, but in addition, the intervention group practised mindfulness meditation for 8 weeks (one 90-min session/week). A Cold Pressor Test (CPT) was used to assess pain tolerance. In contrast, the perception of pain was measured using a Visual Analogue Scale. Other measurements used were the Mindful Attention Awareness Scale (MAAS), Depression Anxiety and Stress Scale (DASS), and Profile of Mood States (POMS).

Results: Our results demonstrated an increase in pain tolerance for the intervention group and an increase in mindful awareness for injured athletes. Moreover, our findings observed a promising change in positive mood for both groups. Regarding the Stress/Anxiety scores, our findings showed a notable decrease across sessions; however, no significant changes were observed in other main and interaction effects in both groups.

Conclusion: Injured athletes can benefit from using mindfulness as part of the sport rehabilitation process to increase their pain tolerance and awareness. Further research is required to assess whether increasing pain tolerance could help in the therapeutic process.

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00722/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_650705_69_Psycho_20180524_arts_A

Reduce the Symptoms of Fibromyalgia with Tai Chi

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Reduce the Symptoms of Fibromyalgia with Tai Chi

 

By John M. de Castro, Ph.D.

 

“Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment. This mind-body approach may be considered a therapeutic option in the multi-disciplinary management of fibromyalgia.” – Wang et al.

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers.

 

There are no completely effective treatments for fibromyalgia. Symptoms are generally treated with pain relievers, antidepressant drugs and exercise. But, these only reduce the severity of the symptoms and do not treat the disease directly. Mindfulness practices have also been shown to be effective in reducing pain from fibromyalgia. Mindfulness practices that are also exercises may be particularly effective. Indeed, yoga practice has been shown to improve the symptoms of fibromyalgia. This suggests that Tai Chi, another mindful exercise might be similarly effective.

 

In today’s Research News article “Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861462/ ), Wang and colleagues recruited patients with fibromyalgia and randomly assigned them to one of three groups; 60 minutes of Tai Chi once a week for 24 weeks, 60 minutes of Tai Chi twice a week for 12 weeks, or 60 minutes of light to moderate aerobic exercises twice a week for 24 weeks. Participants were encouraged to practice at home and continue the exercises after the end of formal sessions. Participants were measured before and at 12, 24, and 52 weeks into the intervention for overall severity of fibromyalgia, including intensity of pain, physical function, fatigue, morning tiredness, depression, anxiety, job difficulty, and overall wellbeing, anxiety, depression, self-efficacy, sleep quality, symptom severity, physical and mental health, coping strategies, social support, disability, and physical function, including muscle strength and power.

 

They found that at 24 and again at 52 weeks all groups showed significant improvement but the Tai Chi groups had significantly greater improvement than the aerobic exercise group in overall fibromyalgia severity, self-efficacy, anxiety, and coping strategies. Hence, participation in Tai Chi exercise produce significant improvement in the symptoms of fibromyalgia that were better than those produced by aerobic exercise.

 

These are remarkable findings that Tai Chi practice is better than aerobic exercise in treating the symptoms of fibromyalgia. Both helped, but Tai Chi helped more. Fibromyalgia patients suffer greatly and to bring relief with a simple, gentle, safe exercise is very important. Tai Chi is inexpensive to administer, can be performed in groups or alone, at home or in a facility or even public park, and can be quickly learned. In addition, it can be practiced in social groups without professional supervision. This can make it fun, improving the likelihood of long-term engagement in the practice. Hence, Tai Chi practice would appear to be a wonderful effective treatment for the relief of the suffering of fibromyalgia patients.

 

So, reduce the symptoms of fibromyalgia with Tai Chi.

 

“The authors attributed the success of the program to the postures and low impact movements of Tai Chi, and to the “controlled breathing and movements leading to restful state and mental tranquility.” Pain thresholds were likely raised in the process, which helped break the cycle of movement pain.“ – Joanna Fernandes

 

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

 

Wang, C., Schmid, C. H., Fielding, R. A., Harvey, W. F., Reid, K. F., Price, L. L., … McAlindon, T. (2018). Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. The BMJ, 360, k851. http://doi.org/10.1136/bmj.k851

 

Abstract

Objectives

To determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends on its dosage or duration.

Design

Prospective, randomized, 52 week, single blind comparative effectiveness trial.

Setting

Urban tertiary care academic hospital in the United States between March 2012 and September 2016.

Participants

226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria) were included in the intention to treat analyses: 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group.

Interventions

Participants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly). Participants were followed for 52 weeks. Adherence was rigorously encouraged in person and by telephone.

Main outcome measures

The primary outcome was change in the revised fibromyalgia impact questionnaire (FIQR) scores at 24 weeks compared with baseline. Secondary outcomes included changes of scores in patient’s global assessment, anxiety, depression, self efficacy, coping strategies, physical functional performance, functional limitation, sleep, and health related quality of life.

Results

FIQR scores improved in all five treatment groups, but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes (patient’s global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005). Tai chi treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks, twice weekly) had greater benefit (between group difference in FIQR scores=16.2 points, 8.7 to 23.6, P<0.001). The groups who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks (difference in FIQR scores=9.6 points, 2.6 to 16.6, P=0.007). There was no significant increase in benefit for groups who received tai chi twice weekly compared with once weekly. Participants attended the tai chi training sessions more often than participants attended aerobic exercise. The effects of tai chi were consistent across all instructors. No serious adverse events related to the interventions were reported.

Conclusion

Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement. This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861462/

 

Improve Psychological Well-Being with EcoMeditation

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Improve Psychological Well-Being with EcoMeditation

 

By John M. de Castro, Ph.D.

 

“Eco Meditation ,. . .is a powerful meditation, a synergy of multiple techniques, doing certain physiological moves to help you get into a deep delta meditative state, the same as a meditative master, and in only 90 seconds. You can do this meditation any time of the day, and cumulative benefits accrue with long-term use.” – Inspire Nation

 

Meditation training has been shown to improve health and well-being. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. As a result, meditation training has been called the third wave of therapies. One problem with understanding meditation effects is that meditation is not a specific practice but rather a category encompassing a wide array of practices. It is not known which work best for the health and well-being of the practitioners and for improving different conditions.

 

In today’s Research News article “The Interrelated Physiological and Psychological Effects of EcoMeditation.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871048/ ), Groesbeck and colleagues study the effects of a relatively new, less commonly practiced, technique called Eco-Meditation. As described by the authors, EcoMeditation “focuses on physiological cues. . . it has participants mimic the physiological state of an experienced practitioner. Participants mechanically assume breathing patterns and body postures that are characteristic of long-time meditators. EcoMeditation combines elements of 4 evidence-based techniques: the Quick Coherence Technique, Clinical Emotional Freedom Techniques, mindfulness meditation, and neurofeedback.”

 

In an uncontrolled pilot study, they recruited participants who were attending a weekend meditation workshop at a residential conference center where they practiced EcoMeditation. Before and after the workshop and 2 months later, the participants were measured for anxiety, depression, happiness, pain, Posttraumatic stress disorder (PTSD), resting blood pressure, heart rate, heart rate variability, heart coherence, and Salivary immunoglobulin A and cortisol levels as physiological markers of stress.

 

They found that in comparison to the levels prior to the workshop, afterward there were significant decreases in anxiety, depression, pain, resting heart rate, salivary cortisol levels, and a significantly increase in happiness. Unfortunately, none of these effects were still present 2 months later. Hence, after participating in the workshop but not 2 months later the participants reported improved psychological well-being and less stress.

 

This is an uncontrolled pilot study and no firm conclusions can be made. Without a control group there are many sources of confounding present and many alternative explanations for the results. But, the results were interesting and provide support for a more controlled study.

 

So, improve psychological well-being with EcoMeditation.

 

“In meditation, you’re seeking a state, like peace of mind, not an outcome. The rest of your life is about doing; meditation is about being.” – Anne Siret

 

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

 

Groesbeck, G., Bach, D., Stapleton, P., Blickheuser, K., Church, D., & Sims, R. (2018). The Interrelated Physiological and Psychological Effects of EcoMeditation. Journal of Evidence-Based Integrative Medicine, 23, 2515690X18759626. http://doi.org/10.1177/2515690X18759626

 

Abstract

This study investigated changes in psychological and physiological markers during a weekend meditation workshop (N = 34). Psychological symptoms of anxiety, depression, posttraumatic stress disorder (PTSD) and happiness were assessed. Physiological markers included cortisol, salivary immunoglobulin A (SigA), heart rate variability (HRV), blood pressure (BP), and resting heart rate (RHR). On posttest, significant reductions were found in cortisol (−29%, P < .0001), RHR (−5%, P = .0281), and pain (−43%, P = .0022). Happiness increased significantly (+11%, P = .0159) while the increase in SigA was nonsignificant (+27%, P = .6964). Anxiety, depression, and PTSD all declined (−26%, P = .0159; −32%, P = .0197; −18%, P = .1533), though changes in PTSD did not reach statistical significance. No changes were found in BP, HRV, and heart coherence. Participants were assessed for psychological symptoms at 3-month follow-up, but the results were nonsignificant due to inadequate sample size (n = 17). EcoMeditation shows promise as a stress-reduction method.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871048/

Improve Headache Pain with Mindfulness

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Improve Headache Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness-based stress reduction (MBSR) can be a safe and effective means of lessening the effect of migraine headache and can be carried out while patients continue to take migraine medication.” – Pauline Anderson

 

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

 

Individual studies have reported that mindfulness training is an effective treatment for headache pain. There is a need, however, to summarize and analyze the existing literature. In today’s Research News article “Mindfulness Meditation for Primary Headache Pain: A Meta-Analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5887742/ ), Gu and colleagues review, summarize, and perform a meta-analysis of the effectiveness of meditation practice for headache pain. They identified 11 published studies with adult patients. They find that the studies report that mindfulness meditation produces not only a significant reduction in headache pain but also a significant reduction in the frequency of headaches. Subgroup analysis revealed that Mindfulness-Based Stress Reduction (MBSR) was effective in reducing pain and 8 weeks of mindfulness meditation was effective in producing pain reduction.

 

Hence, the published research literature supports the conclusion that mindfulness meditation is a safe and effective treatment for headaches, reducing their number and intensity. 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.

 

So, improve headache pain with mindfulness.

 

“Mindfulness meditation is proving to be of significant help in not only reducing migraines or chronic pain, but improvements in mood, outlook on life and illness, increased coping skills, enhanced sense of well-being, changes in perception of pain, higher tolerance of pain, enhanced immune function, less fatigue and stress and better sleep. Beyond that, other benefits that are derived from mindfulness include improved cognitive functioning and memory, more inner peace, empathy and compassion, higher levels of self-awareness, joy, pleasure, creativity, insight and intuition, all of which result in a life that is deeper and more fulfilling on many levels.” – Cynthia Perkins

 

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

 

Gu, Q., Hou, J.-C., & Fang, X.-M. (2018). Mindfulness Meditation for Primary Headache Pain: A Meta-Analysis. Chinese Medical Journal, 131(7), 829–838. http://doi.org/10.4103/0366-6999.228242

 

Abstract

Background:

Several studies have reported that mindfulness meditation has a potential effect in controlling headaches, such as migraine and tension-type headache; however, its role remains controversial. This review assessed the evidence regarding the effects of mindfulness meditation for primary headache pain.

Methods:

Only English databases (PubMed, Cochrane Central Register of Controlled Trials [the Cochrane Library], PsycINFO, Psychology and behavioral science collection, PsyArticles, Web of Science, and Scopus) were searched from their inception to November 2016 with the keywords (“meditation” or “mindfulness” or “vipassana” or “dzogchen” or “zen” or “integrative body-mind training” or “IBMT” or “mindfulness-based stress reduction” or “MBSR” or “mindfulness-based cognitive therapy” or “MBCT” and “Headache” or “Head pain” or “Cephalodynia” or “Cephalalgia” or “Hemicrania” or “Migraine”). Titles, abstracts, and full-text articles were screened against study inclusion criteria: controlled trials of structured meditation programs for adult patients with primary headache pain. The quality of studies included in the meta-analysis was assessed with the Yates Quality Rating Scale. The meta-analysis was conducted with Revman 5.3.

Results:

Ten randomized controlled trials and one controlled clinical trial with a combined study population of 315 patients were included in the study. When compared to control group data, mindfulness meditation induced significant improvement in pain intensity (standardized mean difference, −0.89; 95% confidence interval, −1.63 to −0.15; P = 0.02) and headache frequency (−0.67; −1.24 to −0.10; P = 0.02). In a subgroup analysis of different meditation forms, mindfulness-based stress reduction displayed a significant positive influence on pain intensity (P < 0.000). Moreover, 8-week intervention had a significant positive effect (P< 0.000).

Conclusions:

Mindfulness meditation may reduce pain intensity and is a promising treatment option for patients. Clinicians may consider mindfulness meditation as a viable complementary and alternative medical option for primary headache.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5887742/

Mindful Patients with Multiple Sclerosis Have Less Interference in Living from Pain

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Mindful Patients with Multiple Sclerosis Have Less Interference in Living from Pain

 

By John M. de Castro, Ph.D.

 

“Mindfulness practice appears to be a safe, drug-free approach to coping with stress and anxiety, which may in turn help reduce your MS symptoms.” – Amit Sood

 

Multiple Sclerosis (MS) is a progressive demyelinating disease which attacks the coating on the neural axons which send messages throughout the body and nervous system. It affects about 2 million people worldwide and about 400,000 in the U.S. It is most commonly diagnosed in people between the ages of 20 and 50 years.  Unfortunately, there is no cure for multiple sclerosis. There are a number of approved medications that are used to treat MS but are designed to lessen frequency of relapses and slow the progression of the disease, but they don’t address individual symptoms.

 

Although there is a progressive deterioration, MS is not fatal with MS patients having about the same life expectancy as the general population. Hence, most MS sufferers have to live with the disease for many years. So, quality of life becomes a major issue. Quality of life with MS is affected by fatigue, cognitive decrements, physical impairment, depression, and poor sleep quality. For most MS patients pain accompanies the disease and in about a third of patients the pain is clinically significant. There is a thus a critical need for safe and effective methods to help relieve pain in MS sufferers. Mindfulness practices have been shown to relieve pain from a number of different conditions and also to improve the symptoms of multiple sclerosis. It has yet to be demonstrated that mindfulness can reduce the pain in MS patients.

 

In today’s Research News article “Association Between Pain and Mindfulness in Multiple Sclerosis: A Cross-sectional Survey.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825983/ ), Senders and colleagues examine the relationship between the mindfulness of patients with Multiple Sclerosis (MS) and the interference of the pain with daily activities (pain interference). They recruited adult MS patients with average age of 50 years. They measured them for the degree to which pain interfered with their everyday lives and also their levels of mindfulness.

 

They found that there was a highly significant negative relationship between the MS patients’ levels of pain interference and levels of mindfulness such that patients with high levels of mindfulness tended to have low levels of pain interference and patients with low levels of mindfulness tended to have high levels of pain interference. It should be noted that this finding is correlative and causation cannot be concluded. But in previous research mindfulness training has been shown to cause pain reduction in other disorders. This makes it highly likely that mindfulness reduced the pain interference for MS patients.

 

Mindfulness involves an appreciation of the sensations and feelings in the present moment without judging them. This appears to be important to reduce the tendency to magnify the pain by reacting negatively to it and allows the patient to function effectively even with pain. It remains to be shown that training mindfulness in MS patients will reduce their suffering and its interference with everyday living.

 

“Living with the pain, discomfort, and the uncertainties of MS can lead to feelings of frustration, anger, anxiety, and depression. . . By becoming mindful and aware of our thoughts, feelings, and body sensations, we can better control situations, and we have more choices. It also means that we are less likely to end up striving for too long toward goals that it might be wiser to let go. Mindful awareness helps us to become fully conscious of the world as it is, rather than how we wish it could be.” – Regina Boyle Wheeler

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

 

Senders, A., Borgatti, A., Hanes, D., & Shinto, L. (2018). Association Between Pain and Mindfulness in Multiple Sclerosis: A Cross-sectional Survey. International Journal of MS Care, 20(1), 28–34. http://doi.org/10.7224/1537-2073.2016-076

 

Abstract

Background:

Chronic pain is a common symptom in people with multiple sclerosis (MS) and often requires a multimodal approach to care. The practice of mindfulness has been shown to decrease the experience of pain in other conditions, yet little is known about the relationship between mindfulness and pain in people with MS. The objective of this study was to evaluate the association between pain interference and trait mindfulness in people with MS.

Methods:

In this cross-sectional survey, 132 people with any type of MS completed the Patient-Reported Outcomes Measurement Information System Pain Interference scale and the Five Facet Mindfulness Questionnaire. Linear regression was used to test the association between pain and mindfulness while adjusting for demographic and MS-related characteristics.

Results:

The relationship between pain and mindfulness was clinically meaningful and highly significant (t = −5.52, P < .0001). For every 18-point increase in mindfulness scores, pain interference scores are expected to decrease by 3.96 (95% CI, −2.52 to −5.40) points (β = −0.22, P < .0001). The adjusted model, including age, type of MS, the interaction between mindfulness and age, and the interaction between mindfulness and MS type, explains 26% of the variability in pain interference scores (R2 = 0.26).

Conclusions:

These results suggest a clinically significant association between mindfulness and pain interference in MS and support further exploration of mindfulness-based interventions in the management of MS-related pain.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825983/

 

Mindfulness is Associated with Reduced Pain by Improving the Capacity for Pleasure

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Mindfulness is Associated with Reduced Pain by Improving the Capacity for Pleasure

 

By John M. de Castro, Ph.D.

 

“It felt good to realize [through mindfulness] that I can co-exist with my pain. Being mindful helped me realize that in my angry reaction to my back pain, I was neglecting my whole body. I saw my body only through my pain, which caused me to hate my body over time. I can now see myself outside of my body, and am working day by day with my meditation to become a happier person living with chronic pain.” – Natalia Morone

 

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

 

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. There is an accumulating volume of research findings to demonstrate that mind-body therapies have highly beneficial effects on the health and well-being of humans. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain in adults. But there is very little systematic study of how these practices effect chronic pain.

 

In today’s Research News article “Mindfulness Is Associated with Increased Hedonic Capacity Among Chronic Pain Patients Receiving Extended Opioid Pharmacotherapy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5235319/ ), Thomas and Garland recruited chronic pain patients who were being treated with opioids. They were measured for mindfulness, hedonic (pleasure) capacity, pain severity, pain interference, and depression. The relationships among these variables was explored with regression analysis.

 

They found that for the higher the levels of mindfulness for these chronic pain patients the higher their ability to experience pleasure (hedonic capacity) and the less that pain interfered with their daily lives (pain interference). This was also true for the mindfulness facets of observing inner experience, non-judgment, and acting with awareness. A mediation analysis demonstrated that the association of mindfulness with less pain interference in daily living resulted from mindfulness’ association with higher levels of hedonic capacity that in turn was associated with lower pain interference. So, the higher levels of ability to experience pleasure associated with mindfulness was the mediator of mindfulness’ association with lower ability of pain to interfere with living.

 

It needs to be kept in mind that this study was correlational and causation cannot be determined. But, the results suggest that being mindful predicts a greater ability to experience pleasure and, in turn, less interference in daily life produced by pain. This makes sense as pleasure occurs in the present moment and the ability of mindfulness to focus attention on the present moment would heighten the appreciation of this pleasure. In turn, it makes sense that being able to experience the good things in life would interfere with the ability of pain to interfere with living. So, being mindful may heighten the appreciation of pleasure and lower the difficulties in daily living produced by chronic pain.

 

“The current state of chronic pain and opioid use in the United States may indeed be daunting and require a multifaceted approach; yet, there is promise for our Veterans and the more than 100 million Americans1 who suffer from chronic pain in the age-old and now richly evidence-based practice of mindfulness meditation.” – Dawn Bazarko

 

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

 

Thomas, E. A., & Garland, E. L. (2017). Mindfulness Is Associated with Increased Hedonic Capacity Among Chronic Pain Patients Receiving Extended Opioid Pharmacotherapy. The Clinical Journal of Pain, 33(2), 166–173. http://doi.org/10.1097/AJP.0000000000000379

 

Abstract

Objectives

Chronic pain and long-term opioid use may lead to a persistent deficit in hedonic capacity, characterized by increased sensitivity to aversive states and insensitivity to natural rewards. Dispositional mindfulness has been linked with improved emotion regulation and pain coping. The aim of the current study was to examine associations between dispositional mindfulness, hedonic capacity, and pain-related interference in an opioid-using chronic pain sample.

Methods

Data were obtained from a sample of 115 chronic pain patients on long-term opioid therapy (68% females, M age=48.3, SD=13.6) who completed the Five Facet Mindfulness Questionnaire (FFMQ), the Snaith Hamilton Anhedonia and Pleasure Scale (SHAPS), the Brief Pain Inventory (BPI), and a psychiatric assessment of major depression. Bivariate correlations, hierarchical multiple regression, and path analysis were used to determine if dispositional mindfulness scores (FFMQ) predicted variance in hedonic capacity (SHAPS), and if hedonic capacity mediated the association between mindfulness and pain interference.

Results

We observed a significant positive correlation between dispositional mindfulness and hedonic capacity scores, r=.33, p<.001. Hierarchical regression indicated that after controlling for pain interference and major depressive disorder diagnosis, dispositional mindfulness explained a significant portion of variance in hedonic capacity (Beta = .30, p< .01). The association between dispositional mindfulness and pain interference was mediated by hedonic capacity (b = −.011, SE=.005, 95% C.I. = −.004 to −.024, full model R2=.39).

Discussion

Findings indicate that dispositional mindfulness was associated with hedonic capacity among this chronic pain sample. In light of this association, it is plausible that interventions that increase mindfulness may reduce pain-related impairment among opioid-using patients by enhancing hedonic capacity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5235319/