Mindfulness-based stress reduction (MBSR), a group-based intervention that focuses awareness and acceptance on moment-to-moment experiences, may be effective in the management of chronic pain, according to the results of a systematic review and meta-analysis published in Evidence-Based Mental Health.
Study investigators searched the literature for randomized controlled trials in which adult patients with a ≥3-month history of chronic pain were treated with MBSR, cognitive-behavioral therapy (CBT), or both, and compared them with a control treatment (ie, standard care, passive education, wait-list/no treatment, or the same adjunctive pharmacotherapy treatment). Physical functioning was the study’s primary outcome. Other outcomes included pain intensity and symptoms of depression.
Trials included in the analysis compared CBT vs control (n=1095), MBSR vs control (n=545), and MBSR vs CBT vs control (n=341). Small effect differences favoring MBSR vs control were identified for physical functioning (standardized mean differences [SMD], −0.42; 95% CI, −0.94 to −0.10), pain intensity (SMD, −0.34; 95% CI, −0.79 to -0.03), and depression symptoms (SMD, −0.49; 95% CI, −1.89 to −0.10). Similar changes were observed favoring MBSR over control interventions. MBSR was found to be comparable with CBT for improvements in physical functioning (SMD, −0.02; 95% CI, −0.49 to −0.42), pain intensity (SMD, 0.02; 95% CI, −0.43 to -0.48), and depression symptoms (SMD, −0.06; 95% CI, −1.08 to −0.47).
Study limitations include the clinical and methodologic heterogeneity of the studies and the lack of intention-to-treat analyses in half of the included studies.
“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,” concluded the study authors.
Khoo EL, Small R, Cheng W, et al. Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: A systematic review and network meta-analysis. Evid Based Ment Health. 2019;22(1):26-35.