Fibromyalgia

Fibromyalgia (FM) is a pain-related condition associated with overall bodily stiffness and soreness, pain trigger points located throughout the body, fatigue, and sleep disturbance, where symptoms seem to be exacerbated by stress (Grossman et al. 2007). Earlier pre/post studies and some wait-list or usual care MBI RCTs (Goldenberg et al. 1994; Grossman et al. 2007; Weissbecker et al. 2002) have shown improved pain, sleep, FM impact, global severity of psychological symptoms, coping, quality of life, anxiety, depression, somatic complaints, and sense of coherence. A recent meta-analysis reviewed six trials of MBSR for FM and cautiously concluded that evidence existed for short-term improvements in quality of life compared to usual care, and for both quality of life and pain symptoms compared to active control conditions, but effect sizes were small to medium and effects were not considered robust against bias (Lauche et al. 2013). For example, a recent RCT compared MBSR to usual care in 99 patients and found no group differences on pain, quality of life, physical function, or depression post-program or a year later, but the mindfulness group did improve somewhat faster (Fjorback et al. 2013).

In the largest and most rigorous study reviewed (Schmidt et al. 2011), 177 female patients were randomized to MBSR, an active control condition, or waitlist. The active control was matched to MBSR on format, instructors, contact time, and homework, with the focus on progressive muscle relaxation and stretching, rather than mindfulness practices. There were no significant differences between groups on the primary outcome of health-related QL two months post-treatment, but all patients improved over time. Only MBSR resulted in significant pre-to-post-intervention within-group improvements in QL, and on six of eight secondary outcome variables, compared to improvements on three measures for the active control group, and on two in the wait-list condition.

Hence, MBSR seems to be a potentially effective intervention for alleviating symptoms common in FM such as pain, depression, and a range of psychological outcomes, although as with chronic pain, it has not proven superior to other active control conditions consistently across studies. MBIs have also not yet been tested against proven efficacious treatments such as CBT, which would provide a more rigorous test of overall efficacy.

 
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