Read Full Text: Mindfulness-based interventions for chronic pain: Evidence and applications (This is a paid article, but will still thought it was important to cover.)
Journal: Asian Journal of Psychiatry
Year Published: 2018
Ranked 98th on our 2017-2021 list of the 100 Most Influential OT Journal Articles
CEU Podcast: Mindfulness, Chronic Pain and OT with Patricia Motus
Whether I’m scrolling through social media or reading a business book, it feels like everyone is discussing the benefits of mindfulness.
Yet, with all this fanfare, we must ask: does the evidence justify incorporating mindfulness into occupational therapy?
This week’s article says, “YES!” (At least for specific chronic pain conditions.)
The authors provide a great overview of the problem of chronic pain—and they also discuss various mindfulness-based interventions for chronic pain, including the research behind them.
Then, we were thrilled to welcome Patricia Motus, OTR/L, RYT-200 to join us on the OT Potential podcast. Patricia uses yoga, meditation, grounding, and life & health coaching to help clients navigate life transitions. She and I will discussed this article, including some ways you can incorporate mindfulness into your traditional OT practice.
The problem of chronic pain
It is hard to overstate the global problem of chronic pain. This issue is massive. The opening of this article hits you with lots of facts on chronic pain.
Simply defined, chronic pain lasts longer than 3 months, either progressively worsening or reoccurring intermittently. Chronic pain outlasts the typical healing process, and its presence is often associated with:
- Disability
- Financial loss
- Decrease in productivity
- Absenteeism
- Emotional and social problems
- Poor well-being
Estimates show that chronic pain affects at least 10% of the world’s population. And, this is not only true in adults. It is also common in children and adolescents, the reported prevalence in the article is 25% and this is true in more recent literature as well.
In its 2015 report, the Global Burden of Disease presents information on “years lived with a disability” (YLDs) for 310 diseases and injuries. The report stated that 6 of the top 20 YLDs were related to chronic pain:
- #1- low back pain
- #5 - neck pain
- #7 - migraine
- #8 - other musculoskeletal disorders
- #13 - osteoarthritis
- #18 - medication overdose headache
Of note, major depression (#3) and anxiety disorders (#9) are often associated with (or the result of) chronic pain.
The menace of opioids
The authors rightfully refer to opioids as a “menace.” Many of us have first-hand experience with the devastating effects of the opioid crisis. The use of opioids has risen exponentially in recent decades.
These medications have NOT reduced the prevalence of chronic pain. What they have done is created a public health crisis of opioid overdose deaths, the rate of which continues to rise in the US and recently reached the unprecedented number of 75,000 deaths/year.
(For a history of how effective and safer options, like OT, got sidelined by opioids, I highly recommend our past article: Providing chronic pain management in the “Fifth Vital Sign” era: Historical and treatment perspectives on a modern-day medical dilemma.)
Alternative treatments for chronic pain
Based on the opioid crisis, guidelines like those published by the Center for Disease Control and Prevention (CDC) have evolved. The CDC now encourages using non-opioid pharmacological treatments and alternative therapies as FIRST-LINE treatments for chronic pain.
Past research has shown many non-pharmacological treatments to be effective in treating chronic pain, including:
- Mindfulness-based interventions
- Cognitive behavioral therapies
- Acceptance and commitment therapy
- Hypnosis
- Physical therapy
- Occupational therapy
- Exercise
The authors’ overview of mindfulness-based interventions for chronic pain
The practice of mindfulness can be traced back to several ancient traditions, including Vipassana, Buddhist, and Zen practices.
The authors credit Jon Kabat-Zinn for drawing on the traditions to establish mindfulness-based interventions (MBIs). (I found a MasterClass you can watch with him!)
Kabat-Zinn defines mindfulness as the awareness that emerges through purposeful, non-judgemental attention to the present moment. In MBIs, clients are encouraged to change the way they relate to pain by suspending judgment towards the thoughts accompanying the perception of pain.
This theoretically uncouples the sensory dimension of pain from the affective alarm reaction—which attenuates the experience of suffering via cognitive re-evaluation.
The goal is to reduce the pain (it is often not possible to completely eliminate it) so the patient can learn to live a productive life, even in the presence of discomfort.
MBIs revolve around formal and informal meditation training, patient education, yoga exercises, and individual or group dialogue. They can serve as standalone treatments or be used alongside other pharmacological and non-pharmacological measures (like OT!).
Specific interventions include:
- Mindful meditation (MM)
- Mindfulness-based stress reduction (MBSR)
- Mindfulness-based cognitive therapy (MBCT)
- Mindfulness-based acceptance and commitment therapy (MBACT)
What does this paper add to the body of literature on alternative chronic pain treatment?
This paper is a systematic research review. Two of the three authors appear to be practicing psychiatrists from the United States, who reviewed the research related to mindfulness interventions and specific types of chronic pain. Per the title of the article, I feel like you can tell these are authors who are really trying to understand the clinical applications of the research.
What evidence did the authors include in their review?
The authors searched for evidence from the past five years and included: randomized control trials, randomized clinical trials, and meta-analyses. They looked for papers that included keywords like “mindfulness” and terms related to chronic pain.
What evidence did they find?
The authors identified 11 studies and grouped them into the following categories:
- MBIs for chronic low back pain
- MBIs for chronic migraine and headaches
- MBIs for chronic musculoskeletal pain
I’ll let you dig into the specific results of the studies that might interest you, and I’ll focus on the authors’ high-level discussion and conclusions.
What did their discussion of the research entail?
The authors found there was consistent evidence in support of MBIs in the treatment of chronic low back pain, migraines and headaches, and musculoskeletal pain.
The authors contend that MBIs can reduce pain and improve functioning. Interestingly, MBIs also seem to help alleviate co-morbid conditions, such as depression and anxiety.
This aligns with past research that indicates that mindfulness can decrease all of the following: pain intensity, negative affect, pain catastrophizing, pain-related fear, pain hyper-vigilience, and functional disability.
What did the authors conclude?
The authors concluded that MBIs have consistently demonstrated moderate success in the treatment of several chronic pain disorders. The advantages of MBIs are:
- No risk of addiction or abuse
- Better treatment outcomes
- Improvement in co-morbid conditions
Takeaways for OT Practitioners
(Please note: These are my personal takeaways. They are not mentioned specifically in the article.)
1. This certainly was not the strongest systematic review we’ve looked at.
This article was 98/100 on our list of the most-cited OT-related research articles. I would be remiss not to mention that this particular article does not seem like the strongest review we’ve covered.
The research question and methods did not seem super clear. That said, the tradeoff may be that we got to hear from clinicians—which made it more readable, and you could really sense the strength of their convictions.
2. Despite its shortcomings, this article’s message (and related research) is still important for ALL OTs to consider.
The strength of this particular article (or lack thereof) does not diminish its overall message:
“Alternative” therapies like mindfulness (and OT!) are considered FIRST-LINE treatment for chronic pain, along with non-opioid medications.
Opioids have wreaked havoc on our communities—and they’ve stifled progress on pain treatments that can be just as effective, much safer, and ultimately more cost-effective. OTs should read articles like this and be pushed to examine our role in pain management. There is a massive need across the globe for better, safer ways to address pain.
3. Mindfulness-based interventions can be incorporated into our care—but it’s also OK to refer patients out.
There is a reason we see information about mindfulness everywhere: it is a powerful tool. It is not a cure-all, and does not purport to be, but it’s a shift in perspective that can impact multiple areas of patients’ lives.
As OTs, we should consider incorporating aspects of mindfulness into our treatments. We should provide basic education on mindfulness, but we can also refer out when we think our patients may benefit from more extensive training. I’m super excited to discuss what this all looks like with next week’s podcast guest, Patricia Motus, OTR/L, RYT-200!
Here’s the full APA citation for this article:
Majeed, M. H., Ali, A. A., & Sudak, D. M. (2018). Mindfulness-based interventions for chronic pain: Evidence and applications. Asian journal of psychiatry, 32, 79–83.
Earn one hour of continuing education by listening to the podcast on this article!!
In this podcast episode, we dive even deeper into this topic, with OT (and Club member!), Patricia Motus. You may be eligible for continuing education credit for listening to this podcast. Please read our course page for more details!