Improve Migraine Headaches with Spiritual Meditation

March 26, 2018March 26, 2018 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Meditation is an ancient spiritual practice that people are still using today to get headache relief. This mind-body practice seems to work by relieving stress associated with headache pain.” – Chris Iliades

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. In the U.S. they affect roughly 40 million men, women and children. While most sufferers experience attacks once or twice a month, 14 million people or 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 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.

There are a wide variety of meditation techniques. It is not known which kinds work best for migraine headaches. In today’s Research News article “Effect of Different Meditation Types on Migraine Headache Medication Use.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600642/ ), Wachholtz and colleagues examine the effectiveness of spiritual focused vs. secular meditation techniques on treating migraine headaches. They recruited adult migraine sufferers who had at least 2 migraine headaches per month and who were naive to meditation. They were randomly assigned to one of four groups who meditated for 20 minutes per day for 30 days; Spiritual Meditation, Internally Focused Secular Meditation, Externally Focused Secular Meditation, or Progressive Muscle Relaxation.

The meditation techniques differed in a phrase that the participants repeated to themselves and used as a focus for their meditation during the 20-minute daily period. For the Spiritual Meditation group the participants chose one of four phrases; “God is peace,” “God is joy,” God is good,” and “God is love.” For the Secular Internal Meditation group the participants chose either; “I am content,” “I am joyful,” “I am good,” “I am happy.” For the Secular External Meditation group the participants chose either; “Grass is green,” “Sand is soft,” “Cotton is fluffy,” “Cloth is smooth.” The Relaxation group practiced progressive muscle relaxation, systematically tensing and relaxing muscles. Participants were measured before and after the 30 days of meditation for headache frequency, intensity, and usage of migraine medications, and for spiritual and religious experiences and activities. They also maintained daily headache diaries.

They found that while all groups showed some improvement in migraine frequency, the Spiritual Meditation groups had significantly greater improvement than the other groups. In addition, while all groups showed significant reduction in the use of migraine medications, the Spiritual Meditation groups had significantly greater reductions. There was, however, no change in the severity of the migraines. Hence, although there were fewer headaches, when they did occur they were just as intense as usual. It should be noted, however, that there wasn’t a no-treatment control. So, it is unclear that improvements would not have occurred without treatment.

The results suggest that meditation and relaxation, but especially spiritually focused meditation, can improve migraine frequency and medication use. Mindfulness practices, in the previous research have been shown to be effective in treating pain from a variety of sources including headaches. It is not clear, however, why meditating with a spiritual focus is superior to secular focused meditation or relaxation. Perhaps focusing on a greater power relieves the stress of searching for the sources of the headaches within the self or the environment, and the stress reduction, in turn, reduces the likelihood of a migraine.

So, improve migraine headaches with spiritual meditation.

“This kind of moment-to-moment, positive mindfulness is crucial for chronic pain sufferers. Pain is only ever exacerbated by depression and despair. And depression and despair most definitely intensify pain. Thus, the dark circle of chronic illness. Mindfulness can stop this cycle in its tracks by allowing the patient to take back control and climb out of the gloom, a single moment at a time. “ – Ashley Jonkman

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

Wachholtz, A. B., Malone, C. D., & Pargament, K. I. (2017). Effect of Different Meditation Types on Migraine Headache Medication Use. Behavioral Medicine (Washington, D.C.), 43(1), 1–8. http://doi.org/10.1080/08964289.2015.1024601

Abstract

Spiritual meditation has been found to reduce the frequency of migraines and physiological reactivity to stress. However, little is known about how introducing a spirituality component into a meditation intervention impacts analgesic medication usage. In this study, 92 meditation naïve participants were randomly assigned to four groups (Spiritual Meditation (N=25), Internally Focused Secular Meditation (N=23), Externally Focused Secular Meditation (N=22), Progressive Muscle Relaxation (N=22)) and practiced their technique for 20min/day over 30 days while completing daily diaries. Headache frequency, headache severity, and pain medication use were assessed. Migraine frequency decreased in the Spiritual Meditation group compared to other groups (p<.05). Headache severity ratings did not differ across groups (p=NS). After adjusting for headache frequency, migraine medication usage decreased in the Spiritual Meditation group compared to other groups (p<.05). Spiritual Meditation was found to not affect pain sensitivity, but it does improve pain tolerance with reduced headache related analgesic medication usage.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600642/

Reduce Low Back Pain with Yoga

March 2, 2018 psyjdc Leave a comment

Reduce Low Back Pain with Yoga

By John M. de Castro, Ph.D.

“For most of our lives, we take our backs for granted. But at some point in just about everyone’s life, our backs revolt and remind us that they need love and attention too. Thankfully, for many of us, the pain is only temporary. But for others, it can be much more debilitating—and much more frustrating. In severe cases, medical attention may be necessary, but if your pain is less severe, yoga may be able to help by strengthening the back, stretching it and improving circulation to the spine and nerves.” – Liz Rosenblum

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

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back pain. Yoga practice has been shown to have a myriad of health benefits. These include relief of chronic pain. Yoga practice has also been shown to be effective for the relief of chronic low-back pain. Many forms of yoga focus on the proper alignment of the spine, which could directly address the source of back and neck pain for many individuals. So, it makes sense to further explore the effectiveness of yoga therapy for chronic low back pain.

In today’s Research News article “Yoga treatment for chronic non-specific low back pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294833/ ), Wieland and colleagues review and summarize the published research studies that examined the effectiveness of yoga practice for the treatment of chronic low back pain. They discovered only 12 published research studies on the subject. They reported that the studies found that yoga practice in comparison to no-exercise control conditions produced small but significant improvements in pain and back function that were maintained for 6 months. This demonstrates that yoga practice is effective for back pain but does not allow for a determination of whether exercise in general or yoga specifically was effective. So, they looked at studies of yoga practice in comparison to other forms of exercise and found that yoga practice produced small but significantly better improvements than other exercises in pain but equivalent improvements in back function. When yoga practice was combined with other exercises it did not produce significantly greater benefits than exercise alone.

The summary suggests that yoga practice and other exercises are safe and effective treatments for chronic low back pain that can produce lasting improvements in pain and back function. They found evidence that yoga practice may be slightly better than other exercises in reducing pain, but there is no additional benefit of combining yoga with other exercises. Hence, yoga practice is an acceptable, safe, and effective alternative to drug and surgical treatments that has small but significant benefits for the relief to the suffering of people with chronic low back pain.

So, reduce low back pain with Yoga.

“a structured yoga program may be an alternative to physical therapy for people with chronic low-back pain, depending on individual preferences, availability, and cost.” – NCCIH

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

Wieland, L. S., Skoetz, N., Pilkington, K., Vempati, R., D’Adamo, C. R., & Berman, B. M. (2017). Yoga treatment for chronic non-specific low back pain. The Cochrane Database of Systematic Reviews, 1, CD010671. http://doi.org/10.1002/14651858.CD010671.pub2

Abstract

Background

Non-specific low back pain is a common, potentially disabling condition usually treated with self-care and non-prescription medication. For chronic low back pain, current guidelines state that exercise therapy may be beneficial. Yoga is a mind-body exercise sometimes used for non-specific low back pain.

Objectives

To assess the effects of yoga for treating chronic non-specific low back pain, compared to no specific treatment, a minimal intervention (e.g. education), or another active treatment, with a focus on pain, function, and adverse events.

Search methods

We searched CENTRAL, MEDLINE, Embase, five other databases and four trials registers to 11 March 2016 without restriction of language or publication status. We screened reference lists and contacted experts in the field to identify additional studies.

Selection criteria

We included randomized controlled trials of yoga treatment in people with chronic non-specific low back pain. We included studies comparing yoga to any other intervention or to no intervention. We also included studies comparing yoga as an adjunct to other therapies, versus those other therapies alone.

Data collection and analysis

Two authors independently screened and selected studies, extracted outcome data, and assessed risk of bias. We contacted study authors to obtain missing or unclear information. We evaluated the overall certainty of evidence using the GRADE approach.

Main results

We included 12 trials (1080 participants) carried out in the USA (seven trials), India (three trials), and the UK (two trials). Studies were unfunded (one trial), funded by a yoga institution (one trial), funded by non-profit or government sources (seven trials), or did not report on funding (three trials). Most trials used Iyengar, Hatha, or Viniyoga forms of yoga. The trials compared yoga to no intervention or a non-exercise intervention such as education (seven trials), an exercise intervention (three trials), or both exercise and non-exercise interventions (two trials). All trials were at high risk of performance and detection bias because participants and providers were not blinded to treatment assignment, and outcomes were self-assessed. Therefore, we downgraded all outcomes to ‘moderate’ certainty evidence because of risk of bias, and when there was additional serious risk of bias, unexplained heterogeneity between studies, or the analyses were imprecise, we downgraded the certainty of the evidence further.

For yoga compared to non-exercise controls (9 trials; 810 participants), there was low-certainty evidence that yoga produced small to moderate improvements in back-related function at three to four months (standardized mean difference (SMD) −0.40, 95% confidence interval (CI) −0.66 to −0.14; corresponding to a change in the Roland-Morris Disability Questionnaire of mean difference (MD) −2.18, 95% −3.60 to −0.76), moderate-certainty evidence for small to moderate improvements at six months (SMD −0.44, 95% CI −0.66 to −0.22; corresponding to a change in the Roland-Morris Disability Questionnaire of MD −2.15, 95% −3.23 to −1.08), and low-certainty evidence for small improvements at 12 months (SMD −0.26, 95% CI −0.46 to −0.05; corresponding to a change in the Roland-Morris Disability Questionnaire of MD −1.36, 95% −2.41 to −0.26). On a 0–100 scale there was very low- to moderate-certainty evidence that yoga was slightly better for pain at three to four months (MD −4.55, 95% CI −7.04 to −2.06), six months (MD −7.81, 95% CI −13.37 to −2.25), and 12 months (MD −5.40, 95% CI −14.50 to −3.70), however we pre-defined clinically significant changes in pain as 15 points or greater and this threshold was not met. Based on information from six trials, there was moderate-certainty evidence that the risk of adverse events, primarily increased back pain, was higher in yoga than in non-exercise controls (risk difference (RD) 5%, 95% CI 2% to 8%).

For yoga compared to non-yoga exercise controls (4 trials; 394 participants), there was very-low-certainty evidence for little or no difference in back-related function at three months (SMD −0.22, 95% CI −0.65 to 0.20; corresponding to a change in the Roland-Morris Disability Questionnaire of MD −0.99, 95% −2.87 to 0.90) and six months (SMD −0.20, 95% CI −0.59 to 0.19; corresponding to a change in the Roland-Morris Disability Questionnaire of MD −0.90, 95% −2.61 to 0.81), and no information on back-related function after six months. There was very low-certainty evidence for lower pain on a 0–100 scale at seven months (MD −20.40, 95% CI −25.48 to −15.32), and no information on pain at three months or after seven months. Based on information from three trials, there was low-certainty evidence for no difference in the risk of adverse events between yoga and non-yoga exercise controls (RD 1%, 95% CI −4% to 6%).

For yoga added to exercise compared to exercise alone (1 trial; 24 participants), there was very-low-certainty evidence for little or no difference at 10 weeks in back-related function (SMD −0.60, 95% CI −1.42 to 0.22; corresponding to a change in the Oswestry Disability Index of MD −17.05, 95% −22.96 to 11.14) or pain on a 0–100 scale (MD −3.20, 95% CI −13.76 to 7.36). There was no information on outcomes at other time points. There was no information on adverse events.

Studies provided limited evidence on risk of clinical improvement, measures of quality of life, and depression. There was no evidence on work-related disability.

Authors’ conclusions

There is low- to moderate-certainty evidence that yoga compared to non-exercise controls results in small to moderate improvements in back-related function at three and six months. Yoga may also be slightly more effective for pain at three and six months, however the effect size did not meet predefined levels of minimum clinical importance. It is uncertain whether there is any difference between yoga and other exercise for back-related function or pain, or whether yoga added to exercise is more effective than exercise alone. Yoga is associated with more adverse events than non-exercise controls, but may have the same risk of adverse events as other back-focused exercise. Yoga is not associated with serious adverse events. There is a need for additional high-quality research to improve confidence in estimates of effect, to evaluate long-term outcomes, and to provide additional information on comparisons between yoga and other exercise for chronic non-specific low back pain.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294833/

Improve Physical and Psychological Discomfort from Musculoskeletal Disorders with Mindfulness

February 26, 2018 psyjdc Leave a comment

Improve Physical and Psychological Discomfort from Musculoskeletal Disorders with Mindfulness

By John M. de Castro, Ph.D.

“Meditation’s goal is to relax the mind and body, acknowledge and release feelings about pain or other challenges, let go of tension, and tap into a positive outlook. Focusing on negativity exacerbates pain. Mindfulness practice allows you to step back from that negative thinking. It brings focus to the present moment and allows you to interrupt the vicious cycle of negativity and pain. “With our thoughts, we create a reality,” – Andrea Rudolph

Orthopedic Disorders consist of a wide range of problems that are concerned with muscles, ligaments and joints. Disorders are ailments, injuries or diseases that cause knee problems, whiplash, dislocated shoulder, torn cartilages, foot pain and fibromyalgia. The most common forms of orthopedic disorders are arthritis, and back and neck pain.

Arthritis is a chronic disease that most commonly affects the joints. Depending on the type of arthritis symptoms may include pain, stiffness, swelling, redness, and decreased range of motion. It affects an estimated 52.5 million adults in the United States. The pain, stiffness, and lack of mobility associate with arthritis produce fatigue and markedly reduce the quality of life of the sufferers. Arthritis can have very negative psychological effects diminishing the individual’s self-image and may lead to depression, isolation, and withdrawal from friends and social activities.

The most common forms of chronic pain are back and neck pain. 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. Back and neck pain interferes with daily living and with work, decreasing productivity and creating absences. There are many different treatments for pain, but few are both safe and effective for chronic pain conditions. So, alternative treatments are needed. Mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of arthritis, low back pain and neck pain.

In today’s Research News article “First Use of a Brief 60-second Mindfulness Exercise in an Orthopedic Surgical Practice; Results from a Pilot Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736889/ ), Chad-Friedman and colleagues perform a pilot study of the effectiveness of a brief mindfulness instruction via a video for the symptoms of orthopedic disorders. They recruited adult follow-up patients with a variety of orthopedic problems. The participants then watched a 60 second mindfulness video where they were instructed to envision a stressful situation and place it in a bright star. Over the next 60 seconds they were to envision shrinking that star till it becomes small. They were measured before and after watching the video for pain, anxiety, distress, depression, anger, and satisfaction with the intervention. They found that after watching the video the patients reported large and significant improvements in pain and all psychological measures and high satisfaction ratings.

Obviously, with such a brief and uncontrolled pilot study there can be no clear conclusions. But, mindfulness interventions have been found in numerous controlled studies to decrease pain, anxiety, depression, and anger. So, the results suggest that the 60-second mindfulness practice has similar effects. It remains to be seen if such a brief practice can have lasting effects in comparison to a comparable non-mindfulness control condition and if daily brief practice can help maintain the benefits.

Orthopedic disorders are so common, costly, and debilitating that a simple, safe, and effective intervention is sorely needed. Physicians have little time. So, having mindfulness training via a video relieves them of the need to take the time to train the patients. In addition, making it very brief and simple may promote patient compliance with the practice. So, this pilot study suggests that this 60-second video intervention should be further studied for its effectiveness in relieving the suffering of patients with orthopedic disorders.

“Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease,” – Mary Kreitzer

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

Emma Chad-Friedman, Mojtaba Talaei-Khoei, David Ring, Ana-Maria Vranceanu. First Use of a Brief 60-second Mindfulness Exercise in an Orthopedic Surgical Practice; Results from a Pilot Study. Arch Bone Jt Surg. 2017 Nov; 5(6): 400–405.

Abstract

Background:

Mindfulness based interventions may be useful for patients with musculoskeletal conditions in orthopedic surgical practices as adjuncts to medical procedures or alternatives to pain medications. However, typical mindfulness programs are lengthy and impractical in busy surgical practices. We tested the feasibility, acceptability and preliminary effect of a brief, 60-second mindfulness video in reducing pain and negative emotions in patients presenting to an orthopedics surgical practice.

Methods:

This was an open pilot study. Twenty participants completed the Numerical Rating Scale to assess pain intensity, the State Anxiety subscale of the State Trait Anxiety Scale to assess state anxiety, and emotional thermometers to assess distress, anxiety, anger and depression immediately prior to and following the mindfulness video exercise. At the end of the exercise patients also answered three questions assessing satisfaction with the mindfulness video.

Results:

Feasibility of the mindfulness video was high (100%). Usefulness, satisfaction and usability were also high. Participants showed improvements in state anxiety, pain intensity, distress, anxiety, depression and anger after watching the video. These changes were both statistically significant and clinically meaningful, when such information was available.

Conclusion:

People with musculoskeletal pain seeking orthopedic care seem receptive and interested in brief mindfulness exercises that enhance comfort and calm.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736889/

Improve Pain Responding in Adolescents with Mindfulness

February 13, 2018 psyjdc 1 Comment

Improve Pain Responding in Adolescents with Mindfulness

By John M. de Castro, Ph.D.

“mindfulness was a significant predictor of both real-world and experimental pain outcomes. Adolescents who were more mindful tended to experience less interference in their day-to-day life as a result of pain. Additionally, . . . more mindful adolescents reported less intense pain and a higher level of pain tolerance.” – Mark Petter

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. Sadly, about a quarter to a third of children experience chronic pain. It has to be kept in mind that pain is an important signal that there is something wrong or that damage is occurring. This signals that some form of action is needed to mitigate the damage. This is an important signal that is ignored at the individual’s peril. So, in dealing with pain, it’s important that pain signals not be blocked or prevented. They need to be perceived. But, methods are needed to mitigate the psychological distress produced by chronic pain.

The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and prescription opioid overdoses kill more than 14,000 people annually. The use of drugs in adolescents is even more complicated and potentially directly harmful or could damage the developing brain. So, there is a great need to find safe and effective ways to lower the psychological distress and improve adolescents’ 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. These include meditation, yoga, tai chi, qigong, biofeedback, progressive muscle relaxation, guided imagery, hypnosis, acupuncture, and deep breathing exercises. 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 the application of these practices for the treatment of chronic pain in adolescents.

In today’s Research News article “I Learned to Let Go of My Pain”. The Effects of Mindfulness Meditation on Adolescents with Chronic Pain: An Analysis of Participants’ Treatment Experience.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742755/ ), Ruskin and colleagues recruited adolescents between the ages of 12 to 18 years who suffered from chronic pain. They provided the adolescents with an 8-week program or Mindfulness-Based Stress Reduction (MBSR) modified for adolescents, including meditation, yoga, and body scan, but with reduced expectation for home practice and shortened sessions. One week after the end of the program the youths were asked about their satisfaction with the program and participated in focus groups to provide feedback, evaluations, and suggestions regarding the program. The groups discussions were transcribed and a content analysis performed.

The participants rated their satisfaction program at 8.29 out of 10, suggesting a high degree of satisfaction. Ruskin and colleagues found that the “Qualitative analysis of focus group transcripts revealed six main themes: Mindfulness Skills, Supportive Environment, Group Exercises, Empowerment, Program Expectations, and Logistics.”

In terms of the mindfulness category the participants reported that the program improved their awareness of the present moment, their ability to let go of their pain, their ability to cope with the emotions produced by the pain, and increased their overall emotional well-being and happiness. In addition, they reported that the mindfulness skills transferred to other aspects of their life such as work, and became a part of how they normally viewed the world.

In terms of the supportive environment, the participants reported that the group developed a sense of openness and trust, provided emotional support and made them feel less alone. They also reported that being able to discuss their pain issues with others who were also suffering was very beneficial. In terms of the group exercises, the participants reported that the “weather report”, reporting on their current state with the group was very helpful, that focusing on the pain in meditation was helpful. In terms of empowerment, the participants felt that the program did not actually ease their pain but empowered them to take actions to cope with it and not let it interfere with their activities. In terms of the program expectations, they reported that they had great misconceptions of mindfulness at the beginning believing it to be uninteresting and dumb and some reported that they thought the program would actually lower their pain levels. Finally,

in terms of the logistics, the meeting room was too sterile and needed to be decorated in a more interesting fashion, there needed to be more meetings, and they liked working with other adolescents with chronic pain.

Hence, the participants viewed the program very positively as improving their ability to appreciate and stay in the present moment and better cope with the emotional and practical consequences of their pain. That the practice was conducted in a group of other adolescents with chronic pain was viewed as an important and helpful characteristic of the program. In other words, they were pleased and felt the program was helpful to them in dealing with their pain.

These results must be interpreted carefully. They should be viewed as constructive feedback on the program and nothing more. More empirical evidence is needed to reach firm conclusions regarding the programs efficacy. But, the results are suggestive that more systematic studies are warranted as mindfulness training may be very helpful to adolescents in coping with chronic pain.

“Mindful meditation can have profound effects for those who suffer from chronic pain. This simple practice seems to be able to change a patient’s perception of pain, making it less intense. . . . consistent meditation helped patients locate and turn down the “volume knob” on sensations. Often pain sufferers are unable to focus on anything but their pain, which increases their perception of it.” – Pain Doctor

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

Danielle Ruskin, Lauren Harris, Jennifer Stinson, Sara Ahola Kohut, Kathryn Walker, Erinn McCarthy. I Learned to Let Go of My Pain”. The Effects of Mindfulness Meditation on Adolescents with Chronic Pain: An Analysis of Participants’ Treatment Experience. Children (Basel) 2017 Dec; 4(12): 110. Published online 2017 Dec 15. doi: 10.3390/children4120110

Abstract

Chronic pain can lead to significant negative outcomes across many areas of life. Recently, mindfulness-based interventions (MBIs) have been identified as potentially effective tools for improved pain management among adolescents living with pain. This study aimed to explore the experience of adolescents who participated in an eight-week mindfulness group adapted for adolescents with chronic pain (MBI-A), and obtain their feedback and suggestions on group structure and content. A mixed method design was used employing qualitative data from focus groups and data from a satisfaction questionnaire. Focus group data were transcribed and analyzed using inductive simple descriptive content analysis. Of the total participants (n = 21), 90% (n = 19) provided feedback by completing satisfaction questionnaires and seventeen (n = 17) of those also participated across two focus groups. Analysis of the focus group transcripts uncovered six themes: mindfulness skills, supportive environment, group exercises (likes and dislikes), empowerment, program expectations, and logistics. Participants reported positive experiences in the MBI-A program, including support received from peers and mindfulness skills, including present moment awareness, pain acceptance, and emotion regulation. Group members suggested increasing the number of sessions and being clearer at outset regarding a focus on reduction of emotional suffering rather than physical pain.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742755/

Lessen Fibromyalgia Pain with Mindfulness

January 15, 2018 psyjdc Leave a comment

Lessen Fibromyalgia Pain with Mindfulness

By John M. de Castro, Ph.D.

“You’ve heard the expression “mind over matter,” but did you know that it’s a tried-and-true approach to easing many conditions, including fibromyalgia?” – Madeline Vann

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. In today’s Research News article “Mindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693231/ ), Adler-Neal and Zeidan review and summarize the published research literature on the employment of mindfulness training for the relief of fibromyalgia symptoms.

They report that “mindfulness interventions . . . are generally premised on (a) developing sustained attention to arising sensory, affective, and cognitive events, (b) recognizing such experiences as momentary and fleeting, and (c) attenuating reactions/judgments to said experiences. Mindfulness training reliably improves catastrophizing, anxiety, depression, mood, and stress. Thus, improvements in mood and cognitive flexibility could lead to greater pain relief by altering the way patients interpret/contextualize pain-related ruminations.”

They report that the research finds that mindfulness training, especially if tailored for fibromyalgia, significantly improves fatigue, stress, sleep, pain, pain coping, positive emotions, family stress, loneliness and global well-being in fibromyalgia patients. In addition, these benefits appear to be sustained for at least 2 months after the completion of training. Hence, mindfulness training would appear to be a safe and effective treatment for fibromyalgia.

The improvements produced by mindfulness training appear to be mediated by changes in the nervous system. It heightens activity in the brain cortical areas that underlie the cognitional and emotional evaluation of pain and decreased activation of brain thalamic areas that process sensory information. Hence, mindfulness training appears to alter the brain to improve mechanisms underlying attention and emotions and decrease sensory sensitivity to pain. This can deaden pain itself plus improve the non-judgmental and non-reactive awareness of the pain, reducing the suffering of fibromyalgia pain.

People with fibromyalgia suffer to an extent where some contemplate suicide. It is wonderful to see that relatively simple and safe mindfulness training can effectively reduce the suffering.

So, lessen fibromyalgia pain with mindfulness.

“While being mindful did make them more aware of pain or a symptom of their condition, it also helped them be open to something good happening and they had the choice to focus on the good. Many people spoke of trying to negotiate a balance in their feelings,” – Jaqui Long

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

Adler-Neal, A. L., & Zeidan, F. (2017). Mindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations. Current Rheumatology Reports, 19(9), 59. http://doi.org/10.1007/s11926-017-0686-0

Abstract

Purpose of Review

Fibromyalgia is a disorder characterized by widespread pain and a spectrum of psychological comorbidities, rendering treatment difficult and often a financial burden. Fibromyalgia is a complicated chronic pain condition that requires a multimodal therapeutic approach to optimize treatment efficacy. Thus, it has been postulated that mind-body techniques may prove fruitful in treating fibromyalgia. Mindfulness meditation, a behavioral technique premised on non-reactive sensory awareness, attenuates pain and improves mental health outcomes. However, the impact of mindfulness meditation on fibromyalgia-related outcomes has not been comprehensively characterized. The present review delineates the existing evidence supporting the effectiveness and hypothesized mechanisms of mindfulness meditation in treating fibromyalgia-related outcomes.

Recent Findings

Mindfulness-based interventions premised on cultivating acceptance, non-attachment, and social engagement may be most effective in decreasing fibromyalgia-related pain and psychological symptoms. Mindfulness-based therapies may alleviate fibromyalgia-related outcomes through multiple neural, psychological, and physiological processes.

Summary

Mindfulness meditation may provide an effective complementary treatment approach for fibromyalgia patients, especially when combined with other reliable techniques (exercise; cognitive behavioral therapy). However, characterizing the specific analgesic mechanisms supporting mindfulness meditation is a critical step to fostering the clinical validity of this technique. Identification of the specific analgesic mechanisms supporting mindfulness-based pain relief could be utilized to better design behavioral interventions to specifically target fibromyalgia-related outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693231/

Improve Chronic Back Pain with Mindfulness and Cognitive Therapy

December 28, 2017 psyjdc Leave a comment

Improve Chronic Back Pain with Mindfulness and Cognitive Therapy

By John M. de Castro, Ph.D.

“Mindful mediation is an appealing option for treating your pain because it has an unusual benefit; it places you in a position of control. Unlike pain medications or surgical procedures, meditation is not done to you—but rather it is something you do for yourself.” – Stephanie Burke

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.

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.

In today’s Research News article “Mindfulness-based stress reduction and cognitive-behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069124/ ), Turner and colleagues recruited adults suffering from chronic low back pain and randomly assigned them to either receive usual care, or 8 weeks, 2 hours per day, of Mindfulness-Based Stress Reduction (MBSR), or Cognitive Behavioral Therapy (CBT). The therapies were supplemented with home practice. They were measured before and after treatment and at 26 and 52 weeks later, for mindfulness, back pain bothersomeness, pain duration, pain frequency, pain catastrophizing, pain acceptance, and pain self-efficacy.

They found that before treatment the higher the levels of pain catastrophizing the lower the levels of mindfulness, pain acceptance, and pain self-efficacy. Following treatment both MBSR and CBT produced significant decreases in pain catastrophizing and increases in mindfulness, pain self-efficacy and pain acceptance that remained significant a year later. Hence, both Mindfulness-Based Stress Reduction (MBSR), or Cognitive Behavioral Therapy (CBT) produced significant improvements in the ability of the patients to adjust and cope with low back pain.

These results are interesting as MBSR and CBT are quite different treatments. MBSR consists of a combination of meditation, yoga, and body scan practices that are designed to improve mindfulness and reduce stress On the other hand, CBT is designed to assess and alter aberrant thought process that underlie catastrophizing and pain amplification. So, it would seem that the two therapies may work by different mechanisms but end up producing the same result. This would predict that their combination would be even more effective. On the other hand, it is also possible that they both improve mindfulness and this in turn produces the improvements. In which case their combination would only be as effective as each alone. It remains to be seen if Mindfulness-Based Cognitive Therapy (MBCT) would be even more effective for treating chronic low back pain.

Regardless, both MBSR and CBT appear to help relieve the suffering of patients with chronic low back pain. So, improve chronic back pain with mindfulness and cognitive therapy.

“Mindfulness-based stress reduction (MBSR) practices like yoga and meditation have also been found to improve chronic lower back pain and its physical limitations and can provide patients with ongoing pain management skills,” – Susan McQuillan

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

Turner, J. A., Anderson, M. L., Balderson, B. H., Cook, A. J., Sherman, K. J., & Cherkin, D. C. (2016). Mindfulness-based stress reduction and cognitive-behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain, 157(11), 2434–2444. http://doi.org/10.1097/j.pain.0000000000000635

Abstract

Cognitive-behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit chronic pain patients by increasing mindfulness and pain acceptance. However, little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR versus CBT. In a randomized controlled trial comparing MBSR, CBT, and usual care (UC) for adults aged 20-70 years with chronic low back pain (CLBP) (N = 342), we examined (1) baseline relationships among measures of catastrophizing, self-efficacy, acceptance, and mindfulness; and (2) changes on these measures in the 3 treatment groups. At baseline, catastrophizing was associated negatively with self-efficacy, acceptance, and 3 aspects of mindfulness (non-reactivity, non-judging, and acting with awareness; all P-values <0.01). Acceptance was associated positively with self-efficacy (P < 0.01) and mindfulness (P-values < 0.05) measures. Catastrophizing decreased slightly more post-treatment with MBSR than with CBT or UC (omnibus P = 0.002). Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks (omnibus P = 0.001). In both the entire randomized sample and the sub-sample of participants who attended ≥6 of the 8 MBSR or CBT sessions, differences between MBSR and CBT at up to 52 weeks were few, small in size, and of questionable clinical meaningfulness. The results indicate overlap across measures of catastrophizing, self-efficacy, acceptance, and mindfulness, and similar effects of MBSR and CBT on these measures among individuals with CLBP.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069124/

Produce Lasting Improvement in Fibromyalgia with Yoga

December 26, 2017 psyjdc Leave a comment

Produce Lasting Improvement in Fibromyalgia with Yoga

By John M. de Castro, Ph.D.

“For the nearly 10 million people who suffer from this condition, the thought of any movement can be overwhelming. What makes yoga perfect though is that it can be adapted for each person’s individual needs. Additionally, yoga’s ability to calm the mind and reduce stress may also serve to reduce the main trigger of fibromyalgia attacks, as well as slowly loosen cramped muscles.” – Liz Rosenblum

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. 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.

Yoga is both an exercise and a mindfulness practice. So, it would make sense to investigate the effectiveness of yoga practice in treating fibromyalgia. Indeed, in a previous study, Carson and colleagues (Insert Link to Prior study) found that, yoga practice produced significant improvements in overall fibromyalgia symptoms. These findings need to be replicated and follow-up needs to be performed to establish the duration of the benefits. In today’s Research News article “Follow-up of Yoga of Awareness for Fibromyalgia: Results at 3 Months and Replication in the Wait-list Group.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568073/, Carson and colleagues follow up their previous study (Insert Link to Prior study) to replicate their findings and investigate whether the benefits last.

They recruited adult women who were diagnosed with fibromyalgia for at least a year. They were randomly assigned to receive either yoga practice or be on a wait-list control condition. The Yoga for Awareness training occurred in a group setting for 2 hours, once a week for 8 weeks. Participants were also encouraged to practice at home for 20-40 minutes, 5 to 7 days per week. Yoga for Awareness sessions consisted of yoga stretching poses, mindfulness meditation, breathing exercises, presentations on the application of yogic principles to optimal coping, and group discussions. Participants were measured before and after training for fibromyalgia symptoms and disability, including myalgic tender points, strength deficits, and balance deficits, and pain coping including acceptance, catastrophizing, and adaptive and maladaptive strategies. In addition, daily diaries were maintained of “pain, fatigue, emotional distress, and vigor, along with success at coping via acceptance and relaxation strategies.” In this follow-up study, the wait-list control was provided the yoga training for 8 weeks and the previous yoga group was followed for durability of the symptom relief.

They found that after treating the previous control group, like with the previous study, there were significant improvements in overall fibromyalgia symptoms and its impact, including pain, fatigue, stiffness, sleep problems, depression, anxiety, memory problems, tenderness, balance, environmental sensitivity, and strength. There were even improvements in the strategies that the patients used to cope with the pain, including increased engagement with the pain, pain problem solving, reappraisal and decreased pain catastrophizing, self-isolation, and disengagement. The daily diaries also revealed significant improvements as a result of yoga practice including reduced pain, fatigue, emotional distress and increased vigor, relaxation, and success with acceptance. The improvements were significantly related to the amount of home practice with the greater the number of days per week that yoga was practiced at home the greater the improvements in overall fibromyalgia symptoms. They also found that the group treated in the previous study maintained their improvements in fibromyalgia symptoms, functional deficits, and coping abilities with no benefit showing a significantly lessened benefit.

Hence, they were able to replicate their prior findings, demonstrating that they were not a one-time event, and they were able to demonstrate that the benefits last at least for 3 months after the end of formal treatment. This is important as fibromyalgia lasts a lifetime. So, having lasting benefit is a prerequisite for a treatment. Yoga practice appears to fulfill these prerequisites and is a safe and effective treatment for fibromyalgia.

So, produce lasting improvement in fibromyalgia with yoga.

“Yoga’s ability to shift the nervous system out of the stress response and into the relaxation response is vital to people whose central nervous systems are sensitive and naturally hyped way up. It also acts directly on the very muscles where fibromyalgia pain occurs.” – Catherine Guthrie

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

Carson, J. W., Carson, K. M., Jones, K. D., Mist, S. D., & Bennett, R. M. (2012). Follow-up of Yoga of Awareness for Fibromyalgia: Results at 3 Months and Replication in the Wait-list Group. The Clinical Journal of Pain, 28(9), 804–813. http://doi.org/10.1097/AJP.0b013e31824549b5

Abstract

Objectives

Published preliminary findings from a randomized-controlled trial suggest that an 8-week Yoga of Awareness intervention may be effective for improving symptoms, functional deficits, and coping abilities in fibromyalgia. The primary aims of this study were to evaluate the same intervention’s posttreatment effects in a wait-list group and to test the intervention’s effects at 3-month follow-up in the immediate treatment group.

Methods

Unpaired t tests were used to compare data from a per protocol sample of 21 women in the immediate treatment group who had completed treatment and 18 women in the wait-list group who had completed treatment. Within-group paired t tests were performed to compare posttreatment data with 3-month follow-up data in the immediate treatment group. The primary outcome measure was the Fibromyalgia Impact Questionnaire Revised (FIQR). Multilevel random-effects models were also used to examine associations between yoga practice rates and outcomes.

Results

Posttreatment results in the wait-list group largely mirrored results seen at posttreatment in the immediate treatment group, with the FIQR Total Score improving by 31.9% across the 2 groups. Follow-up results showed that patients sustained most of their posttreatment gains, with the FIQR Total Score remaining 21.9% improved at 3 months. Yoga practice rates were good, and more practice was associated with more benefit for a variety of outcomes.

Discussion

These findings indicate that the benefits of Yoga of Awareness in fibromyalgia are replicable and can be maintained.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568073/

Reduce Opioid Treated Low Back Pain with Meditation

December 8, 2017 psyjdc Leave a comment

Reduce Opioid Treated Low Back Pain with Meditation

By John M. de Castro, Ph.D.

“When your focus is on the pain, obviously that increases the pain. For people who meditate, their muscle tension and heart rate drops, their respiration slows and breaths gets deeper. All those things have impact on the pain.” – Jane Ehrman

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. Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects.

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. These include reducing pain catastrophizing. Indeed, mindfulness practices have been shown to be safe and beneficial in pain management in general and yoga and mindfulness has been shown to specifically improve back pain. Since opiates are frequently used to treat chronic low back pain, there is a need to study the combination of long-term opiate treatment and meditation practice.

In today’s Research News article “Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063022/, Zgierska and colleagues recruited adult patients with chronic low back pain who had been treated for at least 3 months with relatively high doses (at least 30 mg/day) of opiates for pain. The patients were randomly assigned to receive meditation practice in combination with Cognitive Behavioral Therapy or to a wait-list control condition. The treatment consisted of 2-hour sessions once a week for 8 weeks of Cognitive Behavioral Therapy (CBT) for identifying and modifying unhealthy thought patterns concerning their pain (e.g. catastrophizing) and additionally mindfulness practices including breath meditation, loving-kindness meditation, body scan and mindful movement practices. Patients were also prescribed to practice meditation at home for at least 30 minutes, 6 days per week. Opiate medications were continued throughout testing. Patients were measured before and after treatment a half a year later for mindfulness, pain intensity, pain acceptance and coping, pain sensitivity to thermal stimuli, disability, opiate dose, and inflammatory biomarkers.

They found that the meditation group had a sustained decrease in unpleasantness and pain sensitivity to thermal stimuli (experimentally induced pain) and an 8% reduction in everyday pain intensity while the wait-list control group had an 8% increase in pain. The decrease in pain was greater for patients who consistently meditated at home compared to inconsistent meditators. In addition, the greater the increase in mindfulness in the meditation group, the greater the decrease in disability. No patients withdrew from the study suggesting that the treatment was acceptable and valued.

The intervention employed a combination of meditation with Cognitive Behavioral Therapy (CBT). So, it cannot be determined whether meditation, CBT, or their combination produced the benefits for the patients. Nevertheless, the results clearly demonstrated that the treatment was very effective in reducing pain and sensitivity to pain in patients with chronic low back pain who are under treatment with relatively high doses of opiates. It is quite striking that the effects were so large given the high doses of opiates in use and underscores the efficacy of the treatment. This suggests that perhaps the opioids had lost a degree of effectiveness with these patients and meditation training could replace the lost pain relief. So, meditation and CBT can effectively reduce pain even in patients taking opiates.

So, reduce opioid treated low back pain with meditation.

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., Burzinski, C. A., Cox, J., Kloke, J., Stegner, A., Cook, D. B., … Bačkonja, M. (2016). Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial. Pain Medicine: The Official Journal of the American Academy of Pain Medicine, 17(10), 1865–1881. http://doi.org/10.1093/pm/pnw006

Abstract

Objective. To assess benefits of mindfulness meditation and cognitive behavioral therapy (CBT)-based intervention for opioid-treated chronic low back pain (CLBP).

Design. 26-week parallel-arm pilot randomized controlled trial (Intervention and Usual Care versus Usual Care alone).

Setting. Outpatient.

Subjects. Adults with CLBP, prescribed ≥30 mg/day of morphine-equivalent dose (MED) for at least 3 months.

Methods. The intervention comprised eight weekly group sessions (meditation and CLBP-specific CBT components) and 30 minutes/day, 6 days/week of at-home practice. Outcome measures were collected at baseline, 8, and 26 weeks: primary-pain severity (Brief Pain Inventory) and function/disability (Oswestry Disability Index); secondary-pain acceptance, opioid dose, pain sensitivity to thermal stimuli, and serum pain-sensitive biomarkers (Interferon-γ; Tumor Necrosis Factor-α; Interleukins 1ß and 6; C-reactive Protein).

Results. Thirty-five (21 experimental, 14 control) participants were enrolled and completed the study. They were 51.8 ± 9.7 years old, 80% female, with severe CLBP-related disability (66.7 ± 11.4), moderate pain severity (5.8 ± 1.4), and taking 148.3 ± 129.2 mg/day of MED. Results of the intention-to-treat analysis showed that, compared with controls, the meditation-CBT group reduced pain severity ratings during the study (P = 0.045), with between-group difference in score change reaching 1 point at 26 weeks (95% Confidence Interval: 0.2,1.9; Cohen’s d = 0.86), and decreased pain sensitivity to thermal stimuli (P< 0.05), without adverse events. Exploratory analyses suggested a relationship between the extent of meditation practice and the magnitude of intervention benefits.

Conclusions. Meditation-CBT intervention reduced pain severity and sensitivity to experimental thermal pain stimuli in patients with opioid-treated CLBP.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063022/

Improve Fibromyalgia with Yoga Practice

December 6, 2017 psyjdc Leave a comment

Improve Fibromyalgia with Yoga Practice

By John M. de Castro, Ph.D.

“If you are suffering from fibromyalgia, it can be hard to get yourself moving, but movement and exercise are key ways to help manage and minimize pain. Practicing yoga daily can help. Yoga targets not only the body but also the mind. You can access multiple benefits by using yoga for fibromyalgia pain.” – Pain Doctor

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 produce 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.

In today’s Research News article “A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568071/, Carson and colleagues recruited adult women who were diagnosed with fibromyalgia for at least a year. They were randomly assigned to receive either yoga practice or be on a wait-list control condition. The Yoga for Awareness training occurred in a group setting for 2 hours, once a week for 8 weeks. Participants were also encouraged to practice at home for 20-40 minutes, 5 to 7 days per week. Yoga for Awareness sessions consisted of yoga stretching poses, mindfulness meditation, breathing exercises, presentations on the application of yogic principles to optimal coping, and group discussions. Participants were measured before and after training for fibromyalgia symptoms and disability, including myalgic tender points, strength deficits, and balance deficits, and pain coping including acceptance, catastrophizing, and adaptive and maladaptive strategies. In addition, daily diaries were maintained of “pain, fatigue, emotional distress, and vigor, along with success at coping via acceptance and relaxation strategies.”

They found that, in comparison to baseline and the wait-list condition, yoga practice produced significant improvements in overall fibromyalgia symptoms and its impact, including pain, fatigue, stiffness, sleep problems, depression, anxiety, memory problems, tenderness, balance, environmental sensitivity, and strength. There were even improvements in the strategies that the patients used to cope with the pain, including increased engagement with the pain, pain problem solving, reappraisal and decreased pain catastrophizing, self-isolation, and disengagement. The daily diaries also revealed significant improvements as a result of yoga practice including reduced pain, fatigue, emotional distress and increased vigor, relaxation, and success with acceptance. The improvements were significantly related to the amount of home practice with the greater the number of days per week that yoga was practiced at home the greater the improvements in overall fibromyalgia symptoms.

These results represent highly clinically significant improvements in fibromyalgia produced by just 8 weeks of yoga practice. The observed improvements were broad, covering a wide range of symptoms, and impactful, with relatively large improvements. These are exciting results as fibromyalgia produces great suffering and impairment in the lives of the patients. Yoga practice is generally safe and acceptable to the patients and appears to be very effective. Further research is needed especially research including males and an active control, such as another aerobic exercise. But, the results are so promising that they suggest that yoga practice should be included in the standard treatment package for fibromyalgia.

So, improve fibromyalgia with yoga practice.

“Although yoga has been practiced for millennia, only recently have researchers begun to demonstrate yoga’s effects on persons suffering from persistent pain. The Yoga of Awareness program stands in contrast to previous multimodal interventions with [fibromyalgia] patients in that it integrates a wide spectrum of yoga-based techniques — postures, mindfulness meditation, breathing exercises, application of yogic principles to optimal coping, and group discussions.” – James Carson

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

Carson, J. W., Carson, K. M., Jones, K. D., Bennett, R. M., Wright, C. L., & Mist, S. D. (2010). A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain, 151(2), 530–539. http://doi.org/10.1016/j.pain.2010.08.020

Abstract

A mounting body of literature recommends that treatment for fibromyalgia (FM) encompass medications, exercise and improvement of coping skills. However, there is a significant gap in determining an effective counterpart to pharmacotherapy that incorporates both exercise and coping. The aim of this randomized controlled trial was to evaluate the effects of a comprehensive yoga intervention on FM symptoms and coping. A sample of 53 female FM patients were randomized to the 8-week Yoga of Awareness program (gentle poses, meditation, breathing exercises, yoga-based coping instructions, group discussions) or to wait-listed standard care. Data were analyzed by intention to treat. At post-treatment, women assigned to the yoga program showed significantly greater improvements on standardized measures of FM symptoms and functioning, including pain, fatigue, and mood, and in pain catastrophizing, acceptance, and other coping strategies. This pilot study provides promising support for the potential benefits of a yoga program for women with FM.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568071/

Improve Fibromyalgia with Qigong Practice

November 12, 2017 psyjdc Leave a comment

Improve Fibromyalgia with Qigong Practice

By John M. de Castro, Ph.D.

“the mindful, meditative state that you reach through qigong releases neurochemical and immunological messengers that improve healing and reduce pain.” – Mary Lynch

Many studies have linked fibromyalgia with depression. In fact, people with fibromyalgia are up to three times more likely to be depressed at the time of their diagnosis than someone without fibromyalgia. In addition, the stress from pain and fatigue can cause anxiety and social isolation. As a result, many patients experience intense anger regarding their situation. The emotions are understandable, but can act to amplify the pain. Hence, there is a great need to develop safe and effective treatments for the torment of fibromyalgia.

Mindfulness practices have been shown to be effective in reducing pain from fibromyalgia. This may occur directly by reducing pain or indirectly by reducing emotions or both. In today’s Research News article “Qigong and Fibromyalgia circa 2017.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590073/, Sawynok and Lynch review and summarize the published research literature on the use of Qigong practice for the treatment of fibromyalgia. They review 6 randomized controlled trials and 9 other less controlled studies.

They report that the research reflects consistent positive benefits of Qigong practice with medium-to-large effect sizes. These include significant reductions pain, and improvements in sleep, the impact of fibromyalgia on their ability to conduct their lives, physical well-being, and mental, cognitive, function. These benefits were manifest after 6–8 weeks of practice, and were sustained at 4–6 months. Hence, Qigong practice appears to be a safe and effective treatment for the physical and psychological symptoms of fibromyalgia.

Qigong is a gentle practice, completely safe, can be used by anyone, including the elderly and sickly, is inexpensive to administer, is convenient as it can be performed in groups or alone, at home or in a facility or even public park, and can be quickly learned. In addition, it can also be practiced in social groups without professional supervision. This can make it fun, improving the likelihood of long-term engagement in the practice. Hence, Qigong appears to be an almost ideal treatment for fibromyalgia.

So, improve fibromyalgia with qigong practice.

“When our bodies are chronically uncomfortable we tend to disconnect from them. Qigong invites us to connect our breath, feelings and body sensations.” – Laurie Hope

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

Sawynok, J., & Lynch, M. E. (2017). Qigong and Fibromyalgia circa 2017. Medicines, 4(2), 37. http://doi.org/10.3390/medicines4020037

Abstract

Qigong is an internal art practice with a long history in China. It is currently characterized as meditative movement (or as movement-based embodied contemplative practice), but is also considered as complementary and alternative exercise or mind–body therapy. There are now six controlled trials and nine other reports on the effects of qigong in fibromyalgia. Outcomes are related to amount of practice so it is important to consider this factor in overview analyses. If one considers the 4 trials (201 subjects) that involve diligent practice (30–45 min daily, 6–8 weeks), there are consistent benefits in pain, sleep, impact, and physical and mental function following the regimen, with benefits maintained at 4–6 months. Effect sizes are consistently in the large range. There are also reports of even more extensive practice of qigong for 1–3 years, even up to a decade, indicating marked benefits in other health areas beyond core domains for fibromyalgia. While the latter reports involve a limited number of subjects and represent a self-selected population, the marked health benefits that occur are noteworthy. Qigong merits further study as a complementary practice for those with fibromyalgia. Current treatment guidelines do not consider amount of practice, and usually make indeterminate recommendations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590073/