Mindfulness-Based Interventions as a Solution for Chronic Musculoskeletal Pain Conditions

As of 2016, the prevalence of chronic pain conditions in the United States was as high as 20.4% of adults, with 8% suffering from high-impact chronic pain.1 The most popular form of treatment for patients with chronic pain is medication, which has contributed to a growing opioid addiction crisis worldwide.2 Prescription medication has long been touted as a safe and effective treatment for chronic pain, which has caused the number of opiate prescriptions to quadruple in the last 20 years. However, opiate-related deaths have also quadrupled in this time period and the prevalence of chronic pain has remained constant. This phenomenon has sparked interest in non-pharmacological treatment options for patients with chronic pain, including mindfulness practice. This article summarizes the findings of a November 2018 review in the Asian Journal of Psychiatry that studied existing research on the effectiveness of mindfulness-based interventions (MBIs) for patients with chronic pain conditions. 

Mindfulness-Based Interventions

What are Mindfulness-Based Interventions?

Mindfulness is defined as the awareness that emerges from intentional non-judgmental attention to the present moment.3,4 Through careful, objective focus on present thoughts and emotions, one can gain a fuller understanding of passing events and make clearer decisions to improve their outcomes in the future. Mindfulness practice can increase life satisfaction and overall well-being, improve decision-making skills, and build emotional resilience in this way. There are a variety of different MBIs for chronic pain that all stem from basic mindfulness practice. 

How is Mindfulness Related to Chronic Pain?

People living with pain are encouraged to take a new perspective on the thoughts they have about pain through the use of mindfulness-based interventions. Removing judgment from one’s thoughts theoretically separates the connection between the sensory component of pain and the cognitive and emotional components, meaning the patient experiences reduced suffering from chronic pain. Additionally, the process reduces pain intensity and has been used for decades to treat chronic back, pain, migraines, and musculoskeletal pain. 

MBIs often do not completely cure chronic pain conditions, but they have been shown to be effective for reducing pain and improving patients’ ability to live a normal life while managing their condition. They also work to alleviate the psychological variable such as anxiety and depression associated with pain.  

Mindfulness-Based Interventions

How can Mindfulness-Based Interventions be Used to Treat Chronic Pain?

In this review, researchers investigated the effectiveness of MBIs for a variety of chronic pain conditions including lower back pain, migraines, and musculoskeletal pain. In each of these areas, they analyzed several studies and compared the results to develop a clear picture of the efficacy of MBIs compared to different types of traditional treatment. 

Lower Back Pain

In one large-scale 2016 study with over 340 participants, mindfulness was found to be significantly more effective for reducing lower back pain as compared to treatment as usual.5 In the study, patients were separated into three groups. The control group received normal treatment, while a Cognitive and Behavioral Therapy (CBT) group and an MBI group received the respective non-pharmacological treatment. Patients in the MBI group showed a 50% improvement compared to the control group on the Roland Disability Questionnaire (RDQ) after 26 weeks, and this effect was shown to persist after 56 weeks post-intervention. Scores for the CBT group were not significantly different from those of the MBI group, suggesting mindfulness is at least as effective for treating lower back pain as other leading non-opioid treatment options and significantly more effective than traditional treatment using medication. 

Chronic Migraine

Two small studies found that MBIs decreased the frequency of migraines as well as patients’ perceptions of self-efficacy, pain acceptance, and pain catastrophizing.6,7 A larger study found that treatment with mindfulness practice was just as effective as medication-based treatment in reducing the frequency and severity of migraines as well as long-term medication use. However, patients in the MBI group were observed to have none of the negative side effects associated with pain medication, indicating that mindfulness is a safe, equally effective alternative to medication in patients with chronic migraines.8 The researchers noted that these results were corroborated by several other studies, suggesting that MBIs present a promising new avenue of treatment for chronic migraine conditions.9,10,11 

Musculoskeletal Pain

Though research specifically on musculoskeletal pain alone is scarce, existing studies demonstrate the effectiveness of MBIs in this area. In one study, patients treated using MBIs showed statistically significant improvements in pain self-management, perceived control over pain, and mental health as compared to patients treated as usual.12

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Mindfulness Can Be an Effective Treatment Option for Chronic Pain

There is consistent evidence that mindfulness-based interventions are effective for reducing pain and improving related factors including quality of life in patients with chronic pain conditions. Across multiple types of pain and structures of mindfulness practice, MBIs were shown to have equal or greater results as compared to treatment with prescription medication and other leading non-pharmacological options, without any negative side effects. Based on current and emerging research, mindfulness presents a promising alternative to medication that takes less time and money and exposes patients to less risk. 

To learn how to use mindfulness check out Radical Relief: A Guide to Overcome Chronic Pain Using Pain Science, Mindfulness, and Acceptance and Commitment Therapy by Joe Tatta, PT, DPT.

References:

  1. Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006. DOI: http://dx.doi.org/10.15585/mmwr.mm6736a2.
  2. Dowell, D., Haegerich, T.M., Chou, R., 2016. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA 315, 1624. doi:10.1001/jama.2016.1464
  3. Kabat-Zinn, J., 2006. Mindfulness-Based Interventions in Context: Past, Present, and Future. Clin. Psychol. Sci. Pract. 10, 144–156. doi:10.1093/clipsy.bpg016
  4. Grossman, P., Niemann, L., Schmidt, S., Walach, H., 2004. Mindfulness-based stress reduction and health benefits. J. Psychosom. Res. 57, 35–43. doi:10.1016/S0022-3999(03)00573-7
  5. Cherkin, D.C., Sherman, K.J., Balderson, B.H., Cook, A.J., Anderson, M.L., Hawkes, R.J., Hansen, K.E., Turner, J.A., 2016. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain. JAMA 315, 1240. doi:10.1001/jama.2016.2323
  6. Cathcart, S., Galatis, N., Immink, M., Proeve, M., Petkov, J., 2014. Brief Mindfulness-Based Therapy for Chronic Tension-Type Headache: A Randomized Controlled Pilot Study. Behav. Cogn. Psychother. 42, 1–15. doi:10.1017/S1352465813000234 Center for Health Statistics, N., 2006. Health, United States, 2006 with Chartbook on Trends in the Health of Americans [WWW Document]. Libr. Congr. Cat. Number 76–641496. URL: https://www.cdc.gov/nchs/data/hus/hus06.pdf
  7. Day, M.A., Thorn, B.E., Ward, L.C., Rubin, N., Hickman, S.D., Scogin, F., Kilgo, G.R., 2013. Mindfulness-based Cognitive Therapy for the Treatment of Headache Pain. Clin. J. Pain 30, 1. doi:10.1097/AJP.0b013e318287a1dc
  8. Grazzi, L., Sansone, E., Raggi, A., D’Amico, D., De Giorgio, A., Leonardi, M., De Torres, L., Salgado-García, F., Andrasik, F., 2017. Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with Chronic Migraine: an effectiveness trial with a one-year follow-up. J. Headache Pain 18, 15. doi:10.1186/s10194-017-0728-z
  9. Bakhshani, N.M., Amirani, A., Amirifard, H., Shahrakipoor, M., 2015. The Effectiveness of Mindfulness-Based Stress Reduction on Perceived Pain Intensity and Quality of Life in Patients With Chronic Headache. Glob. J. Health Sci. 8, 142. doi:10.5539/gjhs.v8n4p142
  10. Feuille, M., Pargament, K., 2015. Pain, mindfulness, and spirituality: A randomized controlled trial comparing effects of mindfulness and relaxation on pain-related outcomes in migraineurs. J. Health Psychol. 20, 1090–1106. doi:10.1177/1359105313508459 Global Burden of Disease Study 2013 Collaborators, T., Barber, R.M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., Charlson, F et al., 2015. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England) 386, 743–800. doi:10.1016/S0140-6736(15)60692-4
  11. Wells, R.E., Burch, R., Paulsen, R.H., Wayne, P.M., Houle, T.T., Loder, E., 2014. Meditation for Migraines: A Pilot Randomized Controlled Trial. Headache J. Head Face Pain 54, 1484–1495. doi:10.1111/head.12420
  12. Brown, C.A., Jones, A.K.P., 2013. Psychobiological Correlates of Improved Mental Health in Patients With Musculoskeletal Pain After a Mindfulness-based Pain Management Program. Clin. J. Pain 29, 233–244. doi:10.1097/AJP.0b013e31824c5d9f

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