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Mindfulness-based therapy for chronic pain

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Mindfulness-based therapy for chronic pain

Chronic pain is a common, disabling complaint affecting approximately 20-30% of the adult population in Western countries and is often associated with high rates of comorbid depressive symptoms. While current therapeutic approaches, including analgesics and opioids, can provide significant improvements, the most effective medications only reduce pain by 30-40% in less than 50% of the patients. In addition, surgical techniques such as implantation of artificial spinal discs offer limited pain reduction in only a subset of patients. This has led to the proposal of various psychological treatments for chronic pain (Chiesa & Serretti, 2011).

Over the last three decades, mindfulness-based interventions have become increasingly important in the treatment of chronic pain (Reiner, Tibi, & Lipsitz, 2013). Mindfulness focuses on detached observation of a constantly changing field of objects, which means observing perceptions, emotions and cognitions, without judgement and attempts to change or control them (Kabat-Zinn, Lipworth, & Burney, 1985). A substantial body of research supports the benefits of mindfulness-based interventions for chronic pain patients. However, much of this research primarily addresses global distress, functional capacity and quality of life (Reiner et al., 2013).

Although mindfulness-based interventions are far from being uniform, they are characterized by three core features. The first is to observe the reality of the present moment by focusing attention on objective features of the momentary situation or experience. The second is to focus attention on a single aspect of consciousness and accept it as it is, without judgement, action or preoccupation with its implications. The third is to remain open to whatever is in focus at the moment, without holding on to any particular point of view or outcome. These three characteristics have also been described in terms of a two-component model, where one component involves attention to the present moment and the second component involves an attitude of acceptance and openness (Kabat-Zinn et al., 1985).

There are currently several mindfulness-based interventions that have been shown to be beneficial for pain disorders. The most researched among them are Acceptance and Commitment Therapy and Mindfulness-Based Stress Reduction (MBSR; Reiner et al., 2013). Mindfulness-based stress reduction (MBSR) was originally developed to improve the self-management of chronic pain patients (Kabat-Zinn et al., 1985). MBSR is based on the rationale that mindfulness practice leads to a spontaneous decoupling of the sensory component of pain from the emotional and cognitive components, thus reducing the level of distress caused by pain. In MBSR, individuals learn the principles of mindfulness through various techniques, for example, practicing yoga and various meditations such as body scan meditation or breathing meditation (Kabat-Zinn et al., 1985). A meta-analysis that examined the effects of MBSR in adults with chronic conditions (including chronic pain) concludes that there is evidence of the effectiveness of MBSR in reducing stress and impairment in this population (Bohlmeijer, Prenger, Taal, & Cuijpers, 2010). ACT is also offered for chronic pain as well as a variety for other psychological problems (Reiner et al., 2013). The acceptance method combines mindfulness practice with work on personal values, behaviour commitment and behaviour change strategies to help patients live more fulfilling lives (McCracken, Carson, Eccleston, & Keefe, 2004).

Bibliography :
  • Bohlmeijer, E., Prenger, R., Taal, E., & Cuijpers, P. (2010). The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. Journal of Psychosomatic Research, 68(6), 539–544. doi: 10.1016/j.jpsychores.2009.10.005
  • Chiesa, A., & Serretti, A. (2011). Mindfulness-based interventions for chronic pain: a systematic review of the evidence. Journal of Alternative and Complementary Medicine (New York, N.Y.), 17(1), 83–93. doi: 10.1089/acm.2009.0546
  • Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163–190. doi: 10.1007/BF00845519
  • McCracken, L. M., Carson, J. W., Eccleston, C., & Keefe, F. J. (2004). Acceptance and change in the context of chronic pain. Pain, 109(1–2), 4–7. doi: 10.1016/j.pain.2004.02.006Reiner, K., Tibi, L., & Lipsitz, J. D. (2013). Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Medicine (Malden, Mass.), 14(2), 230–242. doi: 10.1111/pme.12006
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Author : Alexander Ariu