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Paschali M, Lazaridou A, Sadora J, Papianou L, Garland EL, Zgierska AE, Edwards RR. Mindfulness-based Interventions for Chronic Low Back Pain: A Systematic Review and Meta-analysis. Clin J Pain 2024; 40:105-113. [PMID: 37942696 DOI: 10.1097/ajp.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023]
Abstract
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.
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Affiliation(s)
- Myrella Paschali
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
| | - Asimina Lazaridou
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
- Fielding Graduate University, Santa Barbara, CA
| | | | - Lauren Papianou
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development
- College of Social Work, University of Utah, Salt Lake City, UT
| | - Aleksandra E Zgierska
- Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, PA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
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Torres ND, Newman AK, Day MA, Chan JF, Friedly JL, Jensen MP. The Moderating Effects of Cognitive Processes on Pain-related Outcomes. THE JOURNAL OF PAIN 2024:104483. [PMID: 38296008 DOI: 10.1016/j.jpain.2024.01.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 02/23/2024]
Abstract
Although evidence supports the importance of pain-related thoughts (ie, cognitive content, or what people think) as predictors of pain and pain-related function, evidence regarding the role of cognitive processes (ie, how people think about pain, eg, by accepting pain, not making judgments about pain, or being absorbed by the pain experience) in adjustment to chronic pain is in its early stages. Using baseline data from a clinical trial of individuals with chronic low back pain (N = 327), the study aimed to increase knowledge regarding the associations between cognitive processes, pain intensity, pain interference, and depression. The results indicate that a number of cognitive processes are significantly related to pain intensity when controlling for catastrophizing, although the pattern of associations found was opposite to those anticipated. One cognitive process (pain absorption) was found to be significantly associated with pain interference, and 9 of 10 cognitive processes were significantly associated with depression when controlling for catastrophizing. In each case, the processes thought to be adaptive were negatively associated with pain interference and depression, and processes thought to be maladaptive evidenced the opposite pattern. The findings are consistent with-but do not prove, given the cross-sectional nature of the data-the possibility that cognitive processes play an important role in adjustment to chronic pain. The potential role these variables play in depression was particularly noteworthy. Longitudinal and experimental studies to evaluate the causal nature of the associations identified are warranted. PERSPECTIVE: The study findings highlight the potential importance of cognitive process variables (ie, how people think) in adjustment to chronic pain. Research to evaluate cognitive processes as potential mechanism variables in pain treatment is warranted.
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Affiliation(s)
- Nikki D Torres
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Andrea K Newman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Melissa A Day
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Joy F Chan
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Janna L Friedly
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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Becker WC, Frank JW, Edmond SN, Starrels JL. When harms outweigh benefits of long-term opioid therapy for pain: Need for a new diagnostic entity, research and improved treatments. Addiction 2024; 119:4-5. [PMID: 37766414 DOI: 10.1111/add.16348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Affiliation(s)
- William C Becker
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Joseph W Frank
- VA Eastern Colorado Health Care System, Aurora, Colorado, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sara N Edmond
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Joanna L Starrels
- Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, USA
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Hnatešen D, Radoš I, Dimitrijević I, Budrovac D, Omrčen I, Pavić R, Gusar I, Čebohin M, Šolić K. Influence of the Cognitive and Emotional Status of Patients with Chronic Pain on Treatment Success (Reduction in Pain Intensity and Adherence to Pharmacotherapy): A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15968. [PMID: 36498036 PMCID: PMC9735997 DOI: 10.3390/ijerph192315968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
This prospective study aimed to determine the cognitive and emotional status among patients with chronic pain and to examine the potential influence on the treatment success, measured by the reduction in pain intensity and adherence to pharmacotherapy. A total of seventy patients were followed for two months. The results of the comparison between patients who did and did not follow the physician’s instructions regarding adherence to pharmacotherapy showed a significant difference in cognitive status and a reduction in pain intensity. Patients who followed the physician’s instructions on taking analgesics had significantly higher scores on the Montreal Cognitive Assessment (MoCA) of cognitive status and a substantially higher reduction in pain intensity. Scores on the MoCA test provide statistically significant indications regarding patients’ decision to follow instructions regarding adherence to pharmacotherapy. Scores on the MoCA test, anxiety, age, and pain intensity (measured with a numeric rating scale—NRS) on admission were identified as potential predictors for the reduction in pain intensity. The linear regression model was statistically significant (χ2 = 40.0, p < 0.001), explained between 43.5% and 61.1% of variance regarding the reduction in pain intensity. The findings of this study show that cognitive status, measured with MoCA, and emotional status, measured with the Depression, Anxiety, and Stress Scale (DASS-21), significantly influence the reduction in pain intensity and adherence to pharmacotherapy. The results suggest that cognitive and emotional status may be potential predictors of treatment success. This finding points to the importance of a biopsychosocial approach in the treatment of chronic pain, where an important emphasis can be placed on the psychosocial determinants of pain.
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Affiliation(s)
- Dijana Hnatešen
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinical Department of Pain Management, University Hospital Osijek, 31000 Osijek, Croatia
| | - Ivan Radoš
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinical Department of Pain Management, University Hospital Osijek, 31000 Osijek, Croatia
| | - Iva Dimitrijević
- Clinical Department of Pain Management, University Hospital Osijek, 31000 Osijek, Croatia
| | - Dino Budrovac
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinical Department of Pain Management, University Hospital Osijek, 31000 Osijek, Croatia
| | - Ivan Omrčen
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinical Department of Pain Management, University Hospital Osijek, 31000 Osijek, Croatia
| | - Roman Pavić
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinical Hospital of Traumatology, University Hospital Centre “Sestre Milosrdnice”, 10000 Zagreb, Croatia
| | - Ivana Gusar
- Department of Health Studies, University of Zadar, 23000 Zadar, Croatia
| | - Maja Čebohin
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Medical School Osijek, 31000 Osijek, Croatia
| | - Krešimir Šolić
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Faculty of Electrical Engineering, Computer Science and Information Technology Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Khera T, Rangasamy V. Cognition and Pain: A Review. Front Psychol 2021; 12:673962. [PMID: 34093370 PMCID: PMC8175647 DOI: 10.3389/fpsyg.2021.673962] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
Cognition is defined as the brain's ability to acquire, process, store, and retrieve information. Pain has been described as an unpleasant sensory or emotional experience, and for experiencing pain consciously, cognitive processing becomes imperative. Moreover, evaluation of pain strongly depends on cognition as it requires learning and recall of previous experiences. There could be a possible close link between neural systems involved in cognition and pain processing, and studies have reported an association between pain and cognitive impairment. In this narrative review, we explore the available evidence that has investigated cognitive changes associated with pain. We also examine the anatomical, biochemical, and molecular association of pain and neuro-cognition. Additionally, we focus on the cognitive impairment caused by analgesic medications. There is a need to improve our understanding of pathophysiology and cognitive impairment mechanisms associated with chronic pain and its treatment. This area provides a diverse opportunity for grounding future research, aiding institution of timely interventions to prevent chronic pain and associated cognitive decline, ultimately improving patient care.
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Affiliation(s)
- Tanvi Khera
- Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Valluvan Rangasamy
- Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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