Mindfulness-based stress reduction may help ease chronic pain

(Reuters Health) - People with chronic pain may experience as much of a decline in symptoms with mindfulness-based stress-reduction training as they do with cognitive behavioral therapy, a small research review suggests.

Mindfulness interventions are typically designed to help patients learn meditation techniques they can use at home to cultivate awareness of the present moment during ordinary daily activities such as driving or eating. Therapy often incorporates breathing exercises and practices such as yoga to help encourage body awareness and focus on the present.

Mindfulness-bases stress reduction (MBSR) is typically offered as a multi-week group program that teaches patients ways of “increasing awareness of one’s body, emotions, sensations, thoughts as well as learning self-regulation strategies and more adaptive responses to stress,” the study team writes in Evidence Based Mental Health.

For the current analysis, researchers examined data from 7 studies with a total 545 people with chronic pain. Participants were randomly chosen either to receive MBSR training or to join a control group put on a waitlist or just continuing to receive standard care, which often includes prescription painkillers or anti-inflammatory medications, or no treatment at all.

Researchers also looked at 13 studies with a total of 1,095 pain patients, half of whom were randomly assigned to receive what’s known as cognitive behavioral therapy (CBT), a form of talk-therapy that is the “prevailing” non-drug treatment offered for chronic pain, the study team notes.

CBT teaches people to use techniques that address the mental (or cognitive) factors associated with pain, such as intense focus or hyperawareness of discomfort, and to overcome the worry and other negative emotions that often accompany chronic pain. People who didn’t receive CBT got standard care or no treatment.

“We found that both MBSR and CBT improve chronic pain symptoms in terms of physical functioning, pain intensity and depression symptoms, compared with usual care or wait-list (no care),” said study co-author Wei Cheng of the Ottawa Hospital Research Institute in Canada.

“It is still too early to tell which - CBT or mindfulness-based stress reduction might be better for the treatment and management of chronic pain,” Cheng said by email.

Only a single study in the analysis with just 341 patients directly compared CBT to MBSR, and it didn’t find a meaningful difference between these two approaches.

Still, the results are important because chronic pain impacts one in five adults and can impact every aspect of daily life, the study team notes.

CBT and MBSR are both options that can help people manage pain without using opioids, which can be addictive, or other painkillers that can have a variety of side effects that are exacerbated by higher doses and long-term use.

Most of the study participants in the current analysis were women, and they ranged in age from 35 and 65. Most often, they suffered from musculoskeletal pain, and many of them had been living with chronic pain for a decade or more.

There was wide variation among the smaller studies in the duration of pain treatments tested as well as the ways effects of treatment were measured. In the 15 studies that followed patients after treatment ended, follow-up ranged from 8 to 52 weeks.

While these smaller studies were controlled experiments designed to determine the most effective treatments for chronic pain, only 12 of the 21 studies in the analysis were of reasonable or good quality, researchers point out.

“I agree with the authors that the results from this secondary analysis should be interpreted very carefully as few high-quality studies directly compared both treatments,” said Dr. Chenchen Wang, director of Center for Integrative Medicine at Tufts Medical Center in Boston.

Even so, CBT and mindfulness have the potential to improve mental health, and psychological wellbeing may result in easing chronic pain, Wang said by email.

To advise patients on the best approach, “more high-quality evidence is needed,” Wang concluded.

SOURCE: Evidence Based Mental Health, online January 31, 2019.