Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis

A Single-Session, 2-Hour Version of Mindfulness-Oriented Recovery Enhancement (One MORE) Improves Chronic Pain Patients' Pain-Related Outcomes Through 3-Month Follow-Up in a Randomized Controlled Trial

Introduction: Traditional, 8-week, mindfulness-based interventions can effectively treat chronic pain, but require a time and resource investment too burdensome for many patients and providers. The solution to this logistical challenge may be to distill the core, therapeutic elements of an efficacious 8-week, mindfulness-based intervention, Mindfulness-Oriented Recovery Enhancement (MORE), into a 2-h, single-session intervention. Methods: In this study, the authors conducted a waitlist-controlled, randomized clinical trial to assess the impact of a 2-h, single-session adaptation of MORE (i.e., One MORE) on chronic pain patients' (N = 40) pain-related outcomes through 3-month follow-up. Results: Results indicated that One MORE significantly improved chronic pain patients' pain catastrophizing (i.e., primary outcome; F = 9.97, p = 0.002), pain intensity (F = 26.58, p < 0.001), pain interference (F = 39.43, p < 0.001), physical function (F = 16.29, p < 0.001), sleep (F = 16.66, p < 0.001), anxiety (F = 12.54, p < 0.001), and depression (F = 17.48, p < 0.001). One MORE also significantly increased theoretically indicated therapeutic mechanisms through the 3-month follow-up: mindfulness, positive reappraisal, savoring, self-transcendence. Discussion: Study results are promising, and if replicated, would suggest that One MORE is a highly scalable, low-cost (e.g., sustainable), nonpharmacologic treatment for chronic pain. Clinical Trial Registration: NCT05194241.

Mindfulness-based stress reduction for chronic pain: Enhancing psychological well-being without altering attentional biases towards pain faces

INTRODUCTION

This study examines the effects of a Mindfulness-Based Stress Reduction (MBSR) program on psychological measures and attentional patterns to pain stimuli, using eye-tracking methods, in individuals with chronic pain.

METHOD

Thirty-two participants with chronic pain and no prior mindfulness experience were randomly assigned to an experimental group or a waiting list group. Both groups completed self-report measures of symptoms, well-being, and an attentional disengagement task using emotional faces as stimuli. Assessments were conducted at two points: before and after the intervention for the experimental group, with the waiting list group serving as a control.

RESULTS

Before the MBSR program, chronic pain participants exhibited significant attentional biases towards pain-related stimuli during early attentional stages. Following the program, significant improvements were observed in depression, anxiety, stress, pain acceptance, overall well-being, and life satisfaction. However, it had a limited impact on attentional patterns, with only a significant increase in gaze duration across all stimuli.

DISCUSSION

Despite the MBSR program's success in reducing symptoms associated with chronic pain, the lack of broader attentional improvements raises questions about the mechanisms responsible for psychological improvements.

SIGNIFICANCE STATEMENT

This study pioneers the use of eye-tracking to examine how MBSR influences attention in chronic back pain. While the program improved psychological well-being, it did not generally alter attentional patterns, except for an increased ability to maintain attention across stimuli. We discuss whether this attentional change could be associated with the increased acceptance observed in the MBSR program.

Protocol for a randomised trial of a self-directed digital pain management intervention (Empowered Relief) tailored to adults with chronic pain and prescription opioid misuse/disorder: the MOBILE Relief study

INTRODUCTION

Chronic pain increases the risk of prescription opioid misuse or opioid use disorder (OUD). Non-pharmacological treatments are needed to dually address pain and opioid risks. The purpose of the Mobile and Online-Based Interventions to Lessen Pain (MOBILE Relief) study is to compare a one-session, video-based, on-demand digital pain relief skills intervention for chronic pain ('Empowered Relief' (ER); tailored to people at risk for opioid misuse or with opioid misuse/OUD) to a one-session digital health education intervention ('Living Better'; no pain management skills).

METHODS AND ANALYSIS

MOBILE Relief is an international online randomised controlled clinical trial. Study participants are adults with chronic, non-cancer pain (≥6 months) with daily pain intensity ≥3/10, taking ≥10 morphine equivalent daily dose and score ≥6 on the Current Opioid Misuse Measure. Participants are recruited through clinician referrals and clinic advertisements. Study procedures include electronic eligibility screening, informed consent, automated 1:1 randomisation to the treatment group, baseline measures, receipt of assigned digital treatment and six post-treatment surveys spanning 3 months. Study staff will call participants at baseline and 1-month and 3 months post-treatment to verify the opioid prescription. The main statistical analyses will include analysis of covariance and mixed effects model for repeated measurements regression.

MAIN OUTCOMES

Primary outcomes are self-reported pain catastrophising, pain intensity, pain interference, opioid craving and opioid misuse at 1-month and 3 months post-treatment. We will determine the feasibility of ER (≥50% participant engagement, ≥70% treatment appraisal ratings). We hypothesise the ER group will be superior to the Living Better group in the reduction of multiprimary pain outcomes at 1-month post-treatment and opioid outcomes at 1-month and 3 months post-treatment.

ETHICS AND DISSEMINATION

The study protocol was approved by the Stanford University School of Medicine Institutional Review Board (IRB 61643). We will publish results in peer-reviewed journals; National Institute of Drug Abuse (funder) and MOBILE Relief participants will receive result summaries.

TRIAL REGISTRATION NUMBER

NCT05152134.

Effects of mind-body interventions on polycystic ovary syndrome: a comprehensive meta-analysis

BACKGROUND

Mind-body interventions (MBI) have emerged as a potential therapeutic approach, but their effectiveness in the treatment of Polycystic Ovary Syndrome (PCOS) remains inconclusive. This study systematically evaluates the effectiveness of MBI on quality of life, anthropometry, androgen secretion, glucose, and lipid metabolism in PCOS.

METHODS

A computer search was conducted across three databases: PubMed, the Cochrane Library, and EMBASE, to identify randomized controlled trials (RCTs) related to MBI for PCOS from their inception until July 2024. DerSimonian and Laird's random-effects model and Stata 17.0 software was employed for our meta-analysis.

RESULTS

Twelve RCTs were included. MBI significantly improved PCOSQ subscale scores, including emotional disturbances (MD: 7.75, 95% CI: 6.10 to 9.40), body hair (MD: 2.73, 95% CI: 0.54 to 4.91), menstrual problems (MD: 3.79, 95% CI: 2.89 to 4.69), and weight (MD: 1.48, 95% CI: 0.03 to 2.93). Furthermore, there was a reduction in depression levels (MD: -1.53, 95% CI: -2.93 to -0.13). Sensitivity analysis confirmed the robustness of PCOSQ-Emotional disturbances and PCOSQ-Menstrual problems, with a high GRADE level of evidence for these subscales. Secondary outcome measures, including waist-hip ratio, fasting blood glucose, and HOMA-IR exhibited statistically significant differences. Subgroup analysis revealed that obesity could influence treatment outcomes.

CONCLUSION

MBI can serve as an alternative therapy, modulating effect on the quality of life and depression in PCOS patients. Future well-designed, high-quality, and large-scale studies should be conducted to thoroughly assess the impact of different Mind-Body Interventions (MBI) on various PCOS phenotypes.

TRIAL REGISTRATION

PROSPERO (CRD42023472035).

Interoceptive bodily awareness in patients seeking pain relief with osteopathic manipulative treatment: an observational cohort pilot study

CONTEXT

Interoceptive bodily awareness (IBA) is one's attentional focus on and relationship with comfortable and uncomfortable (e.g., pain) internal body sensations. Integrating IBA into research on osteopathic manipulative treatment (OMT) is growing, both as an outcome and predictor of treatment outcomes; however, it has yet to be studied in a clinical setting.

OBJECTIVES

We aimed to conduct a pilot study to measure IBA, with the Multidimensional Assessment of Interoceptive Awareness (MAIA), in patients seeking OMT for pain, and to test if OMT exposure may be associated with higher IBA as measured by the MAIA. The primary outcome was the change in MAIA scores, and the secondary outcomes were reduction in pain intensity, reduction in pain interference, and increase in participants' perception of change post-OMT.

METHODS

A convenience sample was recruited from individuals presenting for OMT appointments at a College of Osteopathic Medicine OMT teaching clinic. Participants were recruited into our single-arm observational cohort study (n=36), and categorized into one of two groups, OMT-naïve (n=19) or OMT-experienced (n=17), based on prior exposure to OMT. We measured MAIA scores and clinical pain-related outcomes prior to, immediately after, and at 1 and 3 weeks after a usual-care OMT session in the clinic. Covariates including experience with mind-body activities, non-OMT body work, and physical and emotional trauma were also collected to explore potential relationships. We utilized t tests to compare MAIA scores and pain outcomes between groups and across time points. Stepwise regression models were utilized to explore potential relationships with covariates.

RESULTS

The OMT-experienced group scored higher on the MAIA scales "Not-worrying" (p=0.002) and "Trusting" (p=0.028) at baseline. There were no significant changes in the MAIA scores before and after the single OMT session. Analysis of secondary outcomes revealed that all pain outcomes significantly decreased post-OMT (p<0.05), with the largest relative improvements in the acute pain and OMT-naïve subgroups, with diminishing effects over time.

CONCLUSIONS

Assessing IBA with MAIA in a clinical OMT setting is feasible. There were significant positive correlations between OMT exposure and two of the eight MAIA scales. Future studies are justified to further explore this relationship.

Relationships Among Pelvic Congestion Syndrome Pain, Daily Activities, and Quality of Life

OBJECTIVE

To examine women's experiences of pelvic congestion syndrome (PCS) pain.

DESIGN

Descriptive, cross-sectional.

SETTING

Online questionnaires in a Facebook PCS support group.

PARTICIPANTS

Convenience sample of 143 women who self-identified as being diagnosed with PCS.

METHODS

We recruited women through a social media support group and invited them to participate in a self-reported questionnaire. We collected demographic information and used the McGill Pain Questionnaire to elicit responses related to pain quality, pain intensity, quality of life, and satisfaction with health care. We analyzed data using descriptive statistics and correlation coefficients.

RESULTS

Respondents characterized their PCS pain as exhausting, stabbing, sharp, shooting, and tender. Respondents indicated that 19 of 24 daily activities increased PCS pain, whereas only 5 reduced PCS pain. Pain intensity was negatively related to the quality of life, health satisfaction, sleep, and sexual relationships.

CONCLUSION

Chronic pelvic pain from PCS severely affected quality of life among respondents. These findings suggest a difference in the presentation of PCS from historical pain depictions and further highlight the need to identify pain profiles to increase timely and precise diagnosis. Further research is needed to evaluate interventions to increase the quality of life for women with PCS.

Mapping Evidence-Based Non-Opioid and Non-Pharmacological Pain Management Modalities Across Minnesota: The Non-Opioid Pain Alleviation Information Network Project

Objective: The Non-Opioid Pain Alleviation Information Network (NOPAINMN) project was designed to identify, consolidate, and map evidence-based non-opioid and non-pharmacological pain management complementary and integrative health (CIH) modalities for chronic pain management across Minnesota into a searchable and informational website (www.nopainmn.org ). Methods: The Academic Consortium for Integrative Medicine & Health's Pain Task Force White Paper identifying evidence-based research of non-pharmacological pain practice (NPPC) was reviewed and referenced. National and state certifying boards and accrediting organizations for NPPC modalities were accessed to identify Minnesota-based NPPC providers' name, business/health-system affiliation, address, contact information, and credentials. The NOPAINMN website displays these data in a consumer-facing website with searchable fields such as NPPC modality type, and location with varying distances. The website was β-tested by practitioners and stakeholders for optimization. Eight main NPPC modalities and their respective subcategories were identified and mapped: Acupuncture; Integrative Medical Care (Functional medicine consultation and Integrative medicine consultation); Massage Therapy; Mind-Body Therapies (Biofeedback, Clinical Hypnosis, Mindfulness-Based Stress Reduction, and Music Therapy); Movement Therapies (Tai Chi, qigong, and Yoga Therapy); Psychology (Cognitive Behavioral Therapy); Rehabilitative Therapies (Physical and Occupational Therapy); and Spinal Manipulation. Results: All information compiled resulted in 17,155 providers/practitioners. Physical Therapy had the greatest number of reported providers (n = 5224), followed by Occupational Therapy (n = 3792), Psychology (n = 3324), Chiropractic (n = 3033), Acupuncture (n = 591), and Massage Therapy (n = 544). The Resource Map included 56 major health systems, 686 facilities, 2651 solo or private group practices, and 14 academic training schools. With web-based cross-referencing, providers and facilities were affiliated and linked with health systems to produce an interconnected mapping system. β-Testing with patients found that the website was reported as relatively easy to use and informative. Conclusion: The website was created to assist individuals, health care providers, insurance carriers, and health care facilities in finding evidence-based information and resources on NPPC to guide, support, and proactively manage and engage chronic pain patients across Minnesota.

Mindfulness in the Clinic Waiting Room May Decrease Pain: Results from Three Pilot Randomized Controlled Trials

Introduction: Mindfulness interventions can improve a broad range of patient outcomes, but traditional mindfulness-based interventions are time and resource intensive. Emerging evidence indicates brief, single-session mindfulness interventions can also improve patient outcomes, and brief mindfulness interventions can be embedded into medical care pathways with minimal disruption. However, the direct impact of a brief mindfulness intervention on patients' pain while waiting in the clinic waiting room remains unexamined. Objective: A series of three, pilot, randomized controlled trials (RCTs) were conducted to examine the impact of a brief, audio-recorded, mindfulness intervention on patients' pain in the clinic waiting room. Method: Study 1 examined an 8-min mindfulness recording delivered before a provider visit; Study 2 examined a 5-min mindfulness recording after a provider visit; and Study 3 examined a 4-min mindfulness recording before a provider visit. Time- and attention-matched control conditions were used in each study. Studies 1 and 2 were conducted in an academic cancer hospital. Study 3 was conducted at a walk-in orthopedic clinic. Pain intensity was measured in each of the three studies. Anxiety and depression symptoms were measured in Studies 2 and 3. Pain unpleasantness was measured in Study 3. Results: A brief (i.e., 4- to 8-min), audio-recorded mindfulness intervention decreased patients' pain intensity in the clinic waiting room, whether delivered before (Study 1 Cohen's d=1.01, Study 3 Cohen's d=0.39) or after (Study 2 Cohen's d=0.89) a provider visit. Mindfulness had a significant effect on anxiety symptoms in both studies in which it was measured. No effect on depression symptoms was observed. Conclusions: Results from these three pilot RCTs indicate brief, audio-recorded, mindfulness interventions may be capable of quickly decreasing clinical symptoms. As such, embedding brief, audio-recorded, mindfulness interventions in clinic waiting rooms may have the potential to improve patient outcomes. The continued investigation of this intervention approach is needed. Clinical Trial Registrations: NCT04477278 and NCT06099964.

Mindfulness-Based Interventions for Perioperative Pain Management and Opioid Risk Reduction Following Surgery: A Stepped Care Approach

Surgical procedures often improve health and function but can sometimes also result in iatrogenic effects, including chronic pain and opioid misuse. Due to the known risks of opioids and the physical, emotional, and financial suffering that often accompanies chronic pain, there has been a call for greater use of complementary non-pharmacological treatments like mindfulness-based interventions. Mindfulness can be broadly described as an attentional state involving moment-by-moment meta-awareness of thoughts, emotions, and body sensations. An expanding number of randomized clinical trials have found strong evidence for the value of mindfulness techniques in alleviating clinical symptomology relevant to surgical contexts. The purpose of this review is to examine the empirical evidence for the perioperative use of mindfulness interventions. We present a mindfulness-based stepped care approach that first involves brief mindfulness to treat preoperative pain and anxiety and prevent development of postoperative chronic pain or opioid misuse. More extensive mindfulness-based interventions are then provided to patients who continue to experience high pain levels or prolonged opioid use after surgery. Finally, we review psychophysiological mechanisms of action that may be integral to the analgesic and opioid sparing effects of mindfulness.

Enhancing Chronic Non-Cancer Pain Management: A Systematic Review of Mindfulness Therapies and Guided Imagery Interventions

Background and Objectives: There has been an increasing interest in the use of non-pharmacological approaches for the multidimensional treatment of chronic pain. The aim of this systematic review was to assess the effectiveness of mindfulness-based therapies and Guided Imagery (GI) interventions in managing chronic non-cancer pain and related outcomes. Materials and Methods: Searching three electronic databases (Web of Science, PubMed, and Scopus) and following the PRISMA guidelines, a systematic review was performed on Randomized Controlled Trials (RCTs) and pilot RCTs investigating mindfulness or GI interventions in adult patients with chronic non-cancer pain. The Cochrane Risk of Bias Tool was utilized to assess the quality of the evidence, with outcomes encompassing pain intensity, opioid consumption, and non-sensorial dimensions of pain. Results: Twenty-six trials met the inclusion criteria, with most of them exhibiting a moderate to high risk of bias. A wide diversity of chronic pain types were under analysis. Amongst the mindfulness interventions, and besides the classical programs, Mindfulness-Oriented Recovery Enhancement (MORE) emerges as an approach that improves interoception. Six trials demonstrated that mindfulness techniques resulted in a significant reduction in pain intensity, and three trials also reported significant outcomes with GI. Evidence supports a significant improvement in non-sensory dimensions of pain in ten trials using mindfulness and in two trials involving GI. Significant effects on opioid consumption were reported in four mindfulness-based trials, whereas one study involving GI found a small effect with that variable. Conclusions: This study supports the evidence of benefits of both mindfulness techniques and GI interventions in the management of chronic non-cancer pain. Regarding the various mindfulness interventions, a specific emphasis on the positive results of MORE should be highlighted. Future studies should focus on specific pain types, explore different durations of the mindfulness and GI interventions, and evaluate emotion-related outcomes.

Effects of perioperative clinical hypnosis on heart rate variability in patients undergoing oncologic surgery: secondary outcomes of a randomized controlled trial

Introduction

Clinical hypnosis has been proposed for post-surgical pain management for its potential vagal-mediated anti-inflammatory properties. Evidence is needed to understand its effectiveness for post-surgical recovery. Iin this secondary outcome study, it was hypothesized that surgical oncology patients randomized to receive perioperative clinical hypnosis (CH) would demonstrate greater heart-rate variability (HRV) during rest and relaxation at a 1-month post-surgery assessment compared to a treatment-as-usual group (TAU).

Methods

After REB approval, trial registration and informed consent, 92 participants were randomized to receive CH (n = 45) or TAU (n = 47). CH participants received a CH session before surgery and during post-surgical in-hospital stay HRV was assessed during rest (5 min) and relaxation (10 min) before and 1-month after surgery. Pain intensity was obtained using a 0-10 numeric rating scale pre and post 1-week and 1-month post surgery.

Results

One month after surgery, HRV was significantly higher in CH group (n = 29) during rest and relaxation (both p < 0.05, d = 0.73) than TAU group (n = 28). By contrast, rest and relaxation HRV decreased from pre- to 1-month post-surgery for the TAU (both p < 0.001, d > 0.48) but not the CH group. Pain intensity increased from pre-surgery to 1-week post-surgery (p < 0.001, d = 0.50), and decreased from 1-week to 1-month post-surgery (p = 0.005, d = 0.21) for all participants.

Discussion

The results suggest that hypnosis prevents the deleterious effects of surgery on HRV by preserving pre-operative vagal activity. These findings underscore the potential of clinical hypnosis in mitigating the adverse effects of surgery on autonomic function and may have significant implications for enhancing post-surgical recovery and pain management strategies.

Clinical Trial Registration

ClinicalTrials.gov, identifier (NCT03730350).

Integrative Medicine for Cancer-Related Pain: A Narrative Review

Cancer-related pain (C-RP) is a prevalent and debilitating concern among patients with cancer, with conventional treatments limited in their ability to provide adequate relief, and by the adverse effects associated with their use. Complementary and integrative medicine (CIM) modalities have been shown to be potentially effective and safe for the treatment of pain and related symptoms, when used in conjunction with conventional medications and under medical supervision. An increasing number of oncology centers provide CIM within their conventional supportive and palliative care service, in an "Integrative Oncology" (IO) setting. A large body of clinical research, including systematic reviews and guidelines such as those published in 2022 by the Society for Integrative Oncology (SIO), in collaboration with the American Society for Clinical Oncology (ASCO), support the use of some CIM modalities for C-RP and related concerns. These include acupuncture for general and peri-operative/procedural pain, as well as aromatase inhibitor-associated arthralgia (AIA); reflexology or acupressure for pain during systemic therapy for cancer; hypnosis for procedural pain or pain due to diagnostic workup; and massage for pain experienced by patients during palliative and hospice care. Further research is needed, within both randomized control trials and pragmatic non-controlled studies which are more reflective of the real-life IO setting. This review summarizes the evidence supporting the use of CIM for C-RP; the analgesic mechanism of the modalities presented; and the challenges facing IO researchers, as well as the implementation of the 2022 SIO-ASCO guideline recommendations.

Mindfulness-based Interventions for Chronic Low Back Pain: A Systematic Review and Meta-analysis

OBJECTIVE

This systematic review aimed to compile existing evidence examining the effects of mindfulness-based interventions (MBIs) for chronic low back pain (CLBP). CLBP leads to millions of disabled individuals in the United States each year. Current pharmacologic treatments are only modestly effective and may present long-term safety issues. MBIs, which have an excellent safety profile, have been shown in prior studies to be effective in treating CLBP yet remained underutilized.

DESIGN

Ovid/Medline, PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs), pilot RCTs, and single-arm studies that explored the effectiveness of MBIs in CLBP.

METHODS

Separate searches were conducted to identify trials that evaluated MBIs in reducing pain intensity in individuals with CLBP. A meta-analysis was then performed using R v3.2.2, Metafor package v 1.9-7.

RESULTS

Eighteen studies used validated patient-reported pain outcome measures and were therefore included in the meta-analysis. The MBIs included mindfulness meditation, mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness-oriented recovery enhancement, acceptance and commitment therapy, dialectical behavioral therapy, meditation-cognitive behavioral therapy, mindfulness-based care for chronic pain, self-compassion course, and loving-kindness course. Pain intensity scores were reported using a numerical rating scale (0 to 10) or an equivalent scale. The meta-analysis revealed that MBIs have a beneficial effect on pain intensity with a large-sized effect in adults with CLBP.

CONCLUSIONS

MBIs seem to be beneficial in reducing pain intensity. Although these results were informative, findings should be carefully interpreted due to the limited data the high variability in study methodologies, small sample sizes, inclusion of studies with high risk of bias, and reliance on pre-post treatment differences with no attention to maintenance of effects. More large-scale RCTs are needed to provide reliable effect size estimates for MBIs in persons with CLBP.

Meta-analytic evidence on the efficacy of hypnosis for mental and somatic health issues: a 20-year perspective

Introduction

Documented use and investigation of hypnosis spans centuries and its therapeutic use has received endorsement by multiple medical associations. We conducted a comprehensive overview of meta-analyses examining the efficacy of hypnosis to provide a foundational understanding of hypnosis in evidence-based healthcare, insight into the safety of hypnosis interventions, and identification of gaps in the current research literature.

Methods

In our systematic review, meta-analyses of randomized controlled trials on the efficacy of hypnosis in patients with mental or somatic health problems compared to any control condition published after the year 2000 were included. A comprehensive literature search using Medline, Scopus, PsycINFO, The Cochrane Library, HTA Database, Web of Science and a manual search was conducted to identify eligible reviews. Methodological quality of the included meta-analyses was rated using the AMSTAR 2 tool. Effect estimates on various outcomes including at least three comparisons (k ≥ 3) were extracted and transformed into a common effect size metric (Cohen's d). If available, information on the certainty of evidence for these outcomes (GRADE assessment) was obtained.

Results

We included 49 meta-analyses with 261 distinct primary studies. Most robust evidence was reported for hypnosis in patients undergoing medical procedures (12 reviews, 79 distinct primary studies) and in patients with pain (4 reviews, 65 primary studies). There was a considerable overlap of the primary studies across the meta-analyses. Only nine meta-analyses were rated to have high methodological quality. Reported effect sizes comparing hypnosis against control conditions ranged from d = -0.04 to d = 2.72. Of the reported effects, 25.4% were medium (d ≥ 0.5), and 28.8% were large (d ≥ 0.8).

Discussion

Our findings underline the potential of hypnosis to positively impact various mental and somatic treatment outcomes, with the largest effects found in patients experiencing pain, patients undergoing medical procedures, and in populations of children/adolescents. Future research should focus on the investigation of moderators of efficacy, on comparing hypnosis to established interventions, on the efficacy of hypnosis for children and adolescents, and on identifying patients who do not benefit from hypnosis.

Clinical Trial Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023395514, identifier CRD42023395514.

Race-Based Differences in the Response to a Mindfulness Based Integrative Medical Group Visit Intervention for Chronic Pain

Background

Chronic pain is one of the most common drivers of healthcare utilization and a marked domain for health disparities, as African American/Black populations experience high rates of chronic pain. Integrative Medical Group Visits (IMGV) combine mindfulness techniques, evidence-based integrative medicine, and medical group visits. In a parent randomized controlled trial, this approach was tested as an adjunct treatment in a diverse, medically underserved population with chronic pain and depression.

Objective

To determine race-based heterogeneity in the effects of a mindfulness based treatment for chronic pain.

Methods

This secondary analysis of the parent trial assessed heterogeneity of treatment effects along racialized identity in terms of primary patient-reported pain outcomes in a racially diverse sample suffering from chronic pain and depression. The analytic approach examined comorbidities and sociodemographics between racialized groups. RMANOVAs examined trajectories in pain outcomes (average pain, pain severity, and pain interference) over three timepoints (baseline, 9, and 21 weeks) between participants identifying as African American/Black (n = 90) vs White (n = 29) across both intervention and control conditions.

Results

At baseline, African American/Black participants had higher pain severity and had significantly different age, work status, and comorbidity profiles. RMANOVA models also identified significant race-based differences in the response to the parent IMGV intervention. There was reduced pain severity in African American/Black subjects in the IMGV condition from baseline to 9 weeks. This change was not observed in White participants over this time period. However, there was a reduction in pain severity in White participants over the subsequent interval from 9 to 21 week where IMGV had no significant effect in African American/Black subjects during this latter time period.

Conclusion

Interactions between pain and racialization require further investigation to understand how race-based heterogeneity in the response to integrative medicine treatments for chronic pain contribute to the broader landscape of health inequity.

A synthesis of meta-analyses of mindfulness-based interventions in pain

ABSTRACT

Mindfulness interventions have become popular in recent decades, with many trials, systematic reviews, and meta-analyses of the impact of mindfulness-based interventions (MBIs) on pain. Although many meta-analyses provide support for MBIs, the results are more mixed than they at first appear. The aim of this umbrella review was to determine the strength of evidence for MBIs by synthesizing available meta-analyses in pain. We conducted a systematic search in 5 databases and extracted data from published meta-analyses as the unit of analysis. For each outcome, we reported the range of effect sizes observed across studies and identified the largest meta-analysis as the "representative" study. We separately analysed effect sizes for different pain conditions, different types of MBIs, different control groups, and different outcomes. We identified 21 meta-analyses that included 127 unique studies. According to Assessment of Multiple Systematic Review ratings, the meta-analyses ranged from very strong to weak. Overall, there was an impact of MBIs on pain severity, anxiety, and depression but not pain interference or disability. When conditions were considered in isolation, only fibromyalgia and headache benefited significantly from MBIs. Mindfulness-based interventions were more efficacious for pain severity than passive control conditions but not active control conditions. Only pain severity and anxiety were affected by MBIs at follow-up. Overall, our results suggest that individual meta-analyses of MBIs may have overestimated the efficacy of MBIs in a range of conditions. Mindfulness-based interventions likely have a role in pain management but should not be considered a panacea.

Patient-targeted interventions for opioid deprescribing: An overview of systematic reviews

BACKGROUND

Deprescribing (reduction or cessation) of prescribed opioids can be challenging for both patients and healthcare professionals.

OBJECTIVE

To synthesize and evaluate evidence from systematic reviews examining the effectiveness and outcomes of patient-targeted opioid deprescribing interventions for all types of pain.

METHODS

Systematic searches were conducted in five databases with results screened against predetermined inclusion/exclusion criteria. Primary outcomes were (i) reduction in opioid dose, reported as change in oral Morphine Equivalent Daily Dose (oMEDD) and (ii) success of opioid deprescribing, reported as the proportion of the sample for which opioid use declined. Secondary outcomes included pain severity, physical function, quality of life and adverse events. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

FINDINGS

Twelve reviews were eligible for inclusion. Interventions were heterogeneous in nature and included pharmacological (n = 4), physical (n = 3), procedural (n = 3), psychological or behavioural (n = 3) and mixed (n = 5) interventions. Multidisciplinary care programmes appeared to be the most effective intervention for opioid deprescribing; however, the certainty of evidence was low, with significant variability in opioid reduction across interventions.

CONCLUSIONS

Evidence is too uncertain to draw firm conclusions about specific populations who may derive the greatest benefit from opioid deprescribing, warranting further investigation.

The nuts and bolts of multimodal anaesthesia in the 21st century: a primer for clinicians

PURPOSE OF REVIEW

This review article explores the application of multimodal anaesthesia in general anaesthesia, particularly in conjunction with locoregional anaesthesia, specifically focusing on the importance of EEG monitoring. We provide an evidence-based guide for implementing multimodal anaesthesia, encompassing drug combinations, dosages, and EEG monitoring techniques, to ensure reliable intraoperative anaesthesia while minimizing adverse effects and improving patient outcomes.

RECENT FINDINGS

Opioid-free and multimodal general anaesthesia have significantly reduced opioid addiction and chronic postoperative pain. However, the evidence supporting the effectiveness of these approaches is limited. This review attempts to integrate research from broader neuroscientific fields to generate new clinical hypotheses. It discusses the correlation between high-dose intraoperative opioids and increased postoperative opioid consumption and their impact on pain indices and readmission rates. Additionally, it explores the relationship between multimodal anaesthesia and pain processing models and investigates the potential effects of nonpharmacological interventions on preoperative anxiety and postoperative pain.

SUMMARY

The integration of EEG monitoring is crucial for guiding adequate multimodal anaesthesia and preventing excessive anaesthesia dosing. Furthermore, the review investigates the impact of combining regional and opioid-sparing general anaesthesia on perioperative EEG readings and anaesthetic depth. The findings have significant implications for clinical practice in optimizing multimodal anaesthesia techniques (Supplementary Digital Content 1: Video Abstract, http://links.lww.com/COAN/A96 ).

Racial Disparities in Pain Among Women with Fibromyalgia: Secondary Data Analysis of Severity, Interference with Function, and Response to Guided Imagery

Background: Fibromyalgia syndrome (FMS) is characterized by widespread persistent musculoskeletal pain. Mostly prevalent among White women, little is known about FMS in other population cohorts. This study examined secondary data of a racially diverse sample of women with FMS that were collected as part of a randomized controlled clinical trial that examined the effect of a complementary therapy intervention over the course of a 10-week guided imagery intervention to identify demographic, social, or economic differences in self-reported pain. Materials and Methods: The Brief Pain Inventory (BPI), which measures pain severity and interference, was administered to 72 women (21 Black and 51 Whites) at baseline, 6 and 10 weeks. Student's t tests and time series regression models examined racial difference in pain dimensions and treatment response. Regression models accounted for age, race, income, duration of symptoms, treatment group, pain at baseline, smoking, alcohol use, comorbid conditions, and time. Results: Black women experienced significantly higher pain severity (β = 5.52, standard deviation [SD] = 2.13) and interference (β = 5.54, SD = 2.74) than Whites (severity β = 4.56, SD = 2.08; interference β = 4.72, SD = 2.76) (interference: t = 1.92, p = 0.05; severity: t = 2.95, p = 0.00). Disparities persisted over time. Controlling for differences in age, income, and previous pain levels, Black women had 0.26 (standard error [SE] = 0.065) higher pain severity and 0.36 (SE = 0.078) higher interference than Whites. Low-income earners also experienced 2.02 (SE = 0.38) and 2.19 (SE = 0.46) higher pain severity and interference, respectively, than other earners. Results were robust to inclusion of comorbidities. Conclusions: Black women and low-income earners experienced significantly higher levels of pain severity and interference and a lower dose response to the intervention. Differentials were robust to inclusion of demographic, health, and behavioral characteristics. Findings suggest that external factors may contribute to pain perception among women with FMS.

Use of Complementary Pain Management Strategies in Postoperative Cardiac Surgical Patients

BACKGROUND

Complementary pain management strategies are effective at reducing pain in postsurgical patients.

LOCAL PROBLEM

Cardiac nurses at a large academic hospital reported inconsistent awareness of patient opioid utilization and poor implementation of complementary pain management strategies.

METHODS

A pre/post-quality improvement project was conducted on 2 inpatient cardiac units. Outcomes included nursing staff's perceived knowledge, confidence, and use of complementary pain management strategies and knowledge of patient postsurgical opioid utilization through calculation of morphine milligram equivalence (MME).

INTERVENTIONS

A comprehensive education program was implemented that included increased patient access to pain management resources, nurse education about complementary pain management strategies, and nurse education and access to MME calculations using a custom electronic health record application.

RESULTS

Nursing staff's perceived knowledge, confidence, and use of complementary pain techniques increased. Patient opioid utilization findings were inconclusive.

CONCLUSIONS

Educational programs about complementary pain management offer promise to improve cardiac postsurgical patient care.

Efficacy of mind-body therapies for sleep disturbance in patients with early-stage cancer: A systematic review and network meta-analysis

OBJECTIVE

To evaluate and compare the efficacy of different mind-body therapies (MBTs) for sleep disturbance in patients with early-stage cancer.

METHODS

Randomised controlled trials that included patients (aged ≥18 years) with early stage cancer who underwent MBTs (mindfulness, hypnosis, relaxation, yoga, and qigong) were searched in the CINAHL via the EBSCO Host, Cochrane Library, Embase, MEDLINE, PsycINFO, PubMed, and Scopus databases, from the date of database inception to October 2022. The outcomes were subjective sleep disturbance and objective sleep efficiency. Network meta-analysis (NMA) and comparative effects ranking were performed using STATA (v14.0; STATACorp, College Station, TX, USA).

RESULTS

Forty-seven studies investigating five MBTs were included in the NMA. For cancer patients receiving active treatment, mindfulness demonstrated the largest effect size in reducing subjective sleep disturbance (standardised mean difference [SMD]: 0.85; 95% confidence intervals [CI]: 0.20-1.50; Grading of Recommendations Assessment, Development, and Evaluation assessment: moderate), and had the highest cumulative probability compared to usual care or waitlist. For cancer patients who had completed active treatment, qigong demonstrated the largest effect size in reducing subjective sleep disturbance (SMD: 0.99; 95% CI: 0.35-1.63; GRADE: low), followed by hypnosis (SMD: 0.87; 95% CI: 0.32-1.42; GRADE: moderate), and mindfulness (SMD: 0.42; 95% CI: 0.24-0.59; GRADE: moderate). Qigong also demonstrated the largest effect size in improving objective sleep efficiency (weighted mean differences: 10.76; 95% CI: 2.01-19.50; GRADE: low); however, the effect of qigong was tested in only one study in this NMA. Among the eight different treatment conditions, cognitive behavioral therapy (CBT) showed the highest cumulative probability (surface under the cumulative ranking curve: 96.3%) in reducing subjective sleep disturbance and the second highest cumulative probability (SUCRA: 83.3%) in improving objective sleep efficiency.

CONCLUSION

There is no evidence supporting the use of MBTs to replace or be comparable to CBT. Mindfulness can be recommended as an optional treatment for reducing sleep disturbance in patients with early-stage cancer. Some support was observed for qigong and hypnosis in reducing sleep disturbances in patients with early-stage cancer who had completed active treatment. More rigorous trials are warranted to confirm whether different forms of MBTs have different effects on sleep in patients with cancer.

Yoga and massage are associated with small experimental placebo effects in chronic orofacial pain

BACKGROUND

Complementary and Integrative Health Approaches (CIHA), including but not limited to, natural products and Mind and Body Practices (MBPs), are promising non-pharmacological adjuvants to the arsenal of pain management therapeutics. We aim to establish possible relationships between use of CIHA and the capacity of descending pain modulatory system in the form of occurrence and magnitude of placebo effects in a laboratory setting.

METHODS

This cross-sectional study investigated the relationship between self-reported use of CIHA, pain disability, and experimentally induced placebo hypoalgesia in chronic pain participants suffering from Temporomandibular Disorders (TMD). In the 361 enrolled TMD participants, placebo hypoalgesia was measured using a well-established paradigm with verbal suggestions and conditioning cues paired with distinct heat painful stimulations. Pain disability was measured with the Graded Chronic Pain Scale, and use of CIHA were recorded with a checklist as part of the medical history.

RESULTS

Use of physically oriented MBPs (e.g., yoga and massage) was associated with reduced placebo effects (F1,2110.44  = 23.15, p < 0.001, Cohen's d = 0.171). Further, linear regressions indicated that greater number of physically oriented MBPs predicted smaller placebo effects (β = -0.17, p = 0.002), and less likelihood of being a placebo responder (OR = 0.70, p = 0.004). Use of psychologically oriented MBPs and natural product were not associated with placebo effects magnitude and responsiveness.

CONCLUSIONS

Our findings suggest that use of physically oriented CIHA was associated with experimental placebo effects possibly through an optimized capability to recognize distinct somatosensorial stimulations. Future research is needed to understand the mechanisms underlying placebo-induced pain modulation in CIHA users.

SIGNIFICANCE

Chronic pain participants who use physically oriented mind-body practices, such as yoga and massage, demonstrated attenuated experimentally induced placebo hypoalgesia in comparison with those who do not use them. This finding disentangled the relationship between use of complementary and integrative approaches and placebo effects, providing the potential therapeutic perspective of endogenous pain modulation in chronic pain management.

A Pilot Randomized Controlled Trial of Effectiveness of a Psychoeducational Intervention on the Management of Musculoskeletal Chronic Noncancer Pain

AIMS

To investigate the effectiveness of a psychoeducational intervention on pain intensity management in musculoskeletal chronic noncancer pain and to identify relevant variables and preliminary data to allow the design of a randomized controlled trial.

DESIGN

Two arms parallel randomized pilot study.

SUBJECTS AND SETTING

ADULT PATIENTS WITH MUSCULOSKELETAL CHRONIC NONCANCER PAIN WITH MODERATE-SEVERE INTENSITY TREATED AT PRIMARY HEALTH CENTERS.

METHODS

Participants were randomly assigned to a psychoeducational intervention or a control group without intervention. Pain intensity, quality of life, and opioid use were assessed at baseline and at a 1-month follow-up.

RESULTS

The sample consisted of 37 adult patients (intervention group: 19; control group: 18). A significant reduction in pain intensity measured by the Verbal Numerical Rating Scale (p = .02, Cohen's d = 0.57) and improvement in quality of life measured by EuroQol-5D questionnaire (p = .04) were observed in the intervention group compared to the control. This improvement on pain intensity was greater in patients without strong opioid treatment (p = .01, Cohen's d = 1.36). Eighty percent of the strong opioids users in the intervention group reduced their consumption, without changes in the control group.

CONCLUSIONS

These findings provide promising support for the beneficial effects of psychoeducation on the intensity of noncancer chronic musculoskeletal pain. Based on the results, future randomized controlled trials are needed.

Yoga Versus Education for Veterans with Chronic Low Back Pain: a Randomized Controlled Trial

BACKGROUND

Yoga is effective for chronic low back pain (cLBP) in civilians but understudied among Veterans.

OBJECTIVE

Determine whether yoga is more effective than an educational book for improving disability and pain among Veterans with cLBP.

DESIGN, SETTING, AND PARTICIPANTS

Veterans diagnosed with cLBP at a VA medical center enrolled in a randomized controlled trial from March to December of 2015.

INTERVENTIONS

Twelve weekly hatha yoga classes or education using The Back Pain Helpbook.

MEASURES

Co-primary outcomes were changes from baseline at 12 weeks in back-related disability on the modified Roland Morris Disability Questionnaire and pain on the Defense & Veterans Pain Rating Scale. Secondary outcomes were global improvement, patient satisfaction, pain medication use, and post-traumatic stress symptoms. An intention-to-treat approach was used in primary analyses.

RESULTS

One hundred twenty Veterans (mean age, 55.5 [SD = 16.9]; 11 [9%] women; mean number of chronic conditions, 5.5) were randomized to yoga (n = 62) and education (n = 58). At 12 weeks, reductions in back-related disability in yoga (mean difference [MD] = - 3.50, 95% CI: - 5.03, - 1.97) were not significantly different than education (MD = - 2.55, 95% CI: - 4.10, - 0.99; between-group difference: - 0.95 [95% CI: - 3.14, 1.23], p = 0.39). For pain, there was no significant difference between yoga (MD = - 1.01, 95% CI: - 1.67, - 0.35) and education (MD = - 0.81, 95% CI: - 1.36, - 0.27; between-group difference: - 0.20, 95% CI: - 1.06, 0.66, p = 0.65). More yoga than education participants reported being very much or extremely improved (39% vs 19%, OR = 3.71, 95% CI: 1.37, 10.02, p = 0.01) and very satisfied with treatment (60% vs 31%, OR = 4.28, 95% CI: 1.70, 10.77, p = 0.002). No differences in pain medication use or post-traumatic stress symptoms were observed at 12 weeks. No serious adverse events were reported in either group.

CONCLUSION

Twelve weekly yoga classes were not more effective than an education intervention for improving pain or disability outcomes among mostly older male Veterans with cLBP and multiple comorbid health conditions.

CLINICALTRIALS

GOV IDENTIFIER

NCT02224183.

To be aware, or to accept, that is the question: Differential roles of awareness of automaticity and pain acceptance in opioid misuse

BACKGROUND

Individuals with chronic low back pain (CLBP) are commonly prescribed long-term opioid therapy (LTOT) for analgesia, placing this population at increased risk for opioid misuse and opioid use disorder. Acceptance of aversive experiences (e.g., chronic pain) and awareness of automatic thoughts and behaviors (i.e., automaticity) are two facets of dispositional mindfulness that may serve as protective mechanisms against opioid misuse risk. Therefore, the aim of the current study was to examine the differential contributions of these constructs to opioid misuse risk among adults with CLBP receiving LTOT.

METHODS

Data were obtained from a sample of 770 adults with opioid-treated CLBP. Bivariate correlations and hierarchical linear regression analyses were used to determine whether chronic pain acceptance and awareness of automatic thoughts and behaviors explained a statistically significant portion of variance in opioid misuse risk after accounting for the effects of other relevant confounders.

RESULTS

Hierarchical regression results revealed that chronic pain acceptance and awareness of automatic thoughts and behaviors contributed a significant portion in the variance of opioid misuse risk. Awareness of automatic thoughts and behaviors was negatively associated with opioid misuse risk, such that individuals with lower levels of awareness of automaticity were at higher risk of opioid misuse. By contrast, pain acceptance was not associated with opioid misuse.

CONCLUSIONS

Findings suggest that awareness of automaticity may buffer against opioid misuse risk. Interventions designed to strengthen awareness of automaticity (e.g., mindfulness-based interventions) might be especially efficacious among this population.

Mind-Body Therapies for Sleep Disturbance among Patients with Cancer: A Systematic Review and Meta-analysis

OBJECTIVE

s: To assess whether mind-body therapies (MBTs) are effective for relieving sleep disturbance among patients with cancer.

DESIGN

Systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

Seven English electronic databases were searched from the date of inception to September 2022. All RCTs that included adults (≥18 years) who were treated with mindfulness, yoga, qigong, relaxation, and hypnosis were screened. The outcome was subjective and/or objective sleep disturbance.The revised Cochrane tool (RoB 2.0) was applied to evaluate the risk of bias. The RevMan software was applied to assessed each outcome according different control groups and assessment time points. Subgroup analyses were performed according to different categories of MBTs.

RESULTS

Sixty-eight RCTs (6339 participants) were identified. After requesting for missing data from corresponding authors of included RCTs, 56 studies (5051 participants) were included in the meta-analysis. The meta-analysis showed a significant immediate effect of mindfulness, yoga, relaxation, and hypnosis on subjective sleep disturbance, compared with usual care or wait list control, and the effect of mindfulness lasted at least 6 months. For objective sleep outcomes, we observed significant immediate effects of yoga on wake after sleep onset and of mindfulness on sleep onset latency and total sleep time. Compared with active control interventions, MBTs had no significant effect on sleep disturbance.

CONCLUSIONS

Mindfulness, yoga, relaxation, and hypnosis were effective in sleep disturbance severity reduction among patients with cancer at post-intervention, and the effect of mindfulness lasted at least 6 months. Future MBTs studies should apply both objective and subjective sleep measurement tools.

Redesigning Opioid Pain Agreements to Promote Patient-Centered Care

This Viewpoint discusses opioid pain agreements to promote patient-centered care.

The Effects of Listening to the Qur'an in the Postoperative Management of the Patients Undergoing Laparoscopic Cholecystectomy in the Day Surgery Unit

PURPOSE

To determine if listening to verses of the Qur'an during the immediate postoperative period has an effect on patients' anxiety levels, the number of opioids used to control pain, and the length of stay (LOS) in the Post Anesthesia Care Unit (PACU).

DESIGN

Randomized Control Trial. Adult Muslim patients who had undergone a laparoscopic cholecystectomy through the Day Surgery Unit were randomly selected using computer-generated sequence into two groups, interventional and control groups.

METHODS

The control group listened to the natural environment and received Fentanyl for pain relief, and the interventional group listened to the Qur'an recitation and received Fentanyl for pain relief. A total of 112 (79.4%) participants completed the study. The level of the pain and anxiety was measured using the Wong-Baker Faces pain scale and Spielberger State-Trait Anxiety Inventory, respectively. Statistical analysis was conducted using SAS version 9.3 (Statistical Analysis System, SAS Institute Inc, Cary, North Carolina).

FINDINGS

This study compared the effects of Qur'an audio therapy on patients' anxiety levels, opioid consumption, pain, and LOS in the PACU. The findings showed that by listening to chosen verses from the Qur'an in the recovery period post-anaesthesia, anxiety scores were significantly reduced (P = .0001), opiate use was reduced (P = .0081), and overall PACU LOS was also reduced (P = .0083).

CONCLUSIONS

Adding the use of listening to the Qur'an as a complementary therapy is a simple and cost-effective measure to reduce the need for narcotics in the PACU, and reduce the overall PACU length of stay. This intervention benefits the patient, the PACU, and reduces health care organization costs.

Integrative Surgery: Embedding Complementary and Nonpharmacologic Therapies into Surgical Pain Management Strategies

There has been a growing interest in the use of complementary and alternative medicine in modern pain management strategies on behalf of both patients and clinicians. Nonpharmacologic modalities such as cryotherapy, acupuncture, music, and mind-body therapies have been shown to aid in symptom control and improve quality of life in patients suffering from acute and chronic pain, and there is a growing body of literature demonstrating their feasibility, acceptability, and efficacy in the perioperative period. Here, we provide a brief review of the current evidence supporting the use of complementary therapies within existing perioperative pain management strategies and highlight evidence-based protocols to facilitate implementation into modern surgical practice.

Feasibility and Acceptability of Online Recruitment and an Online Brief Mindfulness Intervention Among Patients With Sickle Cell Disease

Background Pain among young adult patients with sickle cell disease (PWSCD) is a highly significant public health problem associated with reduced quality of life. Due to issues uniquely affecting PWSCD, including distrust of research, challenging life situations, debilitating pain, stigma, and logistical challenges (e.g., child or elder care and transportation), SCD researchers often find it challenging to meet sample size and enrollment targets. To our knowledge, all known SCD studies have solely recruited participants in person (e.g., clinics and local organizations) and utilized lengthy interventions with suboptimal recruitment and retention results. Newer recruitment methods, such as online recruitment, need to be explored for research among PWSCD. In this pilot project, we sought to address these challenges by investigating: 1) a novel method of using online outreach to recruit/enroll young PWSCD and 2) a novel, brief online mindfulness intervention adapted from Mindfulness-Oriented Recovery Enhancement (MORE): Mini-MORE designed to treat pain among PWSCD.  Methods Participants (N = 32) were recruited online (e.g., paid advertisements on Facebook and NextDoor; free advertisements on Facebook groups and Reddit) and screened by phone from October 25 to November 8, 2022. Participants watched an online Mini-MORE video. Immediately before and after watching the video, participants rated their pain intensity and unpleasantness on an 11-point numeric rating scale (NRS). Afterward, participants were emailed an individualized link to additional audio recordings for ongoing practice. Immediately before and after accessing the additional recordings, participants rated their pain intensity, anxiety, and depression on an 11-point NRS. T-tests were used to examine the impact of Mini MORE on outcomes at two-time points. Results A total of 84 participants completed the self-screening. The majority of self-screeners resulted from free posts in Facebook groups (77%), Reddit (1%), and Craigslist (6%). Thirty-two (32) eligible participants agreed to join a Zoom meeting to watch the video. The entire Mini-MORE video was viewed by 31 of 32 participants (97%). Pain intensity decreased by 1.7 points (p<0.001, Cohen's d=2.19), and pain unpleasantness decreased by 2.1 points (p<0.001, Cohen's d=2.20). Listening to the supplemental recordings was associated with significant, immediate decreases in pain intensity by 1.3 points (p=0.015, Cohen's d=2.05), anxiety by 1.8 points (p=0.022, Cohen's d=3.10), and depression by 1.74 points (p=0.019, Cohen's d=2.94). Conclusions Results suggest that online methods are feasible in recruiting and enrolling young PWSCD, and the online Mini-MORE intervention is acceptable among PWSCD. Future research is needed to assess whether Mini-MORE is associated with decreased pain symptomology in young PWSCD.

A Brief Mindfulness Intervention for Parents and Children before Pediatric Venipuncture: A Randomized Controlled Trial

BACKGROUND

Routine needle procedures can be distressing for parents and children. Mindfulness interventions may be helpful for parents and children but have not been examined for pediatric needle procedures despite showing benefits in the context of pediatric chronic pain and in lab-based pain tasks.

METHODS

This preregistered (NCT03941717) two-arm, parallel-group randomized controlled trial examined the effects of a 5 min mindfulness intervention before pediatric venipuncture for parents and children (aged 7-12) compared to a control group on primary outcomes of child pain and fear, secondary outcomes of parent distress, and tertiary outcomes of parent ratings of child pain and fear. Moderators of parent and children's responses to the intervention were examined: state catastrophizing, trait mindfulness, and experiential avoidance.

RESULTS

Sixty-one parent-child dyads were randomized (31 mindfulness; 30 control). Parents and children completed measures, listened to a 5 min audio recording (mindfulness or control), and parents accompanied their child during routine venipuncture. The mindfulness intervention involved breathing and encouraging nonjudgmental attention to one's experiences, while the control condition involved an unfocused attention task. Three between-subject MANCOVAs assessed for group differences. Child pain and fear rated by children and their parents did not differ between groups. Parents in the mindfulness group were less distressed during the venipuncture than the controls. Parent state catastrophizing may have moderated the intervention effects, such that parents with moderate and high catastrophizing levels had lower distress following the mindfulness intervention versus control.

CONCLUSIONS

The intervention did not reduce child pain or fear but reduced parent distress. It appeared most helpful for parents catastrophizing about their child's pain, which is noteworthy as these children are prone to worse outcomes.

Mind-body therapies in traditional Chinese medicine for Neuropathic Pain: A Systematic Review of Randomized Controlled Trials

OBJECTIVES

To evaluate the effectiveness and safety of traditional Chinese medicine (TCM) mind-body therapies in patients with neuropathic pain.

DESIGN

This systematic review was undertaken according to the PRISMA 2020 statement.

DATA SOURCES

We searched randomized controlled trials (RCTs) in seven English databases and four Chinese databases up to March 2022.

REVIEW/ANALYSIS METHODS

The Cochrane Risk of Bias 2 was used for the quality assessment, and the mean difference with a 95% confidence interval for data pooling. The review was registered in the INPLASY (INPLASY202240016).

RESULTS

Twenty-three RCTs were identified, including 1,693 patients with lumbar herniated discs (LHD), cervical spondylotic radiculopathy (CSR), sympathetic cervical spondylosis (SCS), trigeminal neuralgia, and central poststroke pain. Pooled results showed that for LHD, TCM mind-body therapy used alone (MD: -0.57, [-0.77, -0.36], P＜0.01, week 8) or combined with physiotherapy (MD: -1.02, [-1.12, -0.91], P＜0.01, week 4) showed advantages over physiotherapy alone on pain relief. However, there was no statistical difference on physical function. For CSR, TCM mind-body movement combined with physiotherapy had better effect than physiotherapy alone on pain relief (MD: -1.15, [-1.37, -0.94], P＜0.01, week 4). Six trials reported safety. Nausea, dizziness, fatigue, and pain at the acupuncture point were observed.

CONCLUSIONS

Low-quality evidence showed that TCM mind-body therapies might reduce pain intensity and improve physical function when used as an adjuvant therapy or monotherapy. There is a need to conduct high-quality trials to confirm the effectiveness and safety of TCM mind-body therapies for neuropathic pain.

Efficacy of non-pharmacological interventions in pain relief and opioid consumption after cardiac surgery: A systematic review and Bayesian network meta-analysis

OBJECTIVE

To investigate and rank the evidence for the efficacy of non-pharmacological interventions in relieving pain after cardiac surgery using comprehensive comparisons.

BACKGROUND

Although several previous systematic reviews and meta-analyses showed that non-pharmacological interventions effectively control and reduce pain after cardiac surgery, none quantitatively compared the effect of these different types of interventions.

DESIGN

Systematic review and Bayesian network meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analysis guidelines.

METHODS

Six databases were searched from inception to April 2021 to collect all published evidence from randomised clinical trials. One author extracted the relevant information from the eligible trials; a second author independently reviewed the data. Before analysing the extracted data, two investigators independently assessed the quality of the included studies. Conventional meta-analysis was conducted using either fixed- or random-effects models according to statistical heterogeneity. The Bayesian network meta-analysis was conducted using the consistency model.

RESULTS

We identified 42 randomised clinical trials comparing 14 groups with 4253 patients. Transcutaneous electrical nerve stimulation, acupressure, music and massage were effective for pain relief, with transcutaneous electrical nerve stimulation being associated with the best probability of successful pain relief after cardiac surgery (cumulative ranking curve surface, 0.97; probability, 77.03%). Acupressure (cumulative ranking curve surface, 0.79; probability, 30.69%) was the second-best option. However, there was no evidence that any pair-up intervention significantly reduced opioid use or anxiety.

CONCLUSIONS

These findings suggest that transcutaneous electrical nerve stimulation, acupressure, music and massage may effectively alleviate postoperative cardiac pain, with transcutaneous electrical nerve stimulation representing the best choice for pain relief.

RELEVANCE TO CLINICAL PRACTICE

The results of this network meta-analysis can guide patients after cardiac surgery and healthcare providers to make optimal decisions in managing postoperative cardiac pain.

TRIAL REGISTRATION

PROSPERO CRD42021246183.

Psychoneuroimmunology of Meditation

Background:

Meditation is a conscious mental discipline, that has been implicated in the relaxation response. The mechanism behind such a relaxing effect is psychoneuroimmunology (PNI), based on the interaction between mind, physical health, and self-healing; that conceptualizes that stress and an individual’s emotional state led to predisposition to diseases. Research to date suggests that meditation may play an active role in remodeling the imbalance between mind and body by modulating the psychoneuroimmunological effects of stress. However, to date, the multi-dimensional psychoneuroimmune aspects of meditation together have not been completely explicated. An evidence-based mechanism has been framed for the first time in India to explain the psychoneuroimmunology of regular and long-term meditation practice.

Summary:

Present evidence-based mechanism confirms prefrontal cortex (PFC) acts as a ‘Functional Connectome’ where psycho-neuro-immune aspects of meditation function simultaneously to exert positive benefits in the regulation of cognitive and emotional behavior. Also, this mechanism will help us to understand how human augmentation with lifestyle modification fosters brain plasticity to overcome various neuropsychiatric illnesses.

Key Message:

Meditation is a scientific tool against neuro-psychiatric illnesses.

Effect of progressive muscle relaxation on postoperative pain, fatigue, and vital signs in patients with head and neck cancers: A randomized controlled trial

OBJECTIVE

Surgery for head and neck cancers are associated with significant preoperative stress. We investigated the effects of progressive muscle relaxation (PMR) on postoperative pain, fatigue, and vital signs in patients with head and neck cancers.

METHODS

All patients were hospitalized and randomly assigned to intervention or usual care groups. A generalized estimating equation was used to evaluate the PMR effects on pain and symptoms across the preoperative day to postoperative day 10.

RESULTS

The PMR group displayed significantly lower overall pain and muscle tightness than control group along with the timeline of multiple measurements (p < 0.01). PMR significantly reduces sleep disturbances and levels of fatigue, anxiety, and depression compared with the control group with time trend (p < 0.01). PMR also lowered the respiratory rates and diastolic blood pressure (p < 0.01).

CONCLUSIONS

PMR can reduce sleep disturbances and levels of pain, fatigue, muscle tightness, anxiety, and depression in patients with head and neck cancer undergoing major surgeries. Future study should focus on improving the effectiveness of the exercise and standardization of the application.

PRACTICAL IMPLICATIONS

progressive muscle relaxation help relieve discomforts in patients with head and neck cancers with minimal costs and efforts.

Mind-body therapies for older adults with dementia: a systematic review and meta-analysis

PURPOSE

This systematic review of randomised controlled trials (RCTs) aimed to determine the effects of mind-body therapies (MBTs) among older adults with dementia.

METHODS

We searched five electronic databases (PubMed, PsycINFO, Web of Science, EMBASE, and the Cochrane Library) for publications investigating the effect of MBTs until July 14th, 2020. We included published peer-reviewed RCTs among participants with a mean age of 60 and above and a diagnosis of any dementia. Eligible studies included measurements for all types of health outcomes, including cognitive function, neuropsychiatric inventory, depressive syndromes, agitation, psychosocial status, and other health outcomes. Two investigators extracted data, the risk of bias for each study was evaluated through Review Manager, and statistical meta-analysis was performed using Stata.

RESULTS

A total of nine studies met the eligibility criteria, with full-text available for systematic review. Five of them, with 338 participants, were included in the meta-analysis. For most included RCTs of the review, the methodological quality was moderate. The meta-analysis showed that Tai Chi had a mild effect on global cognitive function (Mini-Mental State Examination, SMD = 0.40, 95% CI 0.10-0.70). Yoga and aromatherapy may also be beneficial for depression, and these three MBTs improved quality of life.

CONCLUSION

The current review suggested that MBTs may act as potential non-pharmaceutical approaches to improve certain health outcomes among older populations with dementia. Systematic review and meta-analysis registration: PROSPERO CRD42021198514.

Emotional distress and pain catastrophizing predict cue-elicited opioid craving among chronic pain patients on long-term opioid therapy

BACKGROUND

Individuals who use illicit substances exhibit cue-elicited craving and autonomic cue-reactivity when exposed to cues associated with past drug use. However, little is known about this phenomenon among chronic pain patients on long-term opioid therapy (LTOT). Negative cognitive-emotional reactivity in general (e.g., distress) and cognitive-emotional reactivity specific to pain (e.g., pain catastrophizing) might drive cue-reactivity independent of pain severity. Here we examined emotional distress and pain catastrophizing as predictors of cue-reactivity among a sample of chronic pain patients receiving LTOT. We also tested whether associations between distress, catastrophizing, and cue-reactivity differed as a function of opioid misuse status.

MATERIALS AND METHODS

Patients receiving LTOT (N = 243) were classified as exhibiting aberrant behavior consistent with opioid misuse (MISUSE+, n = 145) or as using opioids as prescribed (MISUSE-, n = 97). Participants completed assessments of pain catastrophizing and emotional distress and then participated in an opioid cue-reactivity task one week later. Cue-elicited opioid craving and autonomic cue-reactivity were measured with craving ratings and high-frequency heart rate variability (HRV), respectively.

RESULTS

Distress and catastrophizing predicted cue-elicited craving and HRV, whereas pain severity did not. Misuser status moderated the relationship between emotional distress and self-reported craving, such that higher levels of distress predicted craving among the MISUSE+ group, but not among the MISUSE- group. No moderating effects were found for catastrophizing.

CONCLUSIONS

Findings suggest that although opioids are prescribed for analgesia, the exacerbating influence of negative cognitive-emotional reactivity, both in general and specific to pain, on cue-elicited opioid craving extends beyond the effects of pain severity alone.

Meditative and Mindfulness-Focused Interventions in Neurology: Principles, Science, and Patient Selection

A growing body of research suggests that meditative- and mindfulness-focused interventions may improve neuropsychiatric symptoms that commonly occur in a range of neurological disorders. In this article, the principles of meditation and mindfulness are first defined, as well as briefly describing the neurobiological mechanisms implicated in these interventions. Thereafter, a range of meditative- and mindfulness-focused interventions are detailed, along with their supporting evidence to treat neuropsychiatric symptoms in neurological conditions (e.g., headache, movement disorders, chronic pain, etc.). Overall, these interventions warrant further investigation among individuals with neurological conditions. When recommending these interventions, health care professionals must consider a combination of structural (e.g., insurance reimbursement) and patient factors (e.g., ability to tolerate a group setting).

Mindfulness-Oriented Recovery Enhancement vs Supportive Group Therapy for Co-occurring Opioid Misuse and Chronic Pain in Primary Care: A Randomized Clinical Trial

IMPORTANCE

Successful treatment of opioid misuse among people with chronic pain has proven elusive. Guidelines recommend nonopioid therapies, but the efficacy of mindfulness-based interventions for opioid misuse is uncertain.

OBJECTIVE

To evaluate the efficacy of Mindfulness-Oriented Recovery Enhancement (MORE) for the reduction of opioid misuse and chronic pain.

DESIGN, SETTING, AND PARTICIPANTS

This interviewer-blinded randomized clinical trial enrolled patients from primary care clinics in Utah between January 4, 2016, and January 16, 2020. The study included 250 adults with chronic pain receiving long-term opioid therapy who were misusing opioid medications.

INTERVENTIONS

Treatment with MORE (comprising training in mindfulness, reappraisal, and savoring positive experiences) or supportive group psychotherapy (control condition) across 8 weekly 2-hour group sessions.

MAIN OUTCOMES AND MEASURES

Primary outcomes were (1) opioid misuse assessed by the Drug Misuse Index (self-report, interview, and urine screen) and (2) pain severity and pain-related functional interference, assessed by subscale scores on the Brief Pain Inventory through 9 months of follow-up. Secondary outcomes were opioid dose, emotional distress, and ecological momentary assessments of opioid craving. The minimum intervention dose was defined as 4 or more completed sessions of MORE or supportive group psychotherapy.

RESULTS

Among 250 participants (159 women [63.6%]; mean [SD] age, 51.8 [11.9] years), 129 were randomized to the MORE group and 121 to the supportive psychotherapy group. Overall, 17 participants (6.8%) were Hispanic or Latino, 218 (87.2%) were White, and 15 (6.0%) were of other races and/or ethnicities (2 American Indian, 3 Asian, 1 Black, 2 Pacific Islander, and 7 did not specify). At baseline, the mean duration of pain was 14.7 years (range, 1-60 years), and the mean (SD) morphine-equivalent opioid dose was 101.0 (266.3) mg (IQR, 16.0-90.0 mg). A total of 203 participants (81.2%) received the minimum intervention dose (mean [SD], 5.7 [2.2] sessions); at 9 months, 92 of 250 participants (36.8%) discontinued the study. The overall odds ratio for reduction in opioid misuse through the 9-month follow-up period in the MORE group compared with the supportive psychotherapy group was 2.06 (95% CI, 1.17-3.61; P = .01). At 9 months, 36 of 80 participants (45.0%) in the MORE group were no longer misusing opioids compared with 19 of 78 participants (24.4%) in the supportive psychotherapy group. Mixed models demonstrated that MORE was superior to supportive psychotherapy through 9 months of follow-up for pain severity (between-group effect: 0.49; 95% CI, 0.17-0.81; P = .003) and pain-related functional interference (between-group effect: 1.07; 95% CI, 0.64-1.50; P < .001). Participants in the MORE group reduced their opioid dose to a greater extent than those in the supportive psychotherapy group. The MORE group also had lower emotional distress and opioid craving.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, among adult participants in a primary care setting, the MORE intervention led to sustained improvements in opioid misuse and chronic pain symptoms and reductions in opioid dosing, emotional distress, and opioid craving compared with supportive group psychotherapy. Despite attrition caused by the COVID-19 pandemic and the vulnerability of the sample, MORE appeared to be efficacious for reducing opioid misuse among adults with chronic pain.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02602535.

"Practice Makes Perfect"? Associations Between Home Practice and Physical and Emotional Function Outcomes Among Patients with Chronic Pain Enrolled in a Mind-Body Program

Objectives: To summarize the characteristics of home practice adherence in patients with chronic pain randomized to a 10-week group mind-body activity program with (GetActive-Fitbit) and without (GetActive) a digital monitoring device, and test the association between home practice adherence and improvement in physical and emotional treatment outcomes. Methods: Data were collected in a pilot randomized controlled trial (RCT) of the GetActive (n = 41) and GetActive-Fitbit (n = 41) programs. Participants submitted weekly home practice logs depicting their daily physical activity and practice of relaxation and gratitude skills. Participants completed assessments of physical (patient-reported, performance-based, and accelerometer-measured) and emotional function outcomes both before and after the programs. Participants in both programs were combined due to the identical session and home practice content. Results: Participants reported engaging in physical activity on average 30.62 days (SD = 20.28, 48.6% of intervention days), relaxation skill practice on average 29.87 days (SD = 21.16, 47.4% of intervention days), and gratitude practice on average 32.10 days (SD = 22.12, 51.0% of intervention days). The average duration of physical activity and relaxation skill practice were 44.40 min a day (SD = 59.44) and 11.15 min a day (SD = 12.00), respectively. The duration of physical activity was significantly associated with decrease depression symptoms (p = 0.049, η2 = 0.056). No other association was found between home practice and change in outcomes. Conclusions: Patients with chronic pain are generally able and willing to engage in home practice during a mind-body activity intervention. Emphasizing longer duration of physical activity practice may contribute to an improvement in depression. Future fully powered RCTs with rigorous assessment of home practice adherence and dose-response designs may further elucidate the role of home practice in improvements in treatment outcomes. ClinicalTrials.gov identifier: NCT03412916.

Reduced Pain by Mind-Body Intervention Correlates with Improvement of Shoulder Function in People with Shoulder Pain: A Randomized Controlled Trial

Meditation and acupressure-like stimulations have been shown to relieve pain. The aim of this study was to determine whether a short bout of mind-body intervention combined with meditation and acupressure-like stimulation was able to alleviate shoulder pain and improve its function in a short time window. Sixty-five adults with shoulder pain were recruited and randomly classified into two groups. One group participated in an intervention which consisted of acupressure-like stimulation and meditation over a 5 min period. The other group was instructed to rest during this time. A visual analog scale (VAS) pain score and objective constant scores were measured before and after intervention to determine shoulder pain and range of motion (ROM), respectively. A two-way repeated measures analysis of variance with Bonferroni correction and a regression analysis were performed. VAS pain, objective constant score, flexion, abduction, and external rotation score showed significant interactions between time and group. The pain intensity was significantly reduced, while flexion and abduction were significantly improved, in the experimental group compared to the control group, after the intervention. In addition, the change of flexion negatively correlated with the change of pain intensity in the experimental group, but not in the control group. These results show that a short-term application of mind-body intervention significantly alleviates shoulder pain and improves shoulder movement, suggesting its potential use as a therapy for people with shoulder pain.

Interoception and social cognition in chronic low back pain: a common inference disturbance? An exploratory study

Aim: Lower interoceptive abilities are a characteristic of chronic pain conditions. Social support plays an important role in chronic low back pain (cLBP) but social cognitive skills have rarely been investigated. This study aimed to characterize interoceptive and social cognitive abilities in cLBP and to study the relationship between both domains that have been brought closer together by brain predictive coding models. Materials & methods: Twenty-eight patients with cLBP and 74 matched controls were included. Interoceptive accuracy (Heart Beat Perception Task), sensibility/awareness (Multidimensional Assessment of Interoceptive Awareness) and mental-states inference abilities (Mini-Social Cognition and Emotional Assessment) were assessed. Results: cLBP Patients had lower interoceptive accuracy and mentalizing performance. Conclusion: Less efficient interoceptive accuracy and mentalizing abilities were found in cLBP patients without correlation between these performances.

Mind-Body Therapies for Cancer Patients Living with Depression, Anxiety or Insomnia (MIRACLE): A Systematic Review with Individual Participant Data Network Meta-Analysis

Depression, anxiety, and insomnia are common in cancer patients. Mind-body therapies (MBTs) are promising forms of treatment for cancer patients living with depression, anxiety, and insomnia. The objective of this study is to assess the effectiveness and acceptability of MBTs in cancer patients living with depression, anxiety, or insomnia. EMBase, PubMed, Cinahl, PsychINFO, IndMED, CSI-NISCAIR, CNKI, Clinicaltrial.gov, ChiCTR, and CTRI will be searched until October 2020 for relevant studies. Randomized controlled studies in which MBTs were tested in a cancer population will be selected. The authors of the selected studies will be contacted to obtain individual participant data. The participants who reached a defined clinical threshold for depression, anxiety, or insomnia will be selected for the three sub-studies on depression, anxiety, and insomnia, respectively. Pairwise and network meta-analyses will be used to assess the changes in depression, anxiety, sleep quality, and completion rate. We will assess the effect of the treatment dose (number and frequency of interventions) on effectiveness. The results of this study will inform clinical decision-making for the treatment of psychological disturbances in cancer patients. If MBTs are found effective, they will potentially be recommended as treatments for cancer patients with psychological symptoms.