Chronic pain relief: Mindfulness may be just as good as CBT

By | February 11, 2019
New research appearing in the BMJ journal Evidence-Based Mental Health suggests that mindfulness could be a promising alternative to cognitive behavioral therapy for relieving some of the psychological and physical symptoms of chronic pain.
senior woman meditating
Mindfulness may be a useful alternative to CBT for easing chronic pain, new research shows.

According to the most recent survey analysis from the Centers for Disease Control and Prevention (CDC), about 50 million people in the United States — or 20 percent of the U.S. adult population — are living with chronic pain.

Individuals with chronic pain experience pain “most days or every day” for 6 months or more. Also, some of these people experience “high-impact” chronic pain, meaning that the pain severely interferes with their daily activities on most days.

Chronic pain can affect all aspects of a person’s well-being, and the psychologically distressing impact of the condition is significant. Currently, the psychological treatment for chronic pain that doctors most widely prescribe is cognitive behavioral therapy (CBT).

CBT helps people cope with chronic pain by encouraging a more flexible approach to daily challenges, both on a mental and behavioral level.

However, not every person is the same, so CBT does not help everyone living with chronic pain equally. New research evaluates the therapeutic potential of an alternative that practitioners call mindfulness-based stress reduction (MBSR) and compares its results with those of CBT.

Eve-Ling Khoo, of the Clinical Epidemiology department at the Ottawa Hospital Research Institute in Ontario, Canada, is the first author of the paper.

Chronic pain: Comparing MBSR with CBT

Khoo and colleagues examined existing clinical trials that studied the effectiveness of CBT or MBSR, respectively, for coping with chronic pain.

The researchers found 184 clinical trials that looked at chronic pain and, after a further screening, they narrowed these down to 21 clinical trials.

The studies summed up almost 2,000 participants who were between 35 and 65 years old. Most of the participants were women.

The majority of the studies examined musculoskeletal pain, such as fibromyalgia, chronic lower back pain, rheumatoid arthritis, and osteoarthritis, plus others.

Khoo and team examined both direct and indirect evidence for the effectiveness of CBT in comparison to no care or standard care, MBSR in comparison to no care or standard care, and finally, MBSR up against CBT.

Their analysis revealed that both techniques considerably improved the physical functioning of the participants and eased their pain and pain-related depression.

Khoo and colleagues conclude, “This review suggests that MBSR offers another potentially helpful intervention for CP management.”

However, the authors add, “While CBT is considered to be the preferred psychological intervention of [chronic pain], not all patients with [it] experience a clinically significant treatment response.”

Finally, Khoo and colleagues conclude:

Although a number of recommendations have been proposed to improve CBT for patients with chronic pain, an additional solution may be to offer patients [MBSR] since it shows promise in improving pain severity and reducing pain interference and psychological distress.”

The authors note that more research with “consistent measures” would now be helpful to inform decisions about whether to offer CBT or MBSR to those experiencing chronic pain. They point out that it may be too early to know which individuals would benefit more from CBT or mindfulness, respectively.

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