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Dörner M, von Känel R, König N, Pazhenkottil AP, Altwegg R, Nager L, Attanasio V, Guth L, Zirngast S, Menzi A, Zuccarella-Hackl C, Princip M. Mindfulness Is Associated with Lower Depression, Anxiety, and Post-Traumatic Stress Disorder Symptoms and Higher Quality of Life in Patients with an Implantable Cardioverter-Defibrillator-A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1118. [PMID: 38891193 PMCID: PMC11172204 DOI: 10.3390/healthcare12111118] [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: 05/09/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Several studies suggested the efficacy of dispositional mindfulness and mindfulness-based interventions in reducing anxiety and depression in cardiovascular diseases. However, data on the impact of mindfulness on the psychological well-being of patients with an implantable cardioverter-defibrillator (ICD) are scarce. In this study, 422 patients with an ICD were prospectively recruited. Logistic regression was applied to determine associations between dispositional mindfulness (Freiburg Mindfulness Inventory), depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7 scale), and post-traumatic stress disorder (PTSD) symptoms (Post-Traumatic Stress Diagnostic Scale), adjusting for age, sex, educational status, number of ICD shocks after ICD implantation, and physical activity. The PROCESS regression path analysis modelling tool was used to identify indirect mediating effects of dispositional mindfulness on depression, anxiety, and PTSD symptoms and quality of life (QoL; EuroQol group 5-dimension questionnaire). Participants presented high baseline QoL (mean 1.06 to 1.72) and medium-high mindfulness scores (mean 40.85 points). Higher mindfulness scores were associated with lower levels of anxiety (OR 0.90, 95% CI 0.86 to 0.95, 0.001), depression (OR 0.93, 95% CI 0.88 to 0.98, p = 0.006), and PTSD symptoms (OR 0.94, 95% CI 0.89 to 0.98, p = 0.011). Furthermore, greater mindfulness partially mediated the relationship between anxiety (indirect effect 0.10, 95% CI 0.02 to 0.21), depression (indirect effect 0.08, 95% CI 0.01 to 0.17), or PTSD (indirect effect 0.04, 95% CI 0.01 to 0.17) as independent variables and the QoL as the dependent variable. This study suggests that greater dispositional mindfulness is associated with less anxiety, depression, and PTSD symptoms. Mindfulness might also increase the QoL in ICD patients by mitigating the impact of those with psychological distress.
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Affiliation(s)
- Marc Dörner
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Noelle König
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Aju P. Pazhenkottil
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Rahel Altwegg
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Ladina Nager
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Veronica Attanasio
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Lisa Guth
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Sina Zirngast
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Anna Menzi
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Mary Princip
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
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2
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Wang X, Ding N, Sun Y, Chen Y, Shi H, Zhu L, Gao S, Liu Z. Non-pharmacological therapies for treating chronic pelvic pain in women: A review. Medicine (Baltimore) 2022; 101:e31932. [PMID: 36626494 PMCID: PMC9750590 DOI: 10.1097/md.0000000000031932] [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] [Indexed: 01/11/2023] Open
Abstract
Chronic pelvic pain (CPP) is an intricate condition with multiple etiologies that lead to indefinite pain mechanisms. Physicians and researchers are challenged in its treatment, and the combined therapy of pharmacologic and non-pharmacologic treatment has been recognized as a multidisciplinary approach cited by guidelines and adopted in clinical practice. As an alternative therapy for CPP, non-pharmacologic therapies benefit patients and deserve further study. This study reviews the literature published from January 1991 to April 2022 on non-pharmacologic therapies for CPP in adult women. Based on a survey, this review found that the most commonly used non-pharmacological therapies for CPP include pelvic floor physical therapy, psychotherapy, acupuncture, neuromodulation, and dietary therapy. By evaluating the efficacy and safety of each therapy, this study concluded that non-pharmacological therapies should be included in the initial treatment plan because of their high degree of safety and low rate of side effects. To fill the lack of data on non-pharmacologic therapies for CPP, this study provides evidence that may guide treatment and pain management.
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Affiliation(s)
- Xinlu Wang
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ning Ding
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanjie Sun
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Chen
- New Zealand College of Chinese Medicine, Greenlane, Aukland, New Zealand
| | - Hangyu Shi
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Lili Zhu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shuai Gao
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Zhishun Liu, Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (e-mail: )
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3
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Zanca JM, Gilchrist C, Ortiz CE, Dyson-Hudson TA. Pilot clinical trial of a clinical meditation and imagery intervention for chronic pain after spinal cord injury. J Spinal Cord Med 2022; 45:339-353. [PMID: 34612802 PMCID: PMC9135436 DOI: 10.1080/10790268.2021.1970894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To assess the feasibility and potential benefits of clinical meditation and imagery (CMI) for people with chronic spinal cord injury (SCI) and chronic pain. DESIGN Pilot randomized, controlled trial. SETTING Outpatients with SCI in the United States. PARTICIPANTS 24 adults with chronic SCI (>1 year) and a >3 month history of pain rated ≥4/10 on average over the last week. INTERVENTIONS 4-week program of once-weekly 2-hour group classes, offered in-person and online. CMI group participants were taught mindfulness, mantra meditation, and guided imagery practices. Control group participants received education on topics related to health and function after SCI. OUTCOME MEASURES Pain interference (primary outcome), pain cognitions, pain intensity/unpleasantness, depressive symptomology, perceived stress. RESULTS Pain interference decreased to a greater extent in the control group at both Day 42 and Day 70, with a large effect size (d > 1.0). Several secondary outcome measures showed changes consistent with more favorable outcomes in the CMI group at both Day 42 and Day 70, with a large effect size d > 0.80, including worst pain intensity over the last week, depressive symptomology, belief in pain as a sign of harm and perceived control over pain. Perceived stress improved to a greater extent in the control group (d = 1.16 at Day 42, d = .20 at Day 70). CONCLUSION CMI is feasible and acceptable to implement with people with SCI and chronic pain. Further study is warranted to assess potential benefits for pain-related outcomes.
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Affiliation(s)
- Jeanne M. Zanca
- Center for Spinal Cord Injury Research, Kessler Foundation, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Correspondence to: Jeanne M. Zanca, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ07052, USA.
| | - Christine Gilchrist
- Department of Integrative Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Caroline E. Ortiz
- Department of Integrative Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Trevor A. Dyson-Hudson
- Center for Spinal Cord Injury Research, Kessler Foundation, West Orange, New Jersey, USA
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4
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Spirituality in Primary Care Settings: Addressing the Whole Person through Christian Mindfulness. RELIGIONS 2022. [DOI: 10.3390/rel13040346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Spirituality is integral to the provision of high-quality health and mental healthcare. Despite this, there is limited research on how to assess and address spiritual determinants of health within primary care settings. Many individuals initiate care within primary care settings, and several will only receive care from their primary care provider. The high prevalence of individuals receiving care within primary care settings coupled with the positive impact spirituality has on health and mental health reveal the need to care for spiritual needs within primary care settings. Integrated care is a model of treatment that addresses the fragmentation of healthcare by assessing and addressing the psychosocial determinants of health within primary care settings. The structure of integrated care models is designed to treat the biological and psychosocial determinants of health and, as a result, provide suitable context for assessing and addressing spirituality in primary care settings. The purpose of this paper is to (1) summarize the efforts to integrate spirituality within primary care (whole person care models), (2) summarize the integrated care efforts to promote psychosocial integration, (3) highlight Christian mindfulness as a potential form of intervention to address spirituality within integrated care models, and (4) operationalize the delivery of Christian mindfulness within a fully integrated care model. The conclusions from the conceptual review include both practice innovation for the assessment and intervention of spirituality in integrated care as well as potential direction for future research to study Christian mindfulness within integrated care settings.
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5
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Santarnecchi E, Egiziano E, D'Arista S, Gardi C, Romanella SM, Mencarelli L, Rossi S, Reda M, Rossi A. Mindfulness-based stress reduction training modulates striatal and cerebellar connectivity. J Neurosci Res 2021; 99:1236-1252. [PMID: 33634892 DOI: 10.1002/jnr.24798] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023]
Abstract
Mindfulness is a meditation practice frequently associated with changes in subjective evaluation of cognitive and sensorial experience, as well as with modifications of brain activity and morphometry. Aside from the anatomical localization of functional changes induced by mindfulness practice, little is known about changes in functional and effective functional magnetic resonance imaging (fMRI) connectivity. Here we performed a connectivity fMRI analysis in a group of healthy individuals participating in an 8-week mindfulness-based stress reduction (MBSR) training program. Data from both a "mind-wandering" and a "meditation" state were acquired before and after the MBSR course. Results highlighted decreased local connectivity after training in the right anterior putamen and insula during spontaneous mind-wandering and the right cerebellum during the meditative state. A further effective connectivity analysis revealed (a) decreased modulation by the anterior cingulate cortex over the anterior portion of the putamen, and (b) a change in left and right posterior putamen excitatory input and inhibitory output with the cerebellum, respectively. Results suggest a rearrangement of dorsal striatum functional and effective connectivity in response to mindfulness practice, with changes in cortico-subcortical-cerebellar modulatory dynamics. Findings might be relevant for the understanding of widely documented mindfulness behavioral effects, especially those related to pain perception.
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Affiliation(s)
- Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eutizio Egiziano
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy
| | - Sicilia D'Arista
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy
| | - Concetta Gardi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Sara M Romanella
- Siena Brain Investigation and Neuromodulation Laboratory (SiBIN-Lab), Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
| | - Lucia Mencarelli
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Siena Brain Investigation and Neuromodulation Laboratory (SiBIN-Lab), Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
| | - Simone Rossi
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.,Siena Brain Investigation and Neuromodulation Laboratory (SiBIN-Lab), Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy.,Department of Medicine, Surgery and Neuroscience, Human Physiology Section, Siena Medical School, Siena, Italy
| | - Mario Reda
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy
| | - Alessandro Rossi
- Siena Brain Investigation and Neuromodulation Laboratory (SiBIN-Lab), Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
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Systematic scoping review of interactions between analgesic drug therapy and mindfulness-based interventions for chronic pain in adults: current evidence and future directions. Pain Rep 2020; 5:e868. [PMID: 33251471 PMCID: PMC7690768 DOI: 10.1097/pr9.0000000000000868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/29/2020] [Accepted: 09/22/2020] [Indexed: 01/17/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. None of the mindfulness-based clinical trials for chronic pain included in this review analyzed the interaction effects between mindfulness interventions and concomitant analgesic drug therapies. Most patients with chronic pain do not find adequate pain relief with a single treatment, and accumulating evidence points to the added benefits of rational combinations of different treatments. Given that psychological therapies, such as mindfulness-based interventions (MBIs), are often delivered in conjunction with concomitant analgesic drug therapies (CADTs), this systematic scoping review examines the evidence for any interactions between MBIs and CADTs. The protocol for this review has been published and registered. MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and PsycINFO databases were searched until July 2019. We included randomized controlled trials that evaluated the efficacy of MBIs for the treatment of chronic pain. A total of 40 randomized controlled trials (2978 participants) were included. Thirty-nine of 40 (97.5%) included mindfulness-based clinical trials allowed the use of CADTs. However, only 6 of these 39 (15.4%) trials provided adequate details of what these CADTs were, and only 4 (10.3%) trials controlled for CADTs. Of great relevance to this review, none of the included trials analyzed the interactions between MBIs and the CADTs to determine whether they have an additive, synergistic, or antagonistic effect on chronic pain. Adverse events were inconsistently reported, and no judgment could be made about safety. Future trials assessing the interactions between MBIs and CADTs, with better harms reporting, are needed to better define the role of MBIs in the management of chronic pain.
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Wolever RQ, Kane RJ, Hazelton AG, Bechard EM, Tucci DL. Integrative medicine for significant dysfunction from tinnitus: Treatment rationale and protocol for a randomized clinical pilot trial. ADVANCES IN INTEGRATIVE MEDICINE 2020. [DOI: 10.1016/j.aimed.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Simshäuser K, Lüking M, Kaube H, Schultz C, Schmidt S. Is Mindfulness-Based Stress Reduction a Promising and Feasible Intervention for Patients Suffering from Migraine? A Randomized Controlled Pilot Trial. Complement Med Res 2019; 27:19-30. [PMID: 31390617 DOI: 10.1159/000501425] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/07/2019] [Indexed: 11/19/2022]
Abstract
AIM We performed a pilot study in order to evaluate the feasibility and to estimate effect sizes of mindfulness-based stress reduction (MBSR) in a sample of patients suffering from migraine. METHOD Migraine patients (n = 62, mean age 44 years, 92% female) were randomly allocated to either MBSR or an active control intervention based on progressive muscle relaxation and psychoeducation. The primary outcome was the number of migraine days per month assessed by headache diaries covering one month before and one month after the intervention. Secondary outcomes included functional impairment, use of medication, psychological symptoms, quality of life, pain acceptance, pain self-efficacy, pain perception and self-attributed mindfulness. To measure feasibility, questionnaires assessing study compliance and contentment were administered. RESULTS The primary outcome migraine frequency showed no significant group difference. Compared to the control group, the MBSR group showed greater improvements in variables of psychological symptoms, pain self-efficacy and sensory pain perception. Within the MBSR condition, all variables showed significant improvements over the course span with effect sizes ranging from d = 0.37 to 0.81, apart from the primary outcome (27% reduction in migraine days, p = 0.07). Compliance and contentment rates were good, supporting the feasibility of the MBSR intervention. CONCLUSION Overall, participants in the MBSR group showed more adaptive coping strategies and decreased levels of psychological impairment compared to the control group, indicating a reduced impact of migraine on their everyday lives. It is concluded that this feasibility study demonstrates the ability of mindfulness-based interventions to reduce suffering in patients with migraine.
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Affiliation(s)
- Kathrin Simshäuser
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany.,Interdisciplinary Pain Center, Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany
| | - Marianne Lüking
- Interdisciplinary Pain Center, Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany.,Psychotherapy Practice, Freiburg, Germany
| | - Holger Kaube
- Interdisciplinary Pain Center, Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany.,Headache and Neurology Center, Munich, Germany
| | - Claudia Schultz
- University Center for Complementary Medicine, Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany.,General Practice B80, Gundelfingen, Germany
| | - Stefan Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany,
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9
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Hurstak E, Chao MT, Leonoudakis-Watts K, Pace J, Walcer B, Wismer B. Design, Implementation, and Evaluation of an Integrative Pain Management Program in a Primary Care Safety-Net Clinic. J Altern Complement Med 2019; 25:S78-S85. [PMID: 30870021 DOI: 10.1089/acm.2018.0398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To design, implement, and evaluate a comprehensive Integrative Pain Management Program (IPMP) for patients with chronic pain in a safety-net primary care clinic. DESIGN We used a quality improvement "Plan Do Study Act" (PDSA) framework to design, refine, and evaluate an integrative chronic pain program. SETTING An urban federally qualified health center located in a community with high rates of chronic pain, substance use, and opioid overdose. SUBJECTS Eligible participants included individuals with pain for greater than 3 months who were prescribed opioid therapy. OUTCOME MEASURES We designed IPMP using a PDSA framework that promotes continuous evaluation and adaptation of the program to meet the needs of the clinical system. We assessed feasibility and acceptability with program referrals and attendance and evaluated program satisfaction. RESULTS The IPMP delivered a 12-week group-based intervention that involved group support, education on pain etiology and treatments, movement-based interventions, mindfulness-based therapies, acupuncture, and massage therapy. One hundred forty-six patients were referred to IPMP; 58 individuals participated in one of the first three cohorts of the program. Sixty-two percent of participants attended at least half of the sessions. Staff and participants reported high levels of satisfaction with IPMP and demand for longitudinal services. CONCLUSIONS An IPMP delivered within a safety-net primary care clinic could be implemented in a way feasible and acceptable to staff and participants with the support of the local health care system. The application of a PDSA cycle allowed for rigorous implementation and evaluation of a multimodal pain program. Quality improvement frameworks are a strategy to improve and expand the delivery of high-quality patient-centered integrative pain treatments.
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Affiliation(s)
- Emily Hurstak
- 1 Division of General Internal Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California
| | - Maria T Chao
- 1 Division of General Internal Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California.,2 Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California
| | | | - Joseph Pace
- 3 San Francisco Department of Public Health, San Francisco, California
| | - Blue Walcer
- 3 San Francisco Department of Public Health, San Francisco, California
| | - Barbara Wismer
- 3 San Francisco Department of Public Health, San Francisco, California.,4 Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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10
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Jackson W, Zale EL, Berman SJ, Malacarne A, Lapidow A, Schatman ME, Kulich R, Vranceanu AM. Physical functioning and mindfulness skills training in chronic pain: a systematic review. J Pain Res 2019; 12:179-189. [PMID: 30655687 PMCID: PMC6322706 DOI: 10.2147/jpr.s172733] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The importance of improved physical function as a primary outcome in the treatment of chronic pain is widely accepted. There have been limited attempts to assess the effects mindfulness skills training (MST) has on objective outcomes in chronic pain care. METHODS This systematic review evaluated published reports of original randomized controlled trials that described physical function outcomes after MST in the chronic pain population and met methodological quality according to a list of predefined criteria. PRISMA criteria were used to identify and select studies, and assess their eligibility for inclusion. The established guidelines for best practice of systematic reviews were followed to report the results. RESULTS Of the 2,818 articles identified from the original search of four electronic databases, inclusionary criteria were met by 15 studies published as of August 10, 2015, totaling 1,199 patients. All included studies used self-report measures of physical function, and only two studies also employed performance-based measures of function. There were wide variations in how physical function was conceptualized and measured. Although the quality of the studies was rated as high, there was inconclusive evidence for improvement in physical function assessed by self-report due to contradiction in individual study findings and the measures used to assess function. Strong evidence for lack of improvement in physical function assessed via performance-based measures was found. CONCLUSION This review draws attention to the importance of having a unified approach to how physical function is conceptualized and assessed, as well as the importance of using quality performance-based measures in addition to subjective self-reports that appropriately assess the physical function construct within MSTs for chronic pain.
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Affiliation(s)
- William Jackson
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA,
| | - Emily L Zale
- Department of Psychiatry, Massachusetts General Hospital, Harvard School of Medicine, MA, USA
| | - Stanley J Berman
- Department of Clinical Health Psychology, William James College, MA, USA
| | - Alberto Malacarne
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA,
| | - Amy Lapidow
- Department of Health Sciences Library, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Michael E Schatman
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Research and Network Development, Boston PainCare, Waltham, MA, USA
| | - Ronald Kulich
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA,
- Department of Anesthesia, Massachusetts General Hospital, Harvard School of Medicine, MA, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Harvard School of Medicine, MA, USA
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11
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12
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Reddan MC, Wager TD. Brain systems at the intersection of chronic pain and self-regulation. Neurosci Lett 2018; 702:24-33. [PMID: 30503923 DOI: 10.1016/j.neulet.2018.11.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic pain is a multidimensional experience with cognitive, affective, and somatosensory components that can be modified by expectations and learning. Individual differences in cognitive and affective processing, as well as contextual aspects of the pain experience, render chronic pain an inherently personal experience. Such individual differences are supported by the heterogeneity of brain representations within and across chronic pain pathologies. In this review, we discuss the complexity of brain representations of pain, and, with respect to this complexity, identify common elements of network-level disruptions in chronic pain. Specifically, we identify prefrontal-limbic circuitry and the default mode network as key elements of functional disruption. We then discuss how these disrupted circuits can be targeted through self-regulation and related cognitive strategies to alleviate chronic pain. We conclude with a proposal for how to develop personalized multivariate models of pain representation in the brain and target them with real-time neurofeedback, so that patients can explore and practice self-regulatory techniques with maximal efficiency.
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Affiliation(s)
| | - Tor D Wager
- University of Colorado, Boulder, United States.
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Abstract
PURPOSE OF REVIEW Psychological factors are associated with chronic pain. Mindfulness meditation may ameliorate symptoms. The objective was to evaluate the effects of mindfulness meditation in chronic pain. RECENT FINDINGS A systematic search of four databases identified 534 citations; 13 Randomised controlled trials satisfied the inclusion criteria. Mindfulness meditation significantly reduced depression [Standardised mean difference (SMD) -0.28; 95% confidence interval (CI) -0.53, -0.03; P = 0.03; I = 0%]. For affective pain (SMD -0.13; 95% CI -0.42, 0.16; I = 0%), sensory pain (SMD -0.02; 95% CI -0.31, 0.27; I = 0%) and anxiety (SMD -0.16; 95% CI -0.47, 0.15; I = 0%) there was a trend towards benefit with intervention. Quality of life items on mental health (SMD 0.65; 95% CI -0.27, 1.58; I = 69%), physical health (SMD 0.08; 95% CI -0.40, 0.56; I = 32%) and overall score (SMD 0.86, 95% CI -0.06, 1.78; I = 88%) improved with mindfulness meditation. SUMMARY Mindfulness meditation has most prominent effect on psychological aspects on living with chronic pain, improving associated depression and quality of life.
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14
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Hess D. Mindfulness-Based Interventions for Hematology and Oncology Patients with Pain. Hematol Oncol Clin North Am 2018; 32:493-504. [PMID: 29729784 DOI: 10.1016/j.hoc.2018.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Pain is a reality for approximately half of all of patients with cancer and can negatively affect patient cognitive and emotional states, resulting in "total pain." Total pain may not respond to pharmacologic interventions and may pave the way for the onset of suffering, where suffering is defined as physical pain accompanied by negative cognitive interpretations. Mindfulness-based interventions provide an alternate interpretive framework for both pain and suffering and may lessen a patient's experience of pain. Mindfulness-based interventions have the potential to alter a patient's relationship to pain, reducing pain catastrophizing, and enhancing patient reported overall well-being.
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Affiliation(s)
- Denise Hess
- Supportive Care Coalition, Providence St. Joseph Health, 18530 Northwest Cornell Road, Suite 101, Hillsboro, OR 97124, USA.
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15
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Tavallaei V, Rezapour-Mirsaleh Y, Rezaiemaram P, Saadat SH. Mindfulness for female outpatients with chronic primary headaches: an internet-based bibliotherapy. Eur J Transl Myol 2018; 28:7380. [PMID: 29991985 PMCID: PMC6036307 DOI: 10.4081/ejtm.2018.7380] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 03/29/2018] [Indexed: 01/03/2023] Open
Abstract
Our aim was to investigate effectiveness of mindfulness by bibliotherapy on disability, distress, perceived pain and mindfulness in women with tension headaches and migraines. Primary headaches have been of great interest to mental health researchers because of the high prevalence, as well as significant disability and distress in the affected people. Despite the promising results of in-person treatment and some limitations that such interventions may cause, patients may be encountered with problems when using health care services. The present study is a quasi-experimental randomized design with pre-test, post-test, and control group. The study population consisted of 1396 women with migraine headache referring to headache clinic of Baqiyatallah Hospital in Tehran. Of these, 30 patients (including tboh experimental and control group) were selected by objective sampling method and were randomly assigned to the two groups. The experimental group, in addition to medical treatment as usual, was treated for a period of 8 sessions by Mindfulness-based Stress Reduction Internet-based Bibliotherapy, but the control group used only the medical treatment. The sample had no attritions. Data were collected by the four scales of (DASS-21), Migraine Disability Assessment Test (MIDAS), McGill's Short Form Questionnaire (MPQ-SF), and Mindfulness Inventory (MAAS). We used covariance analysis to analyze the findings in the measured scales. MBSR-IBB treatment had no significant effect on pain sensory dimension (P <0.44), despite improvement of mindfulness (P <0.0001). In contrast, the greatest effect was on the level of disability (P <0.0001). We observed also a significant improvement in distress (P <0.0001). In conclusion, in spite of the presence of headaches, the mindfulness improved the quality of life and reduced the level of mental distress. In addition, using the Internet-based bibliotherapy method, these services can be used with easier access, lower cost, and more flexibility.
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Affiliation(s)
- Vahid Tavallaei
- Counseling Department, Education & Psychology Faculty, Ardakan University, Ardakan, Iran
| | | | - Peyman Rezaiemaram
- Psychology Department, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Seyed Hassan Saadat
- Behavioral Science Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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16
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Ball E, Newton S, Kahan BC, Forbes G, Wright N, Cantalapiedra Calvete C, Gibson HAL, Rogozinska E, Rivas C, Taylor SJC, Birch J, Dodds J. Smartphone App Using Mindfulness Meditation for Women With Chronic Pelvic Pain (MEMPHIS): Protocol for a Randomized Feasibility Trial. JMIR Res Protoc 2018; 7:e8. [PMID: 29335232 PMCID: PMC5789162 DOI: 10.2196/resprot.7720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 08/26/2017] [Accepted: 09/27/2017] [Indexed: 11/23/2022] Open
Abstract
Background Female chronic pelvic pain (CPP) is defined as intermittent or constant pelvic or lower abdominal pain occurring in a woman for at least 6 months. Up to a quarter of women are estimated to be affected by CPP worldwide and it is responsible for one fifth of specialist gynecological referrals in the United Kingdom. Psychological interventions are commonly utilized. As waiting times and funding capacity impede access to face-to-face consultations, supported self-management (SSM) has emerged as a viable alternative. Mindfulness meditation is a potentially valuable SSM tool, and in the era of mobile technology, this can be delivered to the individual user via a smartphone app. Objective To assess the feasibility of conducting a trial of a mindfulness meditation intervention delivered by a mobile phone app for patients with CPP. The main feasibility objectives were to assess patient recruitment and app adherence, to obtain information to be used in the sample size estimate of a future trial, and to receive feedback on usability of the app. Methods Mindfulness Meditation for Women With Chronic Pelvic Pain (MEMPHIS) is a three-arm feasibility trial, that took place in two hospitals in the United Kingdom. Eligible participants were randomized in a 1:1:1 ratio to one of three treatment arms: (1) the intervention arm, consisting of a guided, spoken mindfulness meditation app; (2) an active control arm, consisting of a progressive muscle relaxation app; and (3) usual care (no app). Participants were followed-up for 6 months. Key feasibility outcomes included the time taken to recruit all patients for the study, adherence, and estimates to be used in the sample size calculation for a subsequent full-scale trial. Upon completion of the feasibility trial we will conduct focus groups to explore app usability and reasons for noncompliance. Results Recruitment for MEMPHIS took place between May 2016 and September 2016. The study was closed March 2017 and the report was submitted to the NIHR on October 26, 2017. Conclusions This feasibility trial will inform the design of a large multicentered trial to assess the clinical effectiveness of mindfulness meditation delivered via a smartphone app for the treatment of CPP. Trial Registration ClinicalTrials.gov: NCT02721108; https://clinicaltrials.gov/ct2/show/NCT02721108 (Archived by WebCite at http://www.webcitation.org/6wLMAkuaU); BioMed Central: ISRCTN10925965; https://www.isrctn.com/ISRCTN10925965 (Archived by WebCite at http://www.webcitation.org/6wLMVLuys)
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Affiliation(s)
- Elizabeth Ball
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, London, United Kingdom.,Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Sian Newton
- Centre for Primary Care and Population Health, Queen Mary University of London, London, United Kingdom
| | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Gordon Forbes
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Neil Wright
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom
| | | | - Harry A L Gibson
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, London, United Kingdom
| | - Ewelina Rogozinska
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Carol Rivas
- Social Science Research Unit, University College London, London, United Kingdom
| | - Stephanie J C Taylor
- Centre for Primary Care and Population Health, Queen Mary University of London, London, United Kingdom
| | - Judy Birch
- Pelvic Pain Support Network, Poole, United Kingdom
| | - Julie Dodds
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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17
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Ali A. Lyme Disease. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00023-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Hilton L, Hempel S, Ewing BA, Apaydin E, Xenakis L, Newberry S, Colaiaco B, Maher AR, Shanman RM, Sorbero ME, Maglione MA. Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Ann Behav Med 2017; 51:199-213. [PMID: 27658913 PMCID: PMC5368208 DOI: 10.1007/s12160-016-9844-2] [Citation(s) in RCA: 439] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic pain patients increasingly seek treatment through mindfulness meditation. PURPOSE This study aims to synthesize evidence on efficacy and safety of mindfulness meditation interventions for the treatment of chronic pain in adults. METHOD We conducted a systematic review on randomized controlled trials (RCTs) with meta-analyses using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the GRADE approach. Outcomes included pain, depression, quality of life, and analgesic use. RESULTS Thirty-eight RCTs met inclusion criteria; seven reported on safety. We found low-quality evidence that mindfulness meditation is associated with a small decrease in pain compared with all types of controls in 30 RCTs. Statistically significant effects were also found for depression symptoms and quality of life. CONCLUSIONS While mindfulness meditation improves pain and depression symptoms and quality of life, additional well-designed, rigorous, and large-scale RCTs are needed to decisively provide estimates of the efficacy of mindfulness meditation for chronic pain.
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Affiliation(s)
- Lara Hilton
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Susanne Hempel
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Brett A Ewing
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Eric Apaydin
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Lea Xenakis
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Sydne Newberry
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Ben Colaiaco
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Alicia Ruelaz Maher
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Roberta M Shanman
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Melony E Sorbero
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Margaret A Maglione
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
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Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis. Br J Gen Pract 2016; 65:e387-400. [PMID: 26009534 DOI: 10.3399/bjgp15x685297] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Chronic pain and its associated distress and disability are common reasons for seeking medical help. Patients with chronic pain use primary healthcare services five times more than the rest of the population. Mindfulness has become an increasingly popular self-management technique. AIM To assess the effectiveness of mindfulness-based interventions for patients with chronic pain. DESIGN AND SETTING Systematic review and meta-analysis including randomised controlled trials of mindfulness-based interventions for chronic pain. There was no restriction to study site or setting. METHOD The databases MEDLINE(®), Embase, AMED, CINAHL, PsycINFO, and Index to Theses were searched. Titles, abstracts, and full texts were screened iteratively against inclusion criteria of: randomised controlled trials of mindfulness-based intervention; patients with non-malignant chronic pain; and economic, clinical, or humanistic outcome reported. Included studies were assessed with the Yates Quality Rating Scale. Meta-analysis was conducted. RESULTS Eleven studies were included. Chronic pain conditions included: fibromyalgia, rheumatoid arthritis, chronic musculoskeletal pain, failed back surgery syndrome, and mixed aetiology. Papers were of mixed methodological quality. Main outcomes reported were pain intensity, depression, physical functioning, quality of life, pain acceptance, and mindfulness. Economic outcomes were rarely reported. Meta-analysis effect sizes for clinical outcomes ranged from 0.12 (95% confidence interval [CI] = -0.05 to 0.30) (depression) to 1.32 (95% CI = -1.19 to 3.82) (sleep quality), and for humanistic outcomes 0.03 (95% CI = -0.66 to 0.72) (mindfulness) to 1.58 (95% CI = -0.57 to 3.74) (pain acceptance). Studies with active, compared with inactive, control groups showed smaller effects. CONCLUSION There is limited evidence for effectiveness of mindfulness-based interventions for patients with chronic pain. Better-quality studies are required.
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Owens JE, Schorling J, Plews-Ogan M, Goodman M, Moorman R, Zaklin R, Dent J. A randomized controlled trial evaluating Mindfulness-Based Stress Reduction (MBSR) for the treatment of palpitations: A pilot study. Int J Cardiol 2016; 223:25-27. [PMID: 27529583 DOI: 10.1016/j.ijcard.2016.08.183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Justine E Owens
- Division of General, Geriatrics, Palliative Care and Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, United States.
| | - John Schorling
- Division of General, Geriatrics, Palliative Care and Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, United States
| | - Margaret Plews-Ogan
- Division of General, Geriatrics, Palliative Care and Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, United States
| | - Matthew Goodman
- Division of General, Geriatrics, Palliative Care and Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, United States
| | - Randall Moorman
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, United States
| | - Ryan Zaklin
- North Shore Medical Center, Boston, MA, United States; UVA School of Medicine, United States
| | - John Dent
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, United States
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Crawford C, Boyd C, Paat CF, Price A, Xenakis L, Yang E, Zhang W. The Impact of Massage Therapy on Function in Pain Populations-A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population. PAIN MEDICINE (MALDEN, MASS.) 2016; 17:1353-1375. [PMID: 27165971 PMCID: PMC4925170 DOI: 10.1093/pm/pnw099] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life outcomes across all pain populations. METHODS Key databases were searched from inception through February 2014. Eligible randomized controlled trials were assessed for methodological quality using SIGN 50 Checklist. Meta-analysis was applied at the outcome level. A diverse steering committee interpreted the results to develop recommendations. RESULTS Sixty high quality and seven low quality studies were included in the review. Results demonstrate massage therapy effectively treats pain compared to sham [standardized mean difference (SMD) = -.44], no treatment (SMD = -1.14), and active (SMD = -0.26) comparators. Compared to active comparators, massage therapy was also beneficial for treating anxiety (SMD = -0.57) and health-related quality of life (SMD = 0.14). CONCLUSION Based on the evidence, massage therapy, compared to no treatment, should be strongly recommended as a pain management option. Massage therapy is weakly recommended for reducing pain, compared to other sham or active comparators, and improving mood and health-related quality of life, compared to other active comparators. Massage therapy safety, research challenges, how to address identified research gaps, and necessary next steps for implementing massage therapy as a viable pain management option are discussed.
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Crowe M, Jordan J, Burrell B, Jones V, Gillon D, Harris S. Mindfulness-based stress reduction for long-term physical conditions: A systematic review. Aust N Z J Psychiatry 2016; 50:21-32. [PMID: 26419491 DOI: 10.1177/0004867415607984] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To identify whether mindfulness-based stress reduction is effective in improving physical health outcomes for long-term physical conditions. METHOD A systematic review of the literature (retrieved from MEDLINE, PubMed and PsycINFO). RESULTS Fifteen studies were included in the review. None of the studies assessed as having a low risk of bias demonstrated significant improvements in physical health status although there was some emerging evidence that mindfulness-based stress reduction may be useful in pain conditions. There was some preliminary evidence that it may also be effective in improving primary insomnia and irritable bowel syndrome. Small to moderate effect sizes were also found for asthma, pain, tinnitus, fibromyalgia and somatization disorders. CONCLUSION Although there is some preliminary support for the use of mindfulness-based stress reduction in physical health conditions, further research is required before it could be considered an effective intervention for improving physical health outcomes.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand Centre for Postgraduate Nursing, University of Otago-Christchurch, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand Centre for Postgraduate Nursing, University of Otago-Christchurch, Christchurch, New Zealand
| | - Beverley Burrell
- Centre for Postgraduate Nursing, University of Otago-Christchurch, Christchurch, New Zealand
| | - Virginia Jones
- Centre for Postgraduate Nursing, University of Otago-Christchurch, Christchurch, New Zealand
| | - Deborah Gillon
- Centre for Postgraduate Nursing, University of Otago-Christchurch, Christchurch, New Zealand
| | - Shirley Harris
- Centre for Postgraduate Nursing, University of Otago-Christchurch, Christchurch, New Zealand
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Abstract
This article reviews the existing, peer-reviewed evidence for the use of relaxation and mindfulness in both acute and chronic pain.There is some evidence that relaxation can reduce pain outcomes in both acute and chronic pain, however there is evidence that these improvements are not maintained over time.More limited research suggests that mindfulness can lead to improvements in psychological measures and physical functioning and these improvements appear to be maintained at follow-up.Further research is needed. Both researchers and practitioners need to be clearer on the outcomes that their techniques best facilitate and the processes which are active within them.
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Demarzo MMP, Montero-Marin J, Cuijpers P, Zabaleta-del-Olmo E, Mahtani KR, Vellinga A, Vicens C, López-del-Hoyo Y, García-Campayo J. The Efficacy of Mindfulness-Based Interventions in Primary Care: A Meta-Analytic Review. Ann Fam Med 2015; 13:573-82. [PMID: 26553897 PMCID: PMC4639383 DOI: 10.1370/afm.1863] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Positive effects have been reported after mindfulness-based interventions (MBIs) in diverse clinical and nonclinical populations. Primary care is a key health care setting for addressing common chronic conditions, and an effective MBI designed for this setting could benefit countless people worldwide. Meta-analyses of MBIs have become popular, but little is known about their efficacy in primary care. Our aim was to investigate the application and efficacy of MBIs that address primary care patients. METHODS We performed a meta-analytic review of randomized controlled trials addressing the effect of MBIs in adult patients recruited from primary care settings. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines were followed. Effect sizes were calculated with the Hedges g in random effects models. RESULTS The meta-analyses were based on 6 trials having a total of 553 patients. The overall effect size of MBI compared with a control condition for improving general health was moderate (g = 0.48; P = .002), with moderate heterogeneity (I(2) = 59; P <.05). We found no indication of publication bias in the overall estimates. MBIs were efficacious for improving mental health (g = 0.56; P = .007), with a high heterogeneity (I(2) = 78; P <.01), and for improving quality of life (g = 0.29; P = .002), with a low heterogeneity (I(2) = 0; P >.05). CONCLUSIONS Although the number of randomized controlled trials applying MBIs in primary care is still limited, our results suggest that these interventions are promising for the mental health and quality of life of primary care patients. We discuss innovative approaches for implementing MBIs, such as complex intervention and stepped care.
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Affiliation(s)
- Marcelo M P Demarzo
- Federal University of Sao Paulo (UNIFESP), "Mente Aberta" - Brazilian Center for Mindfulness and Health Promotion, Department of Preventive Medicine, Sao Paulo, Brazil
| | - Jesús Montero-Marin
- Faculty of Health Sciences and Sports, University of Zaragoza, Huesca, Spain
| | - Pim Cuijpers
- VU University Amsterdam, Department of Psychology, Amsterdam, Netherlands
| | | | - Kamal R Mahtani
- Oxford University, Department of Primary Care, Oxford, United Kingdom
| | - Akke Vellinga
- National University of Ireland, Galway, Department of Primary Care, Galway, Ireland
| | - Caterina Vicens
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), Primary Care, Palma de Mallorca, Spain
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Abstract
Mindfulness-based interventions (MBIs) are at a pivotal point in their future development. Spurred on by an ever-increasing number of studies and breadth of clinical application, the value of such approaches may appear self-evident. We contend, however, that the public health impact of MBIs can be enhanced significantly by situating this work in a broader framework of clinical psychological science. Utilizing the National Institutes of Health stage model (Onken, Carroll, Shoham, Cuthbert, & Riddle, 2014), we map the evidence base for mindfulness-based cognitive therapy and mindfulness-based stress reduction as exemplars of MBIs. From this perspective, we suggest that important gaps in the current evidence base become apparent and, furthermore, that generating more of the same types of studies without addressing such gaps will limit the relevance and reach of these interventions. We offer a set of 7 recommendations that promote an integrated approach to core research questions, enhanced methodological quality of individual studies, and increased logical links among stages of clinical translation in order to increase the potential of MBIs to impact positively the mental health needs of individuals and communities.
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Affiliation(s)
- Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Zindel V Segal
- Department of Psychology, University of Toronto Scarborough
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Wolever RQ, Price R, Hazelton AG, Dmitrieva NO, Bechard EM, Shaffer JK, Tucci DL. Complementary Therapies for Significant Dysfunction from Tinnitus: Treatment Review and Potential for Integrative Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:931418. [PMID: 26457113 PMCID: PMC4592735 DOI: 10.1155/2015/931418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/31/2015] [Accepted: 09/02/2015] [Indexed: 11/18/2022]
Abstract
Tinnitus is a prevalent and costly chronic condition; no universally effective treatment exists. Only 20% of patients who report tinnitus actually seek treatment, and when treated, most patients commonly receive sound-based and educational (SBE) therapy. Additional treatment options are necessary, however, for nonauditory aspects of tinnitus (e.g., anxiety, depression, and significant interference with daily life) and when SBE therapy is inefficacious or inappropriate. This paper provides a comprehensive review of (1) conventional tinnitus treatments and (2) promising complementary therapies that have demonstrated some benefit for severe dysfunction from tinnitus. While there has been no systematic study of the benefits of an Integrative Medicine approach for severe tinnitus, the current paper reviews emerging evidence suggesting that synergistic combinations of complementary therapies provided within a whole-person framework may augment SBE therapy and empower patients to exert control over their tinnitus symptoms without the use of medications, expensive devices, or extended programs.
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Affiliation(s)
- Ruth Q. Wolever
- Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Schools of Medicine and Nursing, 3401 West End, Suite 380, Nashville, TN 37203, USA
- Duke Integrative Medicine and Duke Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 102904, Durham, NC 27710, USA
| | - Rebecca Price
- Department of Speech Pathology & Audiology, Duke University Health Systems, DUMC 3887, Durham, NC 27710, USA
| | - A. Garrett Hazelton
- Department of Psychiatry and Behavioral Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA
| | - Natalia O. Dmitrieva
- Department of Psychological Sciences, Northern Arizona University, P.O. Box 15106, Flagstaff, AZ 86011, USA
| | | | | | - Debara L. Tucci
- Division of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, DUMC 3085, Durham, NC 27710, USA
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Banth S, Ardebil MD. Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain. Int J Yoga 2015; 8:128-33. [PMID: 26170592 PMCID: PMC4479890 DOI: 10.4103/0973-6131.158476] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIM Recovery of patients with chronic low back pain (LBP) is depended on several physical and psychological factors. Therefore, the authors aimed to examine the efficacy of mindfulness based stress reduction (MBSR) as a mind-body intervention on quality of life and pain severity of female patients with nonspecific chronic LBP (NSCLBP). METHODS Eighty-eight patients diagnosed as NSCLBP by physician and randomly assigned to experimental (MBSR+ usual medical care) and the control group (usual medical care only). The subjects assessed in 3 times frames; before, after and 4 weeks after intervention by Mac Gil pain and standard brief quality of life scales. Data obtained from the final sample analyzed by ANCOVA using SPSS software. RESULTS The findings showed MBSR was effective in reduction of pain severity and the patients who practiced 8 sessions meditation reported significantly lower pain than patients who only received usual medical care. There was a significant effect of the between subject factor group (F [1, 45] = 16.45, P < 0.001) and (F [1, 45] = 21.51, P < 0.001) for physical quality of life and (F [1, 45] = 13.80, P < 0.001) and (F [1, 45] = 25.07, P < 0.001) mental quality of life respectively. CONCLUSION MBSR as a mind-body therapy including body scan, sitting and walking meditation was effective intervention on reduction of pain severity and improvement of physical and mental quality of life of female patients with NSCLBP.
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Affiliation(s)
- Sudha Banth
- Department of Psychology, Panjanb University, Chandigarh, India
| | - Maryam Didehdar Ardebil
- Member Young Researchers and Elite Club, Ardabil Branch, Islamic Azad University, Ardebil, Iran
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Juberg M, Jerger KK, Allen KD, Dmitrieva NO, Keever T, Perlman AI. Pilot study of massage in veterans with knee osteoarthritis. J Altern Complement Med 2015; 21:333-8. [PMID: 25966332 DOI: 10.1089/acm.2014.0254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To (1) assess the feasibility and acceptability of Swedish massage among Department of Veterans Affairs (VA) health care users with knee osteoarthritis (OA) and (2) collect preliminary data on efficacy of Swedish massage in this patient group. DESIGN Experimental pilot study. SETTING Duke Integrative Medicine clinic and VA Medical Center, Durham, North Carolina. PATIENTS Twenty-five veterans with symptomatic knee OA. INTERVENTIONS Eight weekly 1-hour sessions of full-body Swedish massage. OUTCOME MEASURES Primary: Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and global pain (Visual Analog Scale [VAS]). Secondary: National Institutes of Health Patient Reported Outcomes Measurement Information System-Pain Interference Questionnaire 6b (PROMIS-PI 6b), 12-Item Short-Form Health Survey (SF-12 v1) and the EuroQol health status index (EQ-5D-5L), knee range of motion (ROM), and time to walk 50 feet. RESULTS Study feasibility was established by a 92% retention rate with 99% of massage visits and 100% of research visits completed. Results showed significant improvements in self-reported OA-related pain, stiffness and function (30% improvement in Global WOMAC scores; p=0.001) and knee pain over the past 7 days (36% improvement in VAS score; p<0.001). PROMIS-PI, EQ-5D-5L, and physical composite score of the SF-12 also significantly improved (p<0.01 for all), while the mental composite score of the SF-12 and knee ROM showed trends toward significant improvement. Time to walk 50 feet did not significantly improve. CONCLUSIONS Results of this pilot study support the feasibility and acceptability of Swedish massage among VA health care users as well as preliminary data suggesting its efficacy for reducing pain due to knee OA. If results are confirmed in a larger randomized trial, massage could be an important component of regular care for these patients.
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Affiliation(s)
- Michael Juberg
- 1Duke Integrative Medicine, Duke University Medical Center, Durham, NC
| | - Kristin K Jerger
- 1Duke Integrative Medicine, Duke University Medical Center, Durham, NC
| | - Kelli D Allen
- 2Department of Medicine, Division of Rheumatology, and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.,3Health Services Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC
| | - Natalia O Dmitrieva
- 4Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Teresa Keever
- 1Duke Integrative Medicine, Duke University Medical Center, Durham, NC
| | - Adam I Perlman
- 1Duke Integrative Medicine, Duke University Medical Center, Durham, NC
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Abstract
The rapidly growing body of research regarding the use of meditation interventions in chronic disease presents an opportunity to compare outcomes based on intervention content. For this review, meditation interventions were described as those interventions delivered to persons with chronic disease where sitting meditation was the main or only content of the intervention with or without the addition of mindful movement. This systematic review identified 45 individual research studies that examined meditations effect on levels of anxiety, depression, and chronic disease symptoms in persons with chronic disease. Individual studies were assessed based on interventional content, the consistency with which interventions were applied, and the research quality. This study identified seven categories of meditation interventions based on the meditation skills and mindful movement practices that were included in the intervention. Overall, half of the interventions had clearly defined and specific meditation interventions (25/45) and half of the studies were conducted using randomized control trials (24/45).
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Victorson D, Kentor M, Maletich C, Lawton RC, Kaufman VH, Borrero M, Languido L, Lewett K, Pancoe H, Berkowitz C. Mindfulness Meditation to Promote Wellness and Manage Chronic Disease. Am J Lifestyle Med 2014. [DOI: 10.1177/1559827614537789] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Lifestyle medicine is a patient-engaged field that has grown in tandem with our increasing knowledge of the importance of lifestyle factors and modifiable health behaviors for disease prevention, health promotion, and the management of chronic illness. Stress is at the epicenter of many negative behaviors that contribute to unhealthy lives, such as smoking, overeating, and unhealthy diets, and lack of activity. Mindfulness meditation is a stress reduction practice that teaches awareness, appreciation, and nonjudgmental acceptance of one’s present experience, thereby short-circuiting reactive, automatic stress reactions. Our systematic review and meta-analysis focuses on the application of randomized controlled mindfulness intervention studies across a broad range of populations and conditions that are relevant to lifestyle medicine. In addition to organizing and highlighting mindfulness research studies that are relevant to the field of lifestyle medicine, we also empirically examine the impact of study design issues (eg, use of different controls, intervention length and duration, sample size, primary outcomes) on the magnitude of effect of mindfulness interventions in lifestyle medicine. Overall, this systematic review and meta-analysis found partial evidence for mindfulness-based interventions to provide short-term benefits across a wide range of lifestyle medicine–relevant populations and study outcomes, particularly focusing on the areas of diet and weight management and symptom burden. Numerous outcome measures were used; however, the most common were the Perceived Stress Scale and the State Trait Anxiety Inventory. This analysis also provides evidence for mindfulness-based interventions that have fewer than 20 individuals per group, as well as partial support for interventions that are less than the standard 8 weeks in duration.
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Affiliation(s)
- David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (DV, MK, CM, RCL, VHK, MB, LL, KL, HP, CB)
- Osher Center for Integrative Medicine, Northwestern Medical Group, Chicago, Illinois (DV, CB)
| | - Mitchell Kentor
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (DV, MK, CM, RCL, VHK, MB, LL, KL, HP, CB)
- Osher Center for Integrative Medicine, Northwestern Medical Group, Chicago, Illinois (DV, CB)
| | - Carly Maletich
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (DV, MK, CM, RCL, VHK, MB, LL, KL, HP, CB)
- Osher Center for Integrative Medicine, Northwestern Medical Group, Chicago, Illinois (DV, CB)
| | - Rachel C. Lawton
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (DV, MK, CM, RCL, VHK, MB, LL, KL, HP, CB)
- Osher Center for Integrative Medicine, Northwestern Medical Group, Chicago, Illinois (DV, CB)
| | - Vered Hankin Kaufman
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (DV, MK, CM, RCL, VHK, MB, LL, KL, HP, CB)
- Osher Center for Integrative Medicine, Northwestern Medical Group, Chicago, Illinois (DV, CB)
| | - Maria Borrero
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (DV, MK, CM, RCL, VHK, MB, LL, KL, HP, CB)
- Osher Center for Integrative Medicine, Northwestern Medical Group, Chicago, Illinois (DV, CB)
| | - Lauren Languido
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (DV, MK, CM, RCL, VHK, MB, LL, KL, HP, CB)
- Osher Center for Integrative Medicine, Northwestern Medical Group, Chicago, Illinois (DV, CB)
| | - Katherine Lewett
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (DV, MK, CM, RCL, VHK, MB, LL, KL, HP, CB)
- Osher Center for Integrative Medicine, Northwestern Medical Group, Chicago, Illinois (DV, CB)
| | - Hannah Pancoe
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (DV, MK, CM, RCL, VHK, MB, LL, KL, HP, CB)
- Osher Center for Integrative Medicine, Northwestern Medical Group, Chicago, Illinois (DV, CB)
| | - Carla Berkowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (DV, MK, CM, RCL, VHK, MB, LL, KL, HP, CB)
- Osher Center for Integrative Medicine, Northwestern Medical Group, Chicago, Illinois (DV, CB)
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Cherkin DC, Sherman KJ, Balderson BH, Turner JA, Cook AJ, Stoelb B, Herman PM, Deyo RA, Hawkes RJ. Comparison of complementary and alternative medicine with conventional mind-body therapies for chronic back pain: protocol for the Mind-body Approaches to Pain (MAP) randomized controlled trial. Trials 2014; 15:211. [PMID: 24906419 PMCID: PMC4052284 DOI: 10.1186/1745-6215-15-211] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 05/07/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The self-reported health and functional status of persons with back pain in the United States have declined in recent years, despite greatly increased medical expenditures due to this problem. Although patient psychosocial factors such as pain-related beliefs, thoughts and coping behaviors have been demonstrated to affect how well patients respond to treatments for back pain, few patients receive treatments that address these factors. Cognitive-behavioral therapy (CBT), which addresses psychosocial factors, has been found to be effective for back pain, but access to qualified therapists is limited. Another treatment option with potential for addressing psychosocial issues, mindfulness-based stress reduction (MBSR), is increasingly available. MBSR has been found to be helpful for various mental and physical conditions, but it has not been well-studied for application with chronic back pain patients. In this trial, we will seek to determine whether MBSR is an effective and cost-effective treatment option for persons with chronic back pain, compare its effectiveness and cost-effectiveness compared with CBT and explore the psychosocial variables that may mediate the effects of MBSR and CBT on patient outcomes. METHODS/DESIGN In this trial, we will randomize 397 adults with nonspecific chronic back pain to CBT, MBSR or usual care arms (99 per group). Both interventions will consist of eight weekly 2-hour group sessions supplemented by home practice. The MBSR protocol also includes an optional 6-hour retreat. Interviewers masked to treatment assignments will assess outcomes 5, 10, 26 and 52 weeks postrandomization. The primary outcomes will be pain-related functional limitations (based on the Roland Disability Questionnaire) and symptom bothersomeness (rated on a 0 to 10 numerical rating scale) at 26 weeks. DISCUSSION If MBSR is found to be an effective and cost-effective treatment option for patients with chronic back pain, it will become a valuable addition to the limited treatment options available to patients with significant psychosocial contributors to their pain. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01467843.
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Affiliation(s)
- Daniel C Cherkin
- Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA.
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Sturgeon JA. Psychological therapies for the management of chronic pain. Psychol Res Behav Manag 2014; 7:115-24. [PMID: 24748826 PMCID: PMC3986332 DOI: 10.2147/prbm.s44762] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. However, psychological therapies for chronic pain differ in their scope, duration, and goals, and thus show distinct patterns of treatment efficacy. These therapies fall into four categories: operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. The current article explores the theoretical distinctiveness, therapeutic targets, and effectiveness of these approaches as well as mechanisms and individual differences that factor into treatment response and pain-related dysfunction and distress. Implications for future research, dissemination of treatment, and the integration of psychological principles with other treatment modalities are also discussed.
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Affiliation(s)
- John A Sturgeon
- Department of Anesthesiology, Stanford University, Palo Alto, CA, USA
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Lee C, Crawford C, Hickey A. Mind–Body Therapies for the Self-Management of Chronic Pain Symptoms. PAIN MEDICINE 2014; 15 Suppl 1:S21-39. [DOI: 10.1111/pme.12383] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Goyal M, Singh S, Sibinga EMS, Gould NF, Rowland-Seymour A, Sharma R, Berger Z, Sleicher D, Maron DD, Shihab HM, Ranasinghe PD, Linn S, Saha S, Bass EB, Haythornthwaite JA. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med 2014; 174:357-68. [PMID: 24395196 PMCID: PMC4142584 DOI: 10.1001/jamainternmed.2013.13018] [Citation(s) in RCA: 1034] [Impact Index Per Article: 103.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation. OBJECTIVE To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health-related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations. EVIDENCE REVIEW We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. FINDINGS After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health-related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies). CONCLUSIONS AND RELEVANCE Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.
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Affiliation(s)
- Madhav Goyal
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Sonal Singh
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Erica M S Sibinga
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Neda F Gould
- Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland
| | | | - Ritu Sharma
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Zackary Berger
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Dana Sleicher
- Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland
| | - David D Maron
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Hasan M Shihab
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | - Shauna Linn
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Shonali Saha
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Eric B Bass
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland4Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
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Rajguru P, Kolber MJ, Garcia AN, Smith MT, Patel CK, Hanney WJ. Use of Mindfulness Meditation in the Management of Chronic Pain. Am J Lifestyle Med 2014. [DOI: 10.1177/1559827614522580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Chronic pain is a major health condition that has significant financial and lifestyle implications. Due to the complex etiologies of pain, it is difficult to find treatment modalities that would be universally applicable to the general population presenting for care. Mindfulness meditation is a complimentary treatment modality that has some preliminary, inconclusive evidence in support of its benefit on patients with chronic pain. Objectives. The purpose of this article is to systematically review the current literature for randomized controlled trials that assess the outcomes of mindfulness as an intervention for individuals with chronic pain. Methods. An electronic database search was performed for studies investigating the efficacy of mindfulness in treatment for chronic pain. The studies included were randomized controlled trials, published in English, from a peer-reviewed journal that identified mindfulness as the primary treatment focus for chronic pain in at least one group, and included participants with at least a 12-week history of symptoms. Results. The database search revealed 283 articles, of which 6 met the inclusion criteria. Conclusion. Mindfulness meditation appears to have minimal or statistically insignificant effects on chronic pain according to the current data. However, the effects of mindfulness on mental health scores are significant and may be an area for future trials to target. Well-conducted research is necessary before the effects of mindfulness on chronic pain can be definitively determined.
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Affiliation(s)
- Parth Rajguru
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - Morey J. Kolber
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - Ashley N. Garcia
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - Matthew T. Smith
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - Chetan K. Patel
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - William J. Hanney
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
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Esch T. The Neurobiology of Meditation and Mindfulness. MEDITATION – NEUROSCIENTIFIC APPROACHES AND PHILOSOPHICAL IMPLICATIONS 2014. [DOI: 10.1007/978-3-319-01634-4_9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Lauche R, Cramer H, Dobos G, Langhorst J, Schmidt S. A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome. J Psychosom Res 2013; 75:500-10. [PMID: 24290038 DOI: 10.1016/j.jpsychores.2013.10.010] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 10/14/2013] [Accepted: 10/17/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This paper presents a systematic review and meta-analysis of the effectiveness of mindfulness-based stress reduction (MBSR) for FMS. METHODS The PubMed/MEDLINE, Cochrane Library, EMBASE, PsychINFO and CAMBASE databases were screened in September 2013 to identify randomized and non-randomized controlled trials comparing MBSR to control interventions. Major outcome measures were quality of life and pain; secondary outcomes included sleep quality, fatigue, depression and safety. Standardized mean differences and 95% confidence intervals were calculated. RESULTS Six trials were located with a total of 674 FMS patients. Analyses revealed low quality evidence for short-term improvement of quality of life (SMD=-0.35; 95% CI -0.57 to -0.12; P=0.002) and pain (SMD=-0.23; 95% CI -0.46 to -0.01; P=0.04) after MBSR, when compared to usual care; and for short-term improvement of quality of life (SMD=-0.32; 95% CI -0.59 to -0.04; P=0.02) and pain (SMD=-0.44; 95% CI -0.73 to -0.16; P=0.002) after MBSR, when compared to active control interventions. Effects were not robust against bias. No evidence was further found for secondary outcomes or long-term effects of MBSR. Safety data were not reported in any trial. CONCLUSIONS This systematic review found that MBSR might be a useful approach for FMS patients. According to the quality of evidence only a weak recommendation for MBSR can be made at this point. Further high quality RCTs are required for a conclusive judgment of its effects.
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Affiliation(s)
- Romy Lauche
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
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Kenne Sarenmalm E, Mårtensson LB, Holmberg SB, Andersson BA, Odén A, Bergh I. Mindfulness based stress reduction study design of a longitudinal randomized controlled complementary intervention in women with breast cancer. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:248. [PMID: 24088535 PMCID: PMC3850932 DOI: 10.1186/1472-6882-13-248] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 09/10/2013] [Indexed: 11/10/2022]
Abstract
Background The stress of a breast cancer diagnosis and its treatment can produce a variety of psychosocial sequelae including impaired immune responses. Mindfulness Based Stress Reduction (MBSR) is a structured complementary program that incorporates meditation, yoga and mind-body exercises. Despite promising empirical evidence for the efficacy of MBSR, there is a need for randomized controlled trials (RCT). There is also a need for RCTs investigating the efficacy of psychosocial interventions on mood disorder and immune response in women with breast cancer. Therefore, the overall aim is to determine the efficacy of a Mindfulness Based Stress Reduction (MBSR) intervention on well-being and immune response in women with breast cancer. Methods and design In this RCT, patients diagnosed with breast cancer, will consecutively be recruited to participate. Participants will be randomized into one of three groups: MBSR Intervention I (weekly group sessions + self-instructing program), MBSR Intervention II (self-instructing program), and Controls (non-MBSR). Data will be collected before start of intervention, and 3, 6, and 12 months and thereafter yearly up to 5 years. This study may contribute to evidence-based knowledge concerning the efficacy of MBSR to support patient empowerment to regain health in breast cancer disease. Discussion The present study may contribute to evidence-based knowledge concerning the efficacy of mindfulness training to support patient empowerment to regain health in a breast cancer disease. If MBSR is effective for symptom relief and quality of life, the method will have significant clinical relevance that may generate standard of care for patients with breast cancer. Trial registration ClinicalTrials.gov: NCT01591915
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Pike AJ. Body-mindfulness in physiotherapy for the management of long-term chronic pain. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328808x251957] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Brief Mindfulness-Based Therapy for Chronic Tension-Type Headache: A Randomized Controlled Pilot Study. Behav Cogn Psychother 2013; 42:1-15. [DOI: 10.1017/s1352465813000234] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Mindfulness-based therapy (MBT) has been demonstrated to be effective for reducing chronic pain symptoms; however, the use of MBT for Chronic Tension-Type Headache (CTH) exclusively has to date not been examined. Typically, MBT for chronic pain has involved an 8-week program based on Mindfulness Based Stress Reduction. Recent research suggests briefer mindfulness-based treatments may be effective for chronic pain. Aims: To conduct a pilot study into the efficacy of brief MBT for CTH. Method: We conducted a randomized controlled trial of a brief (6-session, 3-week) MBT for CTH. Results: Results indicated a significant decrease in headache frequency and an increase in the mindfulness facet of Observe in the treatment but not wait-list control group. Conclusion: Brief MBT may be an effective intervention for CTH.
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Reiner K, Tibi L, Lipsitz JD. Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. PAIN MEDICINE 2012; 14:230-42. [PMID: 23240921 DOI: 10.1111/pme.12006] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mindfulness-based interventions (MBIs) emphasizing a nonjudgmental attitude toward present moment experience are widely used for chronic pain patients. Although changing or controlling pain is not an explicit aim of MBIs, recent experimental studies suggest that mindfulness practice may lead to changes in pain tolerance and pain intensity ratings. OBJECTIVE The objective of this review is to investigate the specific effect of MBIs on pain intensity. METHODS A literature search was conducted using the databases PUBMED and PsycINFO for relevant articles published from 1960 to December 2010. We additionally conducted a manual search of references from the retrieved articles. Only studies providing detailed results on change in pain intensity ratings were included. RESULTS Sixteen studies were included in this review (eight uncontrolled and eight controlled trials). In most studies (10 of 16), there was significantly decreased pain intensity in the MBI group. Findings were more consistently positive for samples limited to clinical pain (9 of 11). In addition, most controlled trials (6 of 8) reveal higher reductions in pain intensity for MBIs compared with control groups. Results from follow-up assessments reveal that reductions in pain intensity were generally well maintained. CONCLUSIONS Findings suggest that MBIs decrease the intensity of pain for chronic pain patients. We discuss implications for understanding mechanisms of change in MBIs.
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Affiliation(s)
- Keren Reiner
- Department of Psychology, Ben Gurion University of the Negev, Beer Sheva, Israel
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Carlson LE. Mindfulness-based interventions for physical conditions: a narrative review evaluating levels of evidence. ISRN PSYCHIATRY 2012; 2012:651583. [PMID: 23762768 PMCID: PMC3671698 DOI: 10.5402/2012/651583] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 09/19/2012] [Indexed: 12/13/2022]
Abstract
Research on mindfulness-based interventions (MBIs) for treating symptoms of a wide range of medical conditions has proliferated in recent decades. Mindfulness is the cultivation of nonjudgmental awareness in the present moment. It is both a practice and a way of being in the world. Mindfulness is purposefully cultivated in a range of structured interventions, the most popular of which is mindfulness-based stress reduction (MBSR), followed by mindfulness-based cognitive therapy (MBCT). This paper begins with a discussion of the phenomenological experience of coping with a chronic and potentially life-threatening illness, followed by a theoretical discussion of the application of mindfulness in these situations. The literature evaluating MBIs within medical conditions is then comprehensively reviewed, applying a levels of evidence rating framework within each major condition. The bulk of the research looked at diagnoses of cancer, pain conditions (chronic pain, low back pain, fibromyalgia, and rheumatoid arthritis), cardiovascular disease, diabetes, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and irritable bowel syndrome. Most outcomes assessed are psychological in nature and show substantial benefit, although some physical and disease-related parameters have also been evaluated. The field would benefit from more adequately powered randomized controlled trials utilizing active comparison groups and assessing the moderating role of patient characteristics and program "dose" in determining outcomes.
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Affiliation(s)
- Linda E. Carlson
- Division of Psychosocial Oncology, Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada T2N 4N2
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services Cancer Care, Calgary, AB, Canada T2S 3C1
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Mindfulness and psychosocial care in cancer: historical context and review of current and potential applications. Palliat Support Care 2012; 10:287-94. [PMID: 22612897 DOI: 10.1017/s1478951511001015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mindfulness-based interventions and mindfulness techniques have become increasingly popular in psychosocial care. These interventions have also been increasingly used with cancer patients and survivors. However, more attention is due to issues such as how these techniques may be specifically relevant for an oncology population and whether the religious derivation of mindfulness should be considered by frontline psychosocial clinicians. This article provides a history and overview of the use of mindfulness in psychosocial cancer care.
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Casey C, Chen LM, Rabow MW. Symptom management in gynecologic malignancies. Expert Rev Anticancer Ther 2012; 11:1077-89. [PMID: 21806331 DOI: 10.1586/era.11.83] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patients with gynecologic cancer experience significant symptom burden throughout their disease course and treatment, which negatively impacts their quality of life. The most common symptoms in gynecologic cancer include pain, fatigue, depression and anxiety. Palliative care, including symptom management, focuses on the prevention and relief of suffering and improvement in quality of life, irrespective of prognosis. In a comprehensive cancer care model, palliative care, including symptom management, is offered concurrently with anticancer therapies throughout the disease course, not just at the end of life and not only once curative attempts have been abandoned. Good symptom management begins with routine symptom assessment and use of a standardized screening tool can help identify patients with high symptom burden. Literature regarding epidemiology, assessment and management of pain, fatigue, nausea/vomiting, lymphedema, ascites, depression, anxiety and sexual dysfunction in gynecologic oncology patients will be reviewed in this article.
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Affiliation(s)
- Carolyn Casey
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
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Anuar HM, Fadzil F, Ahmad N, Abd Ghani N. Urut Melayu for poststroke patients: a qualitative study. J Altern Complement Med 2012; 18:61-4. [PMID: 22236030 PMCID: PMC3264954 DOI: 10.1089/acm.2010.0797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Urut Melayu, the traditional Malay massage, had been introduced into three pioneer hospitals in Malaysia, as part of the integrated hospital program. It was introduced primarily for the rehabilitation of poststroke patients. After almost 3 years since it was first implemented, there are currently plans to extend it to other hospitals in the country. Information from this study will contribute toward a better future implementation plan. OBJECTIVES This study was conducted to gain an insight into the experiences and views of poststroke patients and their urut Melayu practitioners. METHODS A qualitative study design was adopted. A total of 17 semistructured in-depth interviews were carried out with poststroke patients who were undergoing urut Melayu treatment at one of the three integrated hospitals. Information was solicited from their accompanying caregivers whenever necessary. The 2 urut Melayu practitioners at the hospital were also interviewed. All the interviews were carried out in Malay by the authors, at the Traditional and Complementary Medicine unit of the relevant hospital. The interviews were audiotaped, transcribed, and coded into categories through a constant-comparison method of data analysis. Illustrative quotations were identified to supplement the narrative descriptions of the themes. RESULTS It was found that urut Melayu was sought by patients who had experienced stroke brought about by hypertension and postdelivery complications. They reported the unique characteristics of urut Melayu and their positive experiences with it. CONCLUSIONS Urut Melayu has potential as a complementary therapy for poststroke patients. It is recommended that the number of practitioners at the Traditional and Complementary Medicine unit be increased to provide the optimum care for poststroke patients.
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Blom K, How M, Dai M, Baker B, Irvine J, Abbey S, Abramson BL, Myers M, Perkins N, Tobe SW. Hypertension Analysis of stress Reduction using Mindfulness meditatiON and Yoga (The HARMONY Study): study protocol of a randomised control trial. BMJ Open 2012; 2:e000848. [PMID: 22396225 PMCID: PMC3298834 DOI: 10.1136/bmjopen-2012-000848] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hypertension (HTN) is a leading risk factor for preventable cardiovascular disease, with over one in five adults affected worldwide. Lifestyle modification is a key strategy for the prevention and treatment of HTN. Stress has been associated with greater cardiovascular risk, and stress management is a recommended intervention for hypertensives. Stress reduction through relaxation therapies has been shown to have an effect on human physiology, including lowering blood pressure (BP). However, individualised behavioural interventions are resource intensive, and group stress management approaches have not been validated for reducing HTN. The HARMONY Study is a pilot randomised controlled trial designed to determine if mindfulness-based stress reduction (MBSR), a standardised group therapy, is an effective intervention for lowering BP in stage 1 unmedicated hypertensives. METHODS AND ANALYSIS Men and women unmedicated for HTN with mean daytime ambulatory blood pressure (ABP) ≥135/85 mm Hg or 24 h ABP ≥130/80 mm Hg are included in the study. Subjects are randomised to receive MBSR immediately or after a wait-list control period. The primary outcome measure is mean awake and 24 h ABP. The primary objective of the HARMONY Study is to compare ABP between the treatment and wait-list control arm at the 12-week primary assessment period. Results from this study will determine if MBSR is an effective intervention for lowering BP in early unmedicated hypertensives. ETHICS AND DISSEMINATION This research project was approved by the Sunnybrook Research Ethics Board and the University Health Network Research Ethics Board (Toronto, Canada). Planned analyses are in full compliance with the principles of the Declaration of Helsinki. Data collection will be completed by early spring 2012. Primary and secondary analysis will commence immediately after data monitoring is completed; dissemination plans include preparing publications for submission during the summer of 2012. TRIAL REGISTRATION NUMBER This study is registered with http://clinicaltrials.gov (NCT00825526).
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Affiliation(s)
- Kimberly Blom
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Maxine How
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Monica Dai
- Queen's University, Kingston, Ontario, Canada
| | - Brian Baker
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Jane Irvine
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Susan Abbey
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Beth L Abramson
- Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Martin Myers
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nancy Perkins
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sheldon W Tobe
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Lyme Disease. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Day MA, Thorn BE, Burns JW. The Continuing Evolution of Biopsychosocial Interventions for Chronic Pain. J Cogn Psychother 2012. [DOI: 10.1891/0889-8391.26.2.114] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the last several decades, great strides have been made in the treatment of persistent painful conditions. The scope of treatment has shifted from purely biomedical, including approaches built upon cognitive, behavioral, and social psychological principles. This article reports and discusses several key paradigm shifts that fueled this revolutionary change in the management of chronic pain. The progressive development of theoretical metamodels and treatment conceptualizations is presented. Cognitive behavioral therapy (CBT) is the most widely accepted biopsychosocial treatment for chronic pain and is founded upon a rich theoretical tradition. The CBT rationale, and empirical evidence to support its efficacy, is presented. The emergence and promise of mindfulness-based and acceptance-based interventions is also discussed. The article concludes with the assertion that future treatment outcome research should focus on understanding the treatment-specific and common factors associated with efficacy.
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Salmoirago-Blotcher E, Crawford S, Carmody J, Rosenthal L, Ockene I. Characteristics of Dispositional Mindfulness in Patients with Severe Cardiac Disease. J Evid Based Complementary Altern Med 2011; 16:218-225. [PMID: 22116792 DOI: 10.1177/2156587211405525] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The characteristics of dispositional mindfulness have rarely been explored in unhealthy populations. We sought to evaluate its association(s) with psychological morbidity and disease severity in 30 outpatients with implantable cardioverter defibrillators naïve to mindfulness training. We used the Five Facets of Mindfulness and the Hospital Anxiety and Depression Scale to measure dispositional mindfulness and anxiety/depression, respectively. Associations were estimated using linear regression models. Higher dispositional mindfulness was observed in patients with lower anxiety scores (β = - 1.10, CI: -1.71, -0.49) and no history of depression (β = - 7.95; CI: -14.31, -1.6) by univariate analysis. No associations were observed with disease severity or other covariates. In conclusion, psychological well-being and psychological morbidity, and not disease severity, appear to be associated with dispositional mindfulness in patients with implantable cardioverter defibrillators. Further research is needed to confirm these findings.
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Chiesa A, Serretti A. Mindfulness-based interventions for chronic pain: a systematic review of the evidence. J Altern Complement Med 2011; 17:83-93. [PMID: 21265650 DOI: 10.1089/acm.2009.0546] [Citation(s) in RCA: 190] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Chronic pain is a common disabling illness that does not completely respond to current medical treatments. As a consequence, in recent years many alternative interventions have been suggested. Among them, mindfulness-based interventions (MBIs) are receiving growing attention. The aim of the present article is to review controlled studies investigating the efficacy of MBIs for the reduction of pain and the improvement of depressive symptoms in patients suffering from chronic pain. METHODS A literature search was undertaken using MEDLINE,(®) ISI web of knowledge, the Cochrane database, and references of retrieved articles. The search included articles written in English published up to July 2009. The data were independently extracted by two reviewers from the original reports. Quality of included trials was also assessed. RESULTS Ten (10) studies were considered eligible for the present review. Current studies showed that MBIs could have nonspecific effects for the reduction of pain symptoms and the improvement of depressive symptoms in patients with chronic pain, while there is only limited evidence suggesting specific effects of such interventions. Further findings evidenced some improvements in psychologic measures related to chronic pain such as copying with pain following MBIs as well. DISCUSSION There is not yet sufficient evidence to determine the magnitude of the effects of MBIs for patients with chronic pain. Main limitations of reviewed studies include small sample size, absence of randomization, the use of a waiting list control group that does not allow distinguishing of specific from nonspecific effects of MBI as well as differences among interventions. CONCLUSIONS However, because of these preliminary results, further research in larger properly powered and better designed studies is warranted.
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Affiliation(s)
- Alberto Chiesa
- Institute of Psychiatry, University of Bologna, Bologna, Italy.
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