Pain (chronic pain and low back pain)

Chronic pain affects approximately 13% of the population, and is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage that persists beyond the expected time frame for healing, or that occurs in disease processes in which healing may never occur (Ospina and Harstall 2002). The earliest reported application of MBSR was for patients with chronic pain (Kabat-Zinn 1982). Other more specific pain conditions have also been studied, including low back pain, fibromyalgia, rheumatoid arthritis, and migraine. The pain literature has been reviewed in depth on several recent occasions (Chiesa and Serretti 2011; Elabd 2011; Jensen et al. 2014; McCracken and Thompson 2011; Patil 2009; Veehof et al. 2011). Chiesa and Serretti (2011) systematically reviewed all controlled studies (n = 10) and concluded that MBIs could have non-specific effects on mood, coping, and pain symptoms in chronic pain patients, but studies often suffered from small sample sizes, lack of randomization, and the use of non-specific control groups. In a meta-analysis of both controlled and uncontrolled studies (n = 22), Veehof et al. (2011) found small effect sizes of 0.37 for pain improvements and 0.32 for depression, and suggested that while MBSR and acceptance-based interventions for chronic pain can be viable alternatives to standard CBT for pain, they have not been shown to be superior to it.

While many early studies of MBIs and chronic pain utilized pre/post designs or comparisons to usual care, only three studies have employed randomization to active comparison groups. One study (Plews-Ogan et al. 2005) evaluated MBSR for the management of chronic musculoskeletal pain in 30 pain patients randomly assigned to either MBSR, massage, or a no-intervention control condition. Immediately post-intervention, the massage group had more pain reduction and improved mental health status compared to usual care, while the MBSR group showed greater improvements one month later in mental health outcomes compared to usual care and the massage condition. In this case, MBSR was more effective for enhancing mood in the long term, but massage provided more immediate pain relief.

Wong et al. (2011) compared two active interventions—MBSR versus a multidisciplinary pain intervention, composed of primarily psychoeducation with sessions on physiotherapy for pain and nutrition—for 99 chronic pain patients in Hong

Kong. Patients who completed the interventions improved similarly in both groups on measures of pain intensity and pain-related distress over time. Without a usual care or no-treatment control, it is difficult to conclude if these improvements are due to the interventions themselves or natural fluctuations in symptomatology due to healing over time, historical trends, regression toward average pain and distress, or expectancy effects. However, the non-specificity of treatments is notable.

Finally, in the largest study to date, E. L. Garland et al. (2014) applied an MBI called mindfulness-oriented recovery enhancement (MORE), which was designed to target both chronic pain and opioid misuse in chronic pain sufferers. In 115 patients assigned to either MORE or a support group, reductions in pain severity and pain interference favored MORE and were maintained three months after the program. MORE participants also had greater reductions in stress arousal and desire for opioids and were less likely to meet diagnostic criteria for an opioid misuse disorder post-program compared to the support group, but these benefits were not maintained.

Although the number of RCTs in this area is small, support for MBIs as helpful interventions for improving coping with pain symptoms and overall adjustment in chronic pain patients continues to mount. However, superiority to standard CBT or support groups for pain has not been definitively established.

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