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      Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis

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          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.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s12160-016-9844-2) contains supplementary material, which is available to authorized users.

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          Most cited references49

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          The clinical use of mindfulness meditation for the self-regulation of chronic pain.

          Jon Kabat-Zinn, Leslie Lipworth, Robert G. Burney (1985)
          Ninety chronic pain patients were trained in mindfulness meditation in a 10-week Stress Reduction and Relaxation Program. Statistically significant reductions were observed in measures of present-moment pain, negative body image, inhibition of activity by pain, symptoms, mood disturbance, and psychological symptomatology, including anxiety and depression. Pain-related drug utilization decreased and activity levels and feelings of self-esteem increased. Improvement appeared to be independent of gender, source of referral, and type of pain. A comparison group of pain patients did not show significant improvement on these measures after traditional treatment protocols. At follow-up, the improvements observed during the meditation training were maintained up to 15 months post-meditation training for all measures except present-moment pain. The majority of subjects reported continued high compliance with the meditation practice as part of their daily lives. The relationship of mindfulness meditation to other psychological methods for chronic pain control is discussed.
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            Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials.

            L O Fjorback, M. Arendt, E Ornbøl … (2011)
            Fjorback LO, Arendt M, Ørnbøl E, Fink P, Walach H. Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy - a systematic review of randomized controlled trials.   To systematically review the evidence for MBSR and MBCT.   Systematic searches of Medline, PsycInfo and Embase were performed in October 2010. MBSR, MBCT and Mindfulness Meditation were key words. Only randomized controlled trials (RCT) using the standard MBSR/MBCT programme with a minimum of 33 participants were included.   The search produced 72 articles, of which 21 were included. MBSR improved mental health in 11 studies compared to wait list control or treatment as usual (TAU) and was as efficacious as active control group in three studies. MBCT reduced the risk of depressive relapse in two studies compared to TAU and was equally efficacious to TAU or an active control group in two studies. Overall, studies showed medium effect sizes. Among other limitations are lack of active control group and long-term follow-up in several studies.   Evidence supports that MBSR improves mental health and MBCT prevents depressive relapse. Future RCTs should apply optimal design including active treatment for comparison, properly trained instructors and at least one-year follow-up. Future research should primarily tackle the question of whether mindfulness itself is a decisive ingredient by controlling against other active control conditions or true treatments. © 2011 John Wiley & Sons A/S.
            Article 0 comments Cited 224 times – based on 0 reviews     Review now
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              A refined method for the meta-analysis of controlled clinical trials with binary outcome.

              J Hartung, Rebecca G Knapp (2001)
              For the meta-analysis of controlled clinical trials with binary outcome a test statistic for testing an overall treatment effect is proposed, which is based on a refined estimator for the variance of the treatment effect estimator usually used in the random-effects model of meta-analysis. In simulation studies it is shown that the proposed test keeps the prescribed significance level much better than the commonly used tests in the fixed-effects and random-effects model, respectively. Moreover, when using the test it is not necessary to choose between fixed effects and random effects approaches in advance. The proposed method applies in the same way to the analysis of a controlled multi-centre study with binary outcome, including a possible interaction between drugs and centres. Copyright 2001 John Wiley & Sons, Ltd.
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                Author and article information

                Contributors
                Lara Hilton:
                ORCID: http://orcid.org/0000-0003-2375-8810
                310-393-0411 , hilton@rand.org
                Journal
                Journal ID (nlm-ta): Ann Behav Med
                Journal ID (iso-abbrev): Ann Behav Med
                Title: Annals of Behavioral Medicine
                Publisher: Springer US (New York )
                ISSN (Print): 0883-6612
                ISSN (Electronic): 1532-4796
                Publication date (Electronic): 22 September 2016
                Publication date PMC-release: 22 September 2016
                Publication date (Print): 2017
                Volume: 51
                Issue: 2
                Pages: 199-213
                Affiliations
                ISNI 0000 0004 0370 7685, GRID grid.34474.30, , RAND Corporation, ; 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138 USA
                Author information
                http://orcid.org/0000-0003-2375-8810
                Article
                Publisher ID: 9844
                DOI: 10.1007/s12160-016-9844-2
                PMC ID: 5368208
                PubMed ID: 27658913
                SO-VID: ea803ff5-5fa8-4ff8-b2b9-77ec7bbc8770
                Copyright © © The Author(s) 2016
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Funding
                Funded by: Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury
                Award ID: 14-539.2
                Award Recipient :
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © The Society of Behavioral Medicine 2017

                ScienceOpen disciplines: Neurology
                Keywords: chronic pain,mindfulness,meditation,systematic review
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: chronic pain, mindfulness, meditation, systematic review

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