How mindfulness can help in chronic pain

Young blonde woman meditating in the park

A pooled data analysis published in the BMJ has found that mindfulness meditation may help ease chronic pain 

The analysis, published online in the journal Evidence Based Mental Health, indicates that the practice could reduce the severity and impact on daily life of chronic pain as well as the accompanying distress.

This is important, say the researchers, because the most widely used psychological technique for treating chronic pain is cognitive behavioural therapy (CBT), but not everyone living with chronic pain, which affects around one in five adults, finds CBT helpful.

The researchers looked through research databases for relevant clinical trials which examined the effectiveness of CBT or mindfulness-based stress reduction for the treatment of chronic pain–defined as lasting at least three months.

When practising mindfulness meditation, patients concentrate on moment to moment awareness of thoughts, feelings, bodily sensations and the immediate environment. The stress reduction element aims to help those affected develop ways of coping more effectively with their pain.

Out of an initial 184 suitable clinical trials, 21, involving nearly 2000 people, were selected, and the results data pooled.

Most of the study participants were women and aged between 35 and 65. The conditions causing them pain were largely musculoskeletal. In nearly four out of 10 studies, participants had endured their pain for more than a decade.

The review combined both direct and indirect evidence for the potential health impact of CBT compared with usual or no care; mindfulness compared with usual or no care; and mindfulness compared with CBT.

The analysis showed that there were no important differences between either of the two techniques. Both significantly improved physical functioning and lessened pain severity and associated depression, compared with usual or no care.

However, the researchers caution that only one of the 21 trials directly compared CBT with mindfulness, and only 12 trials were deemed to be of reasonable or good quality.

While the analysis produced comparable results for both techniques, the statistical margin of error was wide, meaning that it is too early to tell which of CBT or mindfulness might be better for people with different types of pain and psychological symptoms, they point out. Further research is needed to plug this gap, they say.

“While CBT is considered to be the preferred psychological intervention of [chronic pain], not all patients with [it] experience a clinically significant treatment response,” they conclude.

“Although a number of recommendations have been proposed to improve CBT for patients with chronic pain, an additional solution may be to offer patients mindfulness based stress reduction since it shows promise in improving pain severity and reducing pain interference and psychological distress.”

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