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The effects of mindfulness on chronic pain management have been studied extensively, with numerous results of the studies available in the academic literature. However, the quality of evidence is inconsistent, with many studies utilizing methodologies that do not comply with the scientific standards. The following literature review explores the standing knowledge on the matter in order to determine its viability for pain management in a practice area.
Bawa et al. (2015) conducted a systematic review and meta-analysis of studies exploring the effectiveness of mindfulness-based interventions for managing chronic pain. The research team utilized inclusion criteria of pain duration and exclusion criteria of several conditions in order to minimize heterogeneity of the sample. Mindfulness-based interventions were reviewed for consistency with MBSR and MBCT formats, with minor deviations permitted under the condition of inclusion of certain elements of the practice. Eleven studies were chosen for final analysis. The results suggested effect sizes ranging from 0.12 to 1.32 for clinical outcomes and 0.03 to 1.58 for humanistic outcomes (Bawa et al., 2015). However, several inconsistencies were detected in the process. First, studies with active control groups reported smaller-scale effects of the intervention compared to inactive controls. Second, economic outcomes of the interventions were rarely reported. Third, methodological quality varied greatly among the studies. Considering the factors above, the research team suggested that the evidence of mindfulness-based interventions effectiveness is limited.
A similar approach was adopted in a meta-analysis by Hilton et al. (2016). The researchers aimed at synthesize evidence on efficacy and safety of mindfulness meditation interventions for the treatment of chronic pain in adults (Hilton et al., 2016, p. 199). The data for the study was obtained from electronic databases such as CINAHL, CENTRAL, PubMed, and PsycINFO. The articles were verified using eligibility criteria specifying the mechanism, and duration of the intervention. The researchers used Hartung-Knapp-Sidik-Jonkman method of meta-analysis. All sources were evaluated for quality of evidence using the GRADE approach.
The results of the study suggested that the use of mindfulness-based interventions was associated with a small decrease in pain in comparison with the control group (Hilton et al., 2016). However, it is important to note that the articles reporting the improvement were considered of insufficient evidence quality, which compromises the validity of findings. In addition, an association was established between mindfulness-based interventions and improvements in depression symptoms and quality of life. While both factors are beneficial for the patients, none is directly linked to chronic pain reduction. It should also be noted that only a fraction of sources used for the analysis reported on safety of mindfulness-based interventions, which is consistent with lack of methodological rigor identified above.
At this point, it is important to understand that mindfulness-based therapy is an umbrella term that includes several well-defined and sufficiently distinct approaches that are thought to produce different results. A systematic review by Veehof, Trompetter, Bohlmeijer, and Schreurs (2016) aimed at determining the relative effectiveness of acceptance and commitment therapy (ACT), mindfulness-based cognitive therapy (MBCT), and mindfulness-based stress reduction (MBSR). The meta-analysis conducted by the researchers was based on data from randomized controlled trials retrieved from several electronic databases, which significantly improves the reliability of findings. The results of the study indicated small effect sizes of the post-treatment interventions on pain intensity, depression, disability, and quality of life and moderate effect sizes of anxiety and pain interference.
Large effect size was observed on pain interference in follow-up interventions. The difference between ACT, MBCT, and MBSR was observed primarily in the areas of depression and anxiety, where the former demonstrated better results. On the whole, neither of the mindfulness-based interventions in question produced results superior to traditional cognitive behavioral approaches and were recommended by the authors as complementary interventions or additional alternatives. It is also worth mentioning that due to the fact that the study was an update of earlier research by the same team, the authors were able to estimate the change in quality of evidence in the field. Since the sources were rated for quality, the authors were able to calculate the change using simple statistical tools. The result indicated no change in mean quality of evidence over the years (Veehof et al., 2016). This outcome is important for understanding the lack of progress in obtaining new knowledge on the effectiveness of mindfulness-based interventions despite increasing demand for non-pharmacological solutions.
The comparative effectiveness of mindfulness-based therapy was also determined in a randomized controlled study by Dowd et al. (2015). The authors tested the effectiveness of an MBCT intervention and compared it to that of computerized pain management education. The participants of the study were randomly assigned to one of the two groups, with data collection commencing before and after the study. According to the findings, both groups demonstrated significant improvement in pain management, as well as a number of related outcomes such as pain catastrophizing and acceptance. Most importantly, the effect could be observed in the long term, suggesting its persistent nature. In addition, some of the factors, namely subjective well-being, emotion control, stress management, and reduction in pain right now, improved greater for mindfulness-based intervention than for (Dowd et al., 2015). However, the data gathered for the analysis was collected using self-reporting by the patients, which introduces the possibility of bias and undermines the quality of results. In addition, the inability to track the participant dropout outside data collection points has led to a situation where the results were partially based on assumptions made to represent a full sample. Therefore, it is advised to apply the findings with caution.
Finally, it is necessary to establish the relative effectiveness of mindfulness-based interventions for pain management compared to similar non-pharmaceutical practices. The most apparent point of comparison is cognitive behavioral therapy (CBT) which is often used as an alternative to MBCT and produces similar outcomes. A study by Davis, Zautra, Wolf, Tennen, and Yeung (2015) compared the effects of CBT, mindful awareness and acceptance treatment, and patient education on a pain cognition and symptoms. The research team randomized the participants into three groups, with each group utilizing a different approach and targeting a specific set of outcomes, such as increased acceptance and coping skills. Multilevel models were used to determine within-person change of several factors. The results indicated a wide range of improvements associated with mindfulness-based interventions in stress and pain reactivity (Davis et al., 2015). It is also worth pointing out that the data was obtained on a daily basis, which provides an accurate representation of changes from pre- to post-treatment, a method which is recommended for use during implementation.
However, it should be pointed out that the agreement on the differentiated effects of mindfulness-based interventions is not uniform. For instance, a study by Turner et al. (2016) compared the effects of cognitive behavioral therapy, MBSR, and usual care on a number of outcomes including patient self-efficacy, pain catastrophizing, pain acceptance, and mindfulness. The data was gathered from three randomly assigned groups and was expected to indicate changes on all of the measurements in comparison to the baseline as well as the relationships between them depending on the type of intervention. The results indicated a positive relationship between acceptance, self-efficacy, and mindfulness and a negative relationship between catastrophizing and acceptance and self-efficacy. More importantly, both CBT and MBSR resulted in reduced catastrophizing compared with usual care, with no significant differences between the two (Turner et al., 2016). In other words, specific differences between CBT and MBSR were of little clinical significance.
As can be seen from the available literature, the precise effects of mindfulness on pain management are not determined conclusively. Despite a widespread belief in the effectiveness of the practice is unclear, some studies identified major positive effects while others reported only minor improvements. In addition, the exact area of improvement is not established, with acceptance, catastrophizing, and improvement of health-related quality of life being the best candidates. Finally, it should be pointed out that the reviewed sources indicate a persistent trend of insufficient quality of evidence in the field. Thus, it is recommended to use mindfulness-based interventions with caution as a basis for evidence-based pain management intervention. However, despite these limitations, it is apparent that mindfulness does provide a certain amount of relief to patients suffering from chronic pain. Thus, it is reasonable to implement it as an additional pain management technique in order to improve long-term results and avoid possible adverse effects associated with medication treatment.
References
Bawa, F. L. M., Mercer, S. W., Atherton, R. J., Clague, F., Keen, A., Scott, N. W., & Bond, C. M. (2015). Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis. Br J Gen Pract, 65(635), 387-400.
Davis, M. C., Zautra, A. J., Wolf, L. D., Tennen, H., & Yeung, E. W. (2015). Mindfulness and cognitivebehavioral interventions for chronic pain: Differential effects on daily pain reactivity and stress reactivity. Journal of Consulting and Clinical Psychology, 83(1), 24-35.
Dowd, H., Hogan, M. J., McGuire, B. E., Davis, M. C., Sarma, K. M., Fish, R. A., & Zautra, A. J. (2015). Comparison of an online mindfulness-based cognitive therapy intervention with online pain management psychoeducation: A randomized controlled study. The Clinical Journal of Pain, 31(6), 517-527.
Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S.,& Maglione, M. A. (2016). Mindfulness meditation for chronic pain: Systematic review and meta-analysis. Annals of Behavioral Medicine, 51(2), 199-213.
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.
Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. G. (2016). Acceptance-and mindfulness-based interventions for the treatment of chronic pain: A meta-analytic review. Cognitive Behaviour Therapy, 45(1), 5-31.
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