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Lee CS, Chu SH, Dunne J, Spintzyk E, Locatelli G, Babicheva V, Lam L, Julio K, Chen S, Jurgens CY. Body listening in the link between symptoms and self-care management in cardiovascular disease: A cross-sectional correlational descriptive study. Int J Nurs Stud 2024; 156:104809. [PMID: 38788262 DOI: 10.1016/j.ijnurstu.2024.104809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/03/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE The aim of this study was to quantify relationships among symptoms, interoceptive sensibility (i.e. the conscious level of sensing, interpreting and integrating signals from the body), and self-care management behaviors (i.e. the response to symptoms when they occur) among adults with cardiovascular disease. We hypothesized that better interoceptive sensibility would increase the positive behavior-driving effects of symptoms on self-care management. METHODS Adult patients with cardiovascular disease who experienced recent symptoms were recruited to participate in this cross-sectional correlational descriptive study. Patient-Reported Outcomes Measurement Information System measures were used to capture dyspnea, pain interference, fatigue, sleep disturbances, nausea and vomiting, anxiety and depressive symptoms. Interoceptive sensibility was measured using the Multidimensional Assessment of Interoceptive Awareness Version 2. The Self-Care of Chronic Illness Inventory was used to measure self-care management. Network analysis was used to identify domains of interoceptive sensibility that were most central. Linear regression with interaction terms was used to test the moderating effect of interoceptive sensibility on the relationship between symptoms and self-care management. RESULTS The age of participants in the sample (n = 387) ranged from 18 to 88 years, a slight majority (53.5 %) were female, and a majority were Caucasian (66.4 %) or African American (32.0 %). Hypertension was the most common disorder (n = 238 (61.5 %)), followed by rhythm disorders (n = 124 (32.0 %)), coronary artery disease (n = 94 (24.3 %)), heart failure (n = 89 (23.0 %)), valve disease (n = 69 (17.8 %)), stroke (n = 62 (16.0 %)) and peripheral vascular disease (n = 49 (12.7 %)). Based on network analysis, body listening (i.e. active listening to the body for insights) was the most central interoceptive domain, and distracting (i.e. tendency to ignore or distract oneself from sensations of discomfort) was the least central. Noticing (i.e. greater awareness of body sensations), distracting, and body listening were significant in moderating relationships between dyspnea, sleep disturbances and anxiety and the outcome of self-care management behaviors (all p < 0.001). Better noticing and body listening were associated with better self-care management across symptoms, whereas ignoring or distracting oneself from discomfort was associated with worse self-care management behaviors. CONCLUSION Among adults with cardiovascular disease, interventions designed to augment the identified interoceptive sensibility domains like body listening, and mitigate the tendency to ignore or distract oneself from discomfort may support adults with cardiovascular disease through the development of future interventions that optimize patient behaviors in response to symptoms when they occur.
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Affiliation(s)
- Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA.
| | - Sang Hui Chu
- Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Julie Dunne
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Elise Spintzyk
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | | | | | - Louisa Lam
- Australian Catholic University, Melbourne, Australia
| | - Kelly Julio
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Summer Chen
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Corrine Y Jurgens
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
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Zheng F, Liu S, Yin Q, Zheng Y, Yang J, Huang H, Chen L, Wang Y, Chen X, Wang C. Long-term impact of self-compassion training with core stability exercise on patients with nonspecific chronic low back pain: A randomized controlled trial. J Psychosom Res 2024; 181:111678. [PMID: 38643684 DOI: 10.1016/j.jpsychores.2024.111678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE To compare the long-term effectiveness of self-compassion therapy (SCT) combined with core stability exercise (CSE) versus CSE alone in managing nonspecific chronic low back pain (NCLBP). METHODS The combined group received SCT and CSE, while the exercise group only received CSE. Treatment was administered once weekly for four weeks, followed by one year of follow-up. The primary outcomes were changes in functional limitations (measured by Roland and Morris Disability Questionnaire scores[RMDQ]) and self-reported back pain (measured by the Numeric Pain Rating Scale[NRS]) at 52 weeks, with assessments also conducted at 2, 4, and 16 weeks. RESULTS 52 (83.9%) completed the follow-up assessments and were included in the analysis (42 women [80.8%]; mean [SD] age,35.3 [10.0] years). In the combined group, the baseline mean (SD) RMDQ score was 9.3 (4.1),5.7 (5.8) at 2 weeks, 3.8 (3.4) at 4 weeks, 3.8 (3.7) at 16 weeks, and 2.4 (2.7) at 52 weeks. For the exercise group, the RMDQ scores were 8.2 (3.3) at baseline, 6.2 (4.2) at 2 weeks, 5.5 (4.7) at 4 weeks, 4.4 (4.5) at 16 weeks, and 5.2 (5.6) at 52 weeks. The estimated mean difference between the groups at 52 weeks was -3.356 points (95% CI, -5.835 to -0.878; P = 0.009), favoring the combined group. NRS scores showed similar changes. CONCLUSION The addition of self-compassion therapy enhances the long-term efficacy of core stability training for NCLBP (Preregistered at chictr.org.cn:ChiCTR2100042810).
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Affiliation(s)
- Fuming Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Shufeng Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Qunhui Yin
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Yiyi Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Jiajia Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Haoxuan Huang
- Department of psychology, Sun Yat-Sen University, Guangzhou 510006, China
| | - Lichang Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Yuyin Wang
- Department of psychology, Sun Yat-Sen University, Guangzhou 510006, China.
| | - Xi Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
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3
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Roberts RL, Hanley AW, Garland EL. Mindfulness-Based Interventions for Perioperative Pain Management and Opioid Risk Reduction Following Surgery: A Stepped Care Approach. Am Surg 2024; 90:939-946. [PMID: 35802881 DOI: 10.1177/00031348221114019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgical procedures often improve health and function but can sometimes also result in iatrogenic effects, including chronic pain and opioid misuse. Due to the known risks of opioids and the physical, emotional, and financial suffering that often accompanies chronic pain, there has been a call for greater use of complementary non-pharmacological treatments like mindfulness-based interventions. Mindfulness can be broadly described as an attentional state involving moment-by-moment meta-awareness of thoughts, emotions, and body sensations. An expanding number of randomized clinical trials have found strong evidence for the value of mindfulness techniques in alleviating clinical symptomology relevant to surgical contexts. The purpose of this review is to examine the empirical evidence for the perioperative use of mindfulness interventions. We present a mindfulness-based stepped care approach that first involves brief mindfulness to treat preoperative pain and anxiety and prevent development of postoperative chronic pain or opioid misuse. More extensive mindfulness-based interventions are then provided to patients who continue to experience high pain levels or prolonged opioid use after surgery. Finally, we review psychophysiological mechanisms of action that may be integral to the analgesic and opioid sparing effects of mindfulness.
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Affiliation(s)
- R Lynae Roberts
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, UT, USA
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Adam W Hanley
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, UT, USA
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, UT, USA
- College of Social Work, University of Utah, Salt Lake City, UT, USA
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT, USA
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4
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Čeko M, Baeuerle T, Webster L, Wager TD, Lumley MA. The effects of virtual reality neuroscience-based therapy on clinical and neuroimaging outcomes in patients with chronic back pain: a randomized clinical trial. Pain 2024:00006396-990000000-00549. [PMID: 38466872 DOI: 10.1097/j.pain.0000000000003198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/06/2024] [Indexed: 03/13/2024]
Abstract
ABSTRACT Chronic pain remains poorly managed. The integration of immersive technologies (ie, virtual reality [VR]) with neuroscience-based principles may provide effective pain treatment by targeting cognitive and affective neural processes that maintain pain and therefore potentially changing neurobiological circuits associated with pain chronification and amplification. We tested the effectiveness of a novel VR neuroscience-based therapy (VRNT) to improve pain-related outcomes in n = 31 participants with chronic back pain, evaluated against usual care (waitlist control; n = 30) in a 2-arm randomized clinical trial (NCT04468074). We also conducted pre-treatment and post-treatment MRI to test whether VRNT affects brain networks previously linked to chronic pain and treatment effects. Compared with the control condition, VRNT led to significantly reduced pain intensity (g = 0.63) and pain interference (g = 0.84) at post-treatment vs pre-treatment, with effects persisting at 2-week follow-up. These improvements were partially mediated by reduced kinesiophobia and pain catastrophizing. Several secondary clinical outcomes were also improved by VRNT, including disability, quality of life, sleep, and fatigue. In addition, VRNT was associated with increases in dorsomedial prefrontal functional connectivity with the superior somatomotor, anterior prefrontal and visual cortices, and decreased white matter fractional anisotropy in the corpus callosum adjacent to the anterior cingulate, relative to the control condition. Thus, VRNT showed preliminary efficacy in significantly reducing pain and improving overall functioning, possibly through changes in somatosensory and prefrontal brain networks.
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Affiliation(s)
- Marta Čeko
- Institute of Cognitive Science, University of Colorado, Boulder, CO, United States
| | | | - Lynn Webster
- U.S. Center for Policy, Scientific Affairs, Dr. Vince Clinical Research, Salt Lake City, UT, United States
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, United States
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5
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Aygün O, Mohr E, Duff C, Matthew S, Schoenberg P. Oxytocin Modulation in Mindfulness-Based Pain Management for Chronic Pain. Life (Basel) 2024; 14:253. [PMID: 38398763 PMCID: PMC10890287 DOI: 10.3390/life14020253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
In the context of chronic pain management, opioid-based treatments have been heavily relied upon, raising concerns related to addiction and misuse. Non-pharmacological approaches, such as Mindfulness-Based Pain Management, offer alternative strategies. We conducted a mechanistic clinical study to investigate the impact of an 8-week Mindfulness-Based Pain Management intervention on chronic pain, the modulation of inflammatory markers, stress physiology, and oxytocin, and their interplay with clinical pain symptoms and perception, in comparison to a patient wait-list active control. A total of 65 participants, including 50 chronic pain patients and 15 healthy controls, underwent salivary assays to assess endocrine markers, oxytocin, interleukin (IL)-1b, IL-6, IL-8, tumor necrosis factor (TNF)-a, and dehydroepiandrosterone sulphate (DHEA-S). Psychological assessments were also conducted to evaluate aspects of pain perception, mindfulness, mood, and well-being. Findings revealed significant differences between chronic pain patients and healthy controls in various clinical metrics, highlighting the psychological distress experienced by patients. Following Mindfulness-Based Pain Management, oxytocin levels significantly increased in chronic pain patients, that was not observed in the patient wait-list control group. In contrast, cytokine and DHEA-S levels decreased (not to statistically significant margins) supporting anti-inflammatory effects of Mindfulness-Based Pain Management. The fact DHEA-S levels, a marker of stress, did attenuate but not to statistically meaningful levels, suggests that pain reduction was not solely related to stress reduction, and that oxytocin pathways may be more salient than previously considered. Psychological assessments demonstrated substantial improvements in pain perception and mood in the intervention group. These results contribute to the growing body of evidence regarding the effectiveness of mindfulness-based interventions in chronic pain management and underscore oxytocin's potential role as a therapeutic target.
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Affiliation(s)
- Oytun Aygün
- Laboratoire DysCo, Université Paris 8 Vincennes-Saint-Denis, 93526 Saint-Denis, France;
| | - Emily Mohr
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Colin Duff
- Breathworks Foundation, Manchester M4 1DZ, UK
| | | | - Poppy Schoenberg
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
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6
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Francis SEB, Shawyer F, Cayoun BA, Grabovac A, Meadows G. Differentiating mindfulness-integrated cognitive behavior therapy and mindfulness-based cognitive therapy clinically: the why, how, and what of evidence-based practice. Front Psychol 2024; 15:1342592. [PMID: 38384351 PMCID: PMC10880191 DOI: 10.3389/fpsyg.2024.1342592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
It is important to be able to differentiate mindfulness-based programs in terms of their model, therapeutic elements, and supporting evidence. This article compares mindfulness-based cognitive therapy (MBCT), developed for relapse prevention in depression, and mindfulness-integrated cognitive behavior therapy (MiCBT), developed for transdiagnostic applications, on: (1) origins, context and theoretical rationale (why), (2) program structure, practice and, professional training (how), and (3) evidence (what). While both approaches incorporate behavior change methods, MBCT encourages behavioral activation, whereas MiCBT includes various exposure procedures to reduce avoidance, including a protocol to practice equanimity during problematic interpersonal interactions, and a compassion training to prevent relapse. MBCT has a substantial research base, including multiple systematic reviews and meta-analyses. It is an endorsed preventative treatment for depressive relapse in several clinical guidelines, but its single disorder approach might be regarded as a limitation in many health service settings. MiCBT has a promising evidence base and potential to make a valuable contribution to psychological treatment through its transdiagnostic applicability but has not yet been considered in clinical guidelines. While greater attention to later stage dissemination and implementation research is recommended for MBCT, more high quality RCTs and systematic reviews are needed to develop the evidence base for MiCBT.
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Affiliation(s)
- Sarah E. B. Francis
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Frances Shawyer
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Bruno A. Cayoun
- Mindfulness-integrated Cognitive Behavior Therapy Institute, Hobart, TAS, Australia
| | - Andrea Grabovac
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Graham Meadows
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Mental Health Program, Monash Health, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
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7
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Navas-Otero A, Calvache-Mateo A, Martín-Núñez J, Valenza-Peña G, Hernández-Hernández S, Ortiz-Rubio A, Valenza MC. The Effectiveness of Combined Exercise and Self-Determination Theory Programmes on Chronic Low Back Pain: A Systematic Review and Metanalysis. Healthcare (Basel) 2024; 12:382. [PMID: 38338267 PMCID: PMC10855905 DOI: 10.3390/healthcare12030382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Low back pain is a pervasive issue worldwide, having considerable prevalence and a significant impact on disability. As low back pain is a complicated condition with many potential contributors, the use of therapeutic exercise, combined with other techniques such as self-determination theory programmes, has the potential to improve several outcomes. The aim of this systematic review was to explore the effectiveness of combined exercise and self-determination theory programmes on chronic low back pain. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A systematic search in three databases (PubMed/MEDLINE, Web of Science, and Scopus) was conducted from September to November 2023. After screening, a total of five random control trials with patients with chronic low back pain were included in this systematic review and meta-analysis. The results showed significant differences in disability (SMD = -0.98; 95% CI = -1.86, -0.09; p = 0.03) and in quality of life (SMD = 0.23; 95% CI = 0.02, 0.44; p = 0.03) in favour of the intervention group versus the control group.
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Affiliation(s)
| | | | | | | | | | - Araceli Ortiz-Rubio
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. de la Ilustración 60, 18016 Granada, Spain; (A.N.-O.); (A.C.-M.); (J.M.-N.); (G.V.-P.); (S.H.-H.); (M.C.V.)
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8
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Casabella Abril B. [New perspectives in the approach to pain]. Aten Primaria 2024; 56:102841. [PMID: 38134845 PMCID: PMC10776413 DOI: 10.1016/j.aprim.2023.102841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Affiliation(s)
- Bartomeu Casabella Abril
- Médico de familia. Doctor en medicina por la Universidad de Barcelona (1993), Miembro del PADEICS -SSC (Programa asistencial de expertez del Institut Català de la Salut en Síndromes de Sensibilización Central).
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9
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Sharpe L, Richmond B, Menzies RE, Forrest D, Crombez G, Colagiuri B. A synthesis of meta-analyses of mindfulness-based interventions in pain. Pain 2024; 165:18-28. [PMID: 37578535 DOI: 10.1097/j.pain.0000000000002997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/13/2023] [Indexed: 08/15/2023]
Abstract
ABSTRACT Mindfulness interventions have become popular in recent decades, with many trials, systematic reviews, and meta-analyses of the impact of mindfulness-based interventions (MBIs) on pain. Although many meta-analyses provide support for MBIs, the results are more mixed than they at first appear. The aim of this umbrella review was to determine the strength of evidence for MBIs by synthesizing available meta-analyses in pain. We conducted a systematic search in 5 databases and extracted data from published meta-analyses as the unit of analysis. For each outcome, we reported the range of effect sizes observed across studies and identified the largest meta-analysis as the "representative" study. We separately analysed effect sizes for different pain conditions, different types of MBIs, different control groups, and different outcomes. We identified 21 meta-analyses that included 127 unique studies. According to Assessment of Multiple Systematic Review ratings, the meta-analyses ranged from very strong to weak. Overall, there was an impact of MBIs on pain severity, anxiety, and depression but not pain interference or disability. When conditions were considered in isolation, only fibromyalgia and headache benefited significantly from MBIs. Mindfulness-based interventions were more efficacious for pain severity than passive control conditions but not active control conditions. Only pain severity and anxiety were affected by MBIs at follow-up. Overall, our results suggest that individual meta-analyses of MBIs may have overestimated the efficacy of MBIs in a range of conditions. Mindfulness-based interventions likely have a role in pain management but should not be considered a panacea.
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Affiliation(s)
| | | | | | | | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
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10
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Li BR, Wang J. Research status of internet-delivered cognitive behavioral therapy in cancer patients. World J Psychiatry 2023; 13:831-837. [DOI: 10.5498/wjp.v13.i11.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023] Open
Abstract
The latest global cancer burden data released by the International Agency for Research on Cancer of the World Health Organization in 2020 shows that there were 19.29 million new cancer cases worldwide, with 4.57 million in China, ranking first. The number of cancer survivors is increasing, with a 5-year survival rate exceeding 85%, but there are emotional disorders. Cognitive behavioral therapy (CBT) can improve negative emotions and has significant effects on patients. However, there is a limited number of physicians and high costs, so internet interventions have become a solution. The feasibility of web-based interventions for breast cancer patients has been proven. Research on internet-delivered CBT is also increasing. The purpose of this study was to review the concept of web-based CBT and its application status in cancer survivors, in order to provide relevant intervention for scholars and provide reference and supplement for patients to provide psychological therapy.
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Affiliation(s)
- Bing-Rui Li
- Operating Room, The Fourth Affiliated Hospital of China Medical University, Shenyang 110033, Liaoning Province, China
| | - Jing Wang
- Operating Room, The Fourth Affiliated Hospital of China Medical University, Shenyang 110033, Liaoning Province, China
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11
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Shi Y, Wu W. Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress. BMC Med 2023; 21:372. [PMID: 37775758 PMCID: PMC10542257 DOI: 10.1186/s12916-023-03076-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Chronic pain conditions impose significant burdens worldwide. Pharmacological treatments like opioids have limitations. Non-invasive non-pharmacological therapies (NINPT) encompass diverse interventions including physical, psychological, complementary and alternative approaches, and other innovative techniques that provide analgesic options for chronic pain without medications. MAIN BODY This review elucidates the mechanisms of major NINPT modalities and synthesizes evidence for their clinical potential across chronic pain populations. NINPT leverages peripheral, spinal, and supraspinal mechanisms to restore normal pain processing and limit central sensitization. However, heterogeneity in treatment protocols and individual responses warrants optimization through precision medicine approaches. CONCLUSION Future adoption of NINPT requires addressing limitations in standardization and accessibility as well as synergistic combination with emerging therapies. Overall, this review highlights the promise of NINPT as a valuable complementary option ready for integration into contemporary pain medicine paradigms to improve patient care and outcomes.
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Affiliation(s)
- Yu Shi
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Wen Wu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
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12
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Paley CA, Johnson MI. Perspective on salutogenic approaches to persistent pain with a focus on mindfulness interventions. FRONTIERS IN PAIN RESEARCH 2023; 4:1188758. [PMID: 37706030 PMCID: PMC10495576 DOI: 10.3389/fpain.2023.1188758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
In this article, we provide a unique perspective on the use of mindfulness interventions in a whole health framework embedded within the theory of salutogenesis and the concept of painogenic environments. We argue that mindfulness is a valuable tool to bridge exploration of inner experiences of bodily pain with socio-ecological influences on thoughts and emotions. We outline research from neuroimaging studies that mindfulness techniques mediate neural processing and neuroplastic changes that alleviate pain and related symptoms. We also review evidence examining behavioural changes associated with mindfulness meditation providing evidence that it promotes self-regulatory activity, including the regulation and control of emotion and catalysation of health behaviour changes; both of which are important in chronic illness. Our viewpoint is that mindfulness could be a core element of salutogenic approaches to promote health and well-being for people living with pain because it rebuilds a fractured sense of cohesion. Mindfulness empowers people in pain to embrace their existence; shifting the focus away from pain and giving their lives meaning. We propose that integrating mindfulness into activities of daily living and individual or community-based activities will promote living well in the modern world, with or without pain; thus, promoting individual potential for fulfilment. Future research should consider the effects of mindfulness on people with pain in real-life settings, considering social, environmental, and economic factors using a broader set of outcomes, including self-efficacy, sense of coherence and quality of life.
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Affiliation(s)
- Carole A. Paley
- Centre for Pain Research, Leeds Beckett University, Leeds, United Kingdom
- Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom
| | - Mark I. Johnson
- Centre for Pain Research, Leeds Beckett University, Leeds, United Kingdom
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Čeko M, Baeuerle T, Webster L, Wager TD, Lumley MA. The Effects of Virtual Reality Neuroscience-based Therapy on Clinical and Neuroimaging Outcomes in Patients with Chronic Back Pain: A Randomized Clinical Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.24.23293109. [PMID: 37546872 PMCID: PMC10402228 DOI: 10.1101/2023.07.24.23293109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Chronic pain remains poorly managed. The integration of innovative immersive technologies (i.e., virtual reality (VR)) with recent neuroscience-based principles that position the brain as the key organ of chronic pain may provide a more effective pain treatment than traditional behavioral therapies. By targeting cognitive and affective processes that maintain pain and potentially directly changing neurobiological circuits associated with pain chronification and amplification, VR-based pain treatment has the potential for significant and long-lasting pain relief. We tested the effectiveness of a novel VR neuroscience-based therapy (VRNT) to improve pain-related outcomes in n = 31 participants with chronic back pain, evaluated against usual care (n = 30) in a 2-arm randomized clinical trial ( NCT04468074) . We also conducted pre- and post-treatment MRI to test whether VRNT affects brain networks previously linked to chronic pain and treatment effects. Compared to the control condition, VRNT led to significantly reduced pain intensity (g = 0.63) and pain interference (g = 0.84) at post-treatment vs. pre-treatment, with effects persisting at 2-week follow-up. The improvements were partially mediated by reduced kinesiophobia and pain catastrophizing. Several secondary clinical outcomes were also improved, including disability, quality of life, sleep, and fatigue. In addition, VRNT was associated with modest increases in functional connectivity of the somatomotor and default mode networks and decreased white matter fractional anisotropy in the corpus callosum adjacent to anterior cingula, relative to the control condition. This, VRNT showed preliminary efficacy in significantly reducing pain and improving overall functioning, possibly via changes in somatosensory and prefrontal brain networks.
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Foulk M, Montagnini M, Fitzgerald J, Ingersoll-Dayton B. Mindfulness-Based Group Therapy for Chronic Pain Management in Older Adults. Clin Gerontol 2023:1-10. [PMID: 37378667 DOI: 10.1080/07317115.2023.2229307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
OBJECTIVES There were two quality improvement goals for this project: (1) to evaluate the outcomes of an 8-week geriatric-focused mindfulness-based group therapy program for chronic pain management called "Mindfulness-based Chronic Pain Care" offered at a senior community center affiliated with a geriatric primary care clinic, and (2) to obtain feedback from participants to make relevant modifications for future groups. METHODS The program consisted of eight 150-minute weekly sessions. Thirteen community-dwelling older adults aged 60 and older participated in the program. The study utilized a non-randomized control-group pretest-posttest design. Participants completed pre- and post-program evaluations measuring pain and related psychosocial outcomes and were also asked to evaluate the importance of the group. Intervention and control groups were compared by t-test, chi-square likelihood ratio, Fischer's exact test, and multivariate analysis of variance with repeated measures. RESULTS There were statistically significant improvements in three areas: 1) increased activity level, 2) increased "pain willingness," and 3) decreased generalized anxiety symptoms. Qualitative analysis highlighted how this intervention was important to participants. CONCLUSIONS The results of this pilot program indicate promising outcomes for older adults suffering from chronic pain. CLINICAL IMPLICATIONS The Mindfulness-based Chronic Pain Care program was a practical, feasible, and acceptable approach for pain management among program participants.
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Affiliation(s)
- Mariko Foulk
- Department of Social Work /Geriatrics Center, Michigan Medicine, University of Michigan, Ann Arbo, Michigan, USA
| | - Marcos Montagnini
- Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Michigan, Ann Arbo, Michigan, USA
| | - James Fitzgerald
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
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15
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Li C, Hou W, Ding D, Yang Y, Gu S, Zhu Y. Evidence Mapping Based on Systematic Reviews of Cognitive Behavioral Therapy for Neuropathic Pain. Neural Plast 2023; 2023:2680620. [PMID: 36994240 PMCID: PMC10041341 DOI: 10.1155/2023/2680620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/03/2023] [Accepted: 02/18/2023] [Indexed: 03/31/2023] Open
Abstract
Objective This evidence mapping is aimed at identifying, summarizing, and analyzing the available evidence on cognitive behavioral therapy (CBT) for neuropathic pain (NP). Methods This study was conducted following the methodology of Global Evidence Mapping (GEM). Searches were conducted in PubMed, Embase, the Cochrane Library, and PsycINFO to identify systematic reviews (SRs) with or without meta-analysis published before February 15, 2022. The authors independently assessed eligibility, extracted data, and evaluated the methodological quality of the included SRs using AMSTAR-2. The results were presented in the tables and a bubble plot based on the identified population-intervention-comparison-outcome (PICO) questions. Results A total of 34 SRs met the eligibility criteria. According to the AMSTAR-2, 2 SRs were rated "high," 2 SRs were rated "moderate," 6 SRs were rated "low," and 24 SRs were rated "critically low." The most common study design utilized to evaluate the efficacy of CBT for NP was the randomized controlled trial. In total, 24 PICOs were identified. Migraine was the most studied population. CBT for NP usually reaches the "potentially better" result at follow-up. Conclusions Evidence mapping is a useful way to present existing evidence. Currently, the existing evidence on CBT for NP is limited. Overall, the methodological quality of the included SRs was low. Further improvements in the methodological quality of SRs and more research on the most efficient CBT formats for NP are recommended in the future.
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Affiliation(s)
- Conghui Li
- 1The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- 2Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Weiqian Hou
- 1The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- 2Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Dongfang Ding
- 1The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- 2Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Yujie Yang
- 3University of Health and Rehabilitation Sciences, Qingdao, Shandong 266000, China
| | - Shanshan Gu
- 4Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Yi Zhu
- 1The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
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16
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Cardle P, Kumar S, Leach M, McEvoy M, Veziari Y. Mindfulness and Chronic Musculoskeletal Pain: An Umbrella Review. J Multidiscip Healthc 2023; 16:515-533. [PMID: 36879651 PMCID: PMC9985422 DOI: 10.2147/jmdh.s392375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/23/2022] [Indexed: 03/04/2023] Open
Abstract
Background Chronic musculoskeletal pain (CMSP) disorders are a leading cause of disability globally, affecting up to one in three people. Mindfulness-based interventions (MBI) have become a popular treatment for CMSP. The aim of this umbrella review was to synthesise the best available research evidence for the effectiveness of MBI for adults with CMSP. Methods Eight databases were searched from inception to 30th June 2021 for systematic reviews that examined the use of MBI in CMSP (pain experienced >3 months) in adult populations. Two reviewers independently conducted screening and selection, data extraction, and assessment of methodological quality using The Assessing the Methodological Quality of Systematic Reviews tool (AMSTAR 2). Outcomes examined were pain, sleep quality, depression, quality of life, physical functioning, and mindfulness. Furthermore, definitions of mindfulness, and intervention parameters (mindfulness practices used, length, frequency of sessions, duration) were also reported. Results Nineteen systematic reviews (n = 1 rated high quality, n = 1 moderate quality, n = 2 low quality and n = 15 critically low quality) examining 194 primary studies met the review criteria. Although some promising evidence was identified for the use of MBI in CMSP, the general low quality and widespread heterogeneity of included SRs and made it difficult to reach a definitive conclusion. Differences in results and outcomes amongst systematic reviews that, in many cases, had a high overlap of included RCTs, suggests fundamental differences in critical design elements that make data difficult to compare. Conclusion This umbrella review found mixed results on the effectiveness of MBI for the management of CMSP across a range of outcomes (pain, sleep quality, depression, quality of life, physical functioning, mindfulness). Definitions of MBI varied as did parameters, which may have contributed to these mixed results. More rigorous research with stringent MBI protocols is required.
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Affiliation(s)
- Paul Cardle
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| | - Saravana Kumar
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| | - Matthew Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia
| | - Maureen McEvoy
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| | - Yasamin Veziari
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
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17
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Marks E, Moghaddam N, De Boos D, Malins S. A systematic review of the barriers and facilitators to adherence to
mindfulness‐based
cognitive therapy for those with chronic conditions. Br J Health Psychol 2022; 28:338-365. [PMID: 36310447 DOI: 10.1111/bjhp.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Mindfulness-Based Cognitive Therapy (MBCT) can improve the lives of those with a chronic condition and psychological distress, however, high drop-out rates limit benefits. MBCT might be a candidate treatment for this population if nonadherence can be overcome. This review explores the existing literature on the barriers and facilitators to adherence to MBCT for those with chronic conditions. METHOD Databases MEDLINE, PsycINFO, CINAHL and Scopus were searched between 28th May and 11th June 2021. We included empirical papers that identified barriers and/or facilitators to MBCT adherence in patients with chronic conditions-excluding non-English and grey literature. Papers were screened and duplicates removed. Extracted data included: setting, design, aim, sample-size, population and identified barriers/facilitators to MBCT adherence. The Mixed Methods Appraisal Tool (MMAT) was adapted and used to appraise the quality of studies RESULTS: Twenty papers were eligible for review. Synthesis identified six themes (in prevalence order): (1) Practical Factors (e.g., time and other commitments), (2) Motivation (e.g., change-readiness), (3) Patient clinical and demographic characteristics (e.g., current physical health), (4) Connection with Others (facilitators and group members), (5) Credibility (perception of the intervention) and (6) Content difficulty (intervention accessibility). Findings highlight potential adaptations to implementation (e.g., clear treatment rationale, preference matching, and eliciting and responding to individual concerns or obstructive assumptions) that could address barriers and harness facilitators. CONCLUSION This review contributes a higher order understanding of factors that may support/obstruct client adherence to MBCT with implications for future implementation in research and practice. Future research should prioritize open exploration of barriers/facilitators.
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Affiliation(s)
- Eleanor Marks
- Clinical Psychology University of Lincoln Lincoln UK
| | | | | | - Sam Malins
- Clinical Psychology University of Nottingham Nottingham UK
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18
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Abstract
Chronic migraine is a neurologic disorder associated with considerable disability, lost productivity, and a profound economic burden worldwide. The past five years have seen a dramatic expansion in new treatments for this often challenging condition, among them calcitonin gene related peptide antagonists and neuromodulatory devices. This review outlines the epidemiology of and diagnostic criteria and risk factors for chronic migraine. It discusses evidence based drug and non-drug treatments, their advantages and disadvantages, and the principles of patient centered care for adults with chronic migraine, with attention to differential diagnosis and comorbidities, clinical reasoning, initiation and monitoring, cost, and availability. It discusses the international guidelines on drug treatment for chronic migraine and evaluates non-drug treatments including behavioral and complementary therapies and lifestyle modifications. Finally, it discusses the management of chronic migraine in special populations, including pediatrics, pregnancy, and older people, and considers future questions and emerging research in the field.
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Affiliation(s)
| | - Julie Roth
- Warren Alpert Medical School of Brown University, Brown University, Providence, RI, USA
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Leça S, Tavares I. Research in Mindfulness Interventions for Patients With Fibromyalgia: A Critical Review. Front Integr Neurosci 2022; 16:920271. [PMID: 35965601 PMCID: PMC9368585 DOI: 10.3389/fnint.2022.920271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Fibromyalgia is one of the most common causes of widespread chronic pain. It has a huge impact on the quality of life, namely because it appears earlier in life than most of the chronic pain conditions. Furthermore, emotional-cognitive distress factors, such as depression and anxiety, are a common feature in patients with fibromyalgia. The neurobiological mechanisms underlying fibromyalgia remain mostly unknown. Among non-pharmacological treatments, cognitive-behavioral therapy has been used during the last decade, namely with the enrolment of patients in programs of mindfulness-based stress reduction (MBSR) and in mindfulness-based interventions (MBI). We critically analyzed the literature to search for scientific evidence for the use of MBI in fibromyalgia. The studies were evaluated as to several outcomes of fibromyalgia improvement along with aspects of the study design which are currently considered relevant for research in mindfulness. We conclude that despite the sparsity of well-structured longitudinal studies, there are some promising results showing that the MBI are effective in reducing the negative aspects of the disease. Future design of studies using MBI in fibromyalgia management should be critically discussed. The importance of active controls, evaluation of sustained effects along with investigation of the subserving neurobiological mechanisms and detailed reports of possible adverse effects should be considered.
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Affiliation(s)
- Salomé Leça
- Unit of Experimental Biology, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Isaura Tavares
- Unit of Experimental Biology, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Institute of Molecular and Cell Biology, University of Porto, Porto, Portugal
- I3S–Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal
- *Correspondence: Isaura Tavares,
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Lin TH, Tam KW, Yang YL, Liou TH, Hsu TH, Rau CL. Meditation-Based Therapy for Chronic Low Back Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PAIN MEDICINE 2022; 23:1800-1811. [DOI: 10.1093/pm/pnac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/27/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Chronic low back pain (CLBP) is among the most common types of pain in adults. Currently, injections and analgesic and nonsteroidal anti-inflammatory drugs are often provided for patients with CLBP. However, their effectiveness remains questionable, and the safest approach to CLBP remains debated. Meditation-based therapies constitute an alternative treatment with high potential for widespread availability. We evaluated the applicability of meditation-based therapies for CLBP management.
Materials and Methods
We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy of meditation-based therapies for CLBP management. The primary outcomes were pain intensity, quality of life, and pain-related disability; the secondary outcomes were the experienced distress or anxiety and pain bothersomeness in the patients. The PubMed, Embase, and Cochrane databases were searched for studies published from their inception until July 2021, without language restrictions.
Results
We reviewed 12 randomized controlled trials with 1153 patients. In 10 trials, meditation-based therapies significantly reduced the CLBP pain intensity compared with nonmeditation therapies (standardized mean difference [SMD] −0.27, 95% CI = −0.43 to − 0.12, P = 0.0006). In 7 trials, meditation-based therapies also significantly reduced CLBP bothersomeness compared with nonmeditation therapies (SMD −0.21, 95% CI = −0.34 to − 0.08, P = 0.002). In 3 trials, meditation-based therapies significantly improved patient quality of life compared with nonmeditation therapies (SMD 0.27, 95% CI = 0.17 to 0.37, P < 0.00001)
Conclusions
In conclusion, meditation-based therapies constitute a safe and effective alternative approach for CLBP management.
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Affiliation(s)
- Ting-Han Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei City, Taiwan
- Center for Evidence-Based Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Yu-Ling Yang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 11031, Taiwan
| | - Tzu-Herng Hsu
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 11031, Taiwan
| | - Chi-Lun Rau
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City, Taiwan
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Garcia-Campayo J, López del Hoyo Y, Navarro-Gil M. Contemplative sciences: A future beyond mindfulness. World J Psychiatry 2021; 11:87-93. [PMID: 33889534 PMCID: PMC8040148 DOI: 10.5498/wjp.v11.i4.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/02/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
Mindfulness is a psychological technique based on Eastern meditative practices that was developed in the late 1970s by Kabat-Zinn at the University of Massachusetts. Initially, there was a debate over whether it should be considered a scientific technique or labelled as part of the "new wave" practices. Today, mindfulness is omnipresent in modern societies but has suffered from merchandising and banalization, which has been strongly criticized. Despite some limitations regarding methodological aspects of mindfulness research, it is considered effective for treating many physical and psychological disorders, and even it is recommended in clinical guidelines such the British National Institute for Health and Care Excellence. During the last 2500 years, mindfulness practices have moved from Northern India across most of Asia, but their mixing with Western science and culture at the end of the 20th century is considered a key event in recent history. For the first time in human history, due to globalization, the wisdom of all contemplative traditions can be shared with all human beings and assessed by science. Mindfulness practices, yoga included, are giving birth to a new field of knowledge, contemplative sciences, which go beyond mindfulness and is devoted to helping humanity to reach higher levels of happiness and mental peace.
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Affiliation(s)
- Javier Garcia-Campayo
- Department of Psychiatry, Miguel Servet Hospital, Aragon Institute for Health Research, University of Zaragoza, Zaragoza 50009, Spain
| | | | - Mayte Navarro-Gil
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza 50009, Spain
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