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Brintz CE, Polser G, Coronado RA, French B, Faurot KR, Gaylord SA. Are Formal and Informal Home Mindfulness Practice Quantities Associated With Outcomes? Results From a Pilot Study of a Four-Week Mindfulness Intervention for Chronic Pain Management. Glob Adv Integr Med Health 2024; 13:27536130241236775. [PMID: 38434590 PMCID: PMC10906052 DOI: 10.1177/27536130241236775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/19/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
Background The association between home mindfulness practice quantity in standard length mindfulness-based interventions (MBIs) and chronic pain outcomes is variable. Few studies focus on abbreviated MBIs (< 8 weeks) and distinguish between formal guided practices and informal practices in daily life. Objectives To characterize home mindfulness practice and explore associations between home practice quantity and pre-to-post-outcome changes after an MBI for chronic pain. Methods In this single-arm study, 21 adults with chronic pain (mean age = 54 years, 81% White, mean pain duration = 7 years) completed an MBI with four weekly group sessions. Pre and post self-report measures of pain intensity/interference, physical function, depression, anxiety, positive affect, sleep disturbance (all PROMIS measures), and pain acceptance, catastrophizing, perceived stress and mindfulness were completed, along with daily surveys of formal (mindfulness of breath, body scan) and informal (breathing space, mindfulness of daily activities) practice. Bivariate correlations and multivariable regression models were used to assess the association between days and minutes of practice and change in outcomes. Results On average, formal practice was completed on 4.3 days per week and 13.5 minutes per day. Informal practice was completed on 3.5 days per week and 8.6 minutes per day. Formal practice was not significantly correlated with outcomes (Spearman's ρ = |.01|-|.32|), whereas informal practice was correlated with multiple outcomes (ρ = |.04|-|.66|). Number of days practiced informally was associated with improved pain interference, physical function, sleep disturbance, and catastrophizing (p's ≤ .05). Number of minutes practiced informally was associated with improved pain interference, anxiety, positive affect, and catastrophizing (p's ≤ .05). Conclusion Informal home practice quantity, but not formal practice quantity, is associated with improved outcomes during an abbreviated MBI for chronic pain. For these MBIs, it is important to evaluate the distinct roles of formal and informal practice. ClinicalTrialsgov Registration NCT03495856.
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Affiliation(s)
- Carrie E. Brintz
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Geneva Polser
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - Rogelio A. Coronado
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Keturah R. Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Susan A. Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Faurot KR, Park J, Miller V, Honvoh G, Domeniciello A, Mann JD, Gaylord SA, Lynch CE, Palsson O, Ramsden CE, MacIntosh BA, Horowitz M, Zamora D. Dietary fatty acids improve perceived sleep quality, stress, and health in migraine: a secondary analysis of a randomized controlled trial. Front Pain Res (Lausanne) 2023; 4:1231054. [PMID: 37954068 PMCID: PMC10634433 DOI: 10.3389/fpain.2023.1231054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Background Migraine is a prevalent disabling condition often associated with comorbid physical and psychological symptoms that contribute to impaired quality of life and disability. Studies suggest that increasing dietary omega-3 fatty acid is associated with headache reduction, but less is known about the effects on quality of life in migraine. Methods After a 4-week run-in, 182 adults with 5-20 migraine days per month were randomized to one of the 3 arms for sixteen weeks. Dietary arms included: H3L6 (a high omega-3, low omega-6 diet), H3 (a high omega-3, an average omega-6 diet), or a control diet (average intakes of omega-3 and omega-6 fatty acids). Prespecified secondary endpoints included daily diary measures (stress perception, sleep quality, and perceived health), Patient-Reported Outcome Measurement Information System Version 1.0 ([PROMIS©) measures and the Migraine Disability Assessment (MIDAS). Analyses used linear mixed effects models to control for repeated measures. Results The H3L6 diet was associated with significant improvements in stress perception [adjusted mean difference (aMD): -1.5 (95% confidence interval: -1.7 to -1.2)], sleep quality [aMD: 0.2 (95% CI:0.1-0.2)], and perceived health [aMD: 0.2 (0.2-0.3)] compared to the control. Similarly, the H3 diet was associated with significant improvements in stress perception [aMD: -0.8 (-1.1 to -0.5)], sleep quality [aMD: 0.2 (0.1, 0.3)], and perceived health [aMD: 0.3 (0.2, 0.3)] compared to the control. MIDAS scores improved substantially in the intervention groups compared with the control (H3L6 aMD: -11.8 [-25.1, 1.5] and H3 aMD: -10.7 [-24.0, 2.7]). Among the PROMIS-29 assessments, the biggest impact was on pain interference [H3L6 MD: -1.8 (-4.4, 0.7) and H3 aMD: -3.2 (-5.9, -0.5)] and pain intensity [H3L6 MD: -0.6 (-1.3, 0.1) and H3 aMD: -0.6 (-1.4, 0.1)]. Discussion The diary measures, with their increased power, supported our hypothesis that symptoms associated with migraine attacks could be responsive to specific dietary fatty acid manipulations. Changes in the PROMIS© measures reflected improvements in non-headache pain as well as physical and psychological function, largely in the expected directions. These findings suggest that increasing omega-3 with or without decreasing omega-6 in the diet may represent a reasonable adjunctive approach to reducing symptoms associated with migraine attacks. Trial Registration: ClinicalTrials.gov NCT02012790.
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Affiliation(s)
- Keturah R. Faurot
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Jinyoung Park
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Vanessa Miller
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Gilson Honvoh
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Anthony Domeniciello
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - J. Douglas Mann
- Department of Neurology, UNC School of Medicine, Chapel Hill, NC, United States
| | - Susan A. Gaylord
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Chanee E. Lynch
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Olafur Palsson
- Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Christopher E. Ramsden
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
- Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, United States
| | - Beth A. MacIntosh
- Metabolic and Nutrition Research Core, UNC Medical Center, Chapel Hill, NC, United States
| | - Mark Horowitz
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - Daisy Zamora
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, United States
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Kelley ML, Strowger M, Chentsova VO, Bravo AJ, Gaylord SA, Burgin EE, Vinci C, Ayers KL, Agha E. Mindfulness to Manage Moral Injury: Rationale and development of a live online 7-week group intervention for veterans with moral injury. Contemp Clin Trials Commun 2022; 30:101011. [PMID: 36340697 PMCID: PMC9626875 DOI: 10.1016/j.conctc.2022.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/27/2022] [Accepted: 10/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background Military service puts service members at risk for moral injury. Moral injury is an array of symptoms (e.g., guilt, shame, anger) that develop from events that violate or transgress one's moral code. Objective We describe adaption of in-person mindfulness training program, Mindfulness to Manage Chronic Pain (MMCP), to address symptoms of moral injury to be delivered live via the web. We discuss how we will assess benchmarks (i.e., recruitment, credibility and acceptability, completion rates, and adherence) of the Mindfulness to Manage Moral Injury (MMMI) program. Methods Aim 1: To develop and then adapt the MMCP program based on feedback from experts and veterans who took part in Study 1. Aim 2: To develop an equally intensive facilitator-led online Educational Support (ES) program to serve as a comparison intervention and conduct a run-through of each program with 20 veterans (10 MMMI; 10 ES). Aim 3: To conduct a small-scale randomized controlled trial (N = 42 veterans; 21 MMMI; 21 ES) in which we will collect pre-post-test and weekly benchmark data for both refined intervention arms. Results Study 1 and 2 are completed. Data collection for Study 3 will be completed in 2022. Conclusion MMMI is designed to provide a live facilitated mindfulness program to address symptoms of moral injury. If Study 3 demonstrates good benchmarks, with additional large-scale testing, MMMI may be a promising treatment that can reach veterans who may not seek traditional VAMC care and/or who prefer a web-based program.
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Affiliation(s)
- Michelle L. Kelley
- Old Dominion University, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
- Corresponding author. Department of Psychology, Old Dominion University, 250 Mills Godwin Building, Norfolk, VA, 23529, USA.
| | - Megan Strowger
- Old Dominion University, Old Dominion University, Norfolk, VA, USA
| | | | - Adrian J. Bravo
- Department of Psychological Sciences, William & Mary, Williamsburg, VA, USA
| | - Susan A. Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth E. Burgin
- School Psychology and Counselor Education, William & Mary, Williamsburg, VA, USA
| | - Christine Vinci
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kenneth L. Ayers
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | - Erum Agha
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Li H, Fu Q, Philips K, Sun Y, Faurot KR, Gaylord SA, Mann JD. Leukocyte inflammatory phenotype and function in migraine patients compared with matched non-migraine volunteers: a pilot study. BMC Neurol 2022; 22:278. [PMID: 35896985 PMCID: PMC9327171 DOI: 10.1186/s12883-022-02781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022] Open
Abstract
Background Migraine is a neurological condition characterized by chronic inflammation. However, not much is known about the potential role of peripheral blood immune cells in the pathophysiology of migraine. Methods We investigated the status of peripheral blood immune cells of 15 adults with frequent episodic or chronic migraine recruited chronologically from a randomized clinical trial (RCT) on Nutrition for Migraine (NCCIH 5R01AT007813-05) and 15 non-migraine, healthy volunteers (control) matched by age, gender, and Body Mass Index (BMI). Continuous variables were presented as means ± standard deviationas well as medians, and comparisons between patients and healthy volunteers were performed with non-parametric Wilcoxon signed rank tests. Statistical analysis was performed using Stata (StataCorp. 2019. Stata Statistical Software). Fluorescence-Activated Cell Sorting (FACS) data were processed using FlowJo software (Ashland, OR: Becton, Dickenson and Company; 2019). Results We observed that migraineurs had a significantly lower percentage of non-classical monocytes (CD14+CD16++) in blood circulation, compared to the control group. In addition, Migraineurs also showed a significantly lower percentage of blood CD3+CD4+ helper T cells and CD4+CD25+ regulatory T cells, compared to controls. Differences in leukocyte surface markers between chronic migraine patients and their matched controls were more prominent than those between episodic migraine patients and their matched controls. Conclusions Our results suggest that migraine is associated with dysregulated peripheral immune homeostasis and that inflammation and autoimmunity may play a role in its pathophysiology. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02781-4.
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Affiliation(s)
- Hongtao Li
- Department of Science and Mathematics, Hulman Hall Room116, Saint Mary-of-the-Woods College, 1 St Mary of Woods Coll, IN, 47876, USA. .,Department of Physical Medicine and Rehabilitation Program On Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Qiang Fu
- School of Pharmacology, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003, People's Republic of China
| | - Kamaira Philips
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Yufei Sun
- School of Pharmacology, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003, People's Republic of China
| | - Keturah R Faurot
- Department of Physical Medicine and Rehabilitation Program On Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Susan A Gaylord
- Department of Physical Medicine and Rehabilitation Program On Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - John Douglas Mann
- Department of Physical Medicine and Rehabilitation Program On Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA.,Department of Neurology, University of North Carolina, Chapel Hill, NC, USA
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Barnhill JL, Roth IJ, Faurot KR, Honvoh GD, Lynch CE, Thompson KL, Gaylord SA. Cultural Transformation in Healthcare: How Well Does the Veterans Health Administration Vision for Whole Person Care Fit the Needs of Patients at an Academic Rehabilitation Center? Glob Adv Health Med 2022; 11:2164957X221082994. [PMID: 35321235 PMCID: PMC8935551 DOI: 10.1177/2164957x221082994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background The Veterans Health Administration is undergoing a cultural transformation toward person-driven care referred to as the Whole Health System of Care. Objective This pilot study evaluated whether the Whole Health model resonates with patients of a large public university rehabilitation clinic. Methods Thirty participants completed the Veterans Health Administration’s Personal Health Inventory (PHI), and six attended the course “Taking Charge of My Life and Health.” Researchers analyzed PHI responses and post-course focus group transcripts. A short post-PHI survey and post-course evaluation were collected. Results Participants agreed the PHI is a simple, useful tool. The course, while well attended, did not meet participants’ expectations. Participants wanted access to integrative therapies and opportunities to contribute to healthcare transformation. Conclusion Rehabilitation patients resonated with the Whole Health vision. They expressed enthusiasm for the cultural transformation represented by the model along with frustration that standard healthcare experiences fall short of this vision.
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Post EL, Faurot K, Kadro Z, Hill J, Nguyen C, Asher GN, Gaylord SA, Corbett A. Patient Perspectives on the Development of a Novel Mobile Health (mHealth) Application for Dietary Supplement Tracking and Reconciliation – A Qualitative Focus Group Study. Glob Adv Health Med 2022; 11:21649561221075268. [PMID: 35211359 PMCID: PMC8862130 DOI: 10.1177/21649561221075268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background: More than 170 million adults use dietary supplements (DS) in the United States, which can have both benefit and harm to patient health. DS use is often poorly documented in the medical record and can pose health risks if not properly communicated with providers. Reasons for poor DS documentation include low disclosure rates, time constraints of clinical encounters, and providers’ failure to inquire about DS use. This study was conducted to assess patients’ views on the facilitators and barriers to using a mobile health (mHealth) application (app) to collect and share DS information with their healthcare providers.
Methods: Utilizing a theory-based conceptual model, we conducted seven patient focus groups (FGs) to assess opinions on DS safety, provider communication, comfort with technology use, and our proposed mHealth app. Participants were recruited from the general public and through patient advisory groups. Patient views will inform the creation of an mHealth app to improve DS patient-provider communication and tracking and reconciliation in the electronic medical record (EMR).
Results: Overall, participants believe their DS information is inaccurately represented in the EMR leading to safety concerns and negatively impacting overall quality-of-care. Participants desired an app designed with: 1) Health Insurance Portability and Accountability Act (HIPAA)-compliance; 2) ease of use for a variety of technical efficacy levels; 3) access to reliable DS information, including a DS-drug interaction checker; 4) integration with the EMR.
Conclusion: An app to simplify and improve DS entry and reconciliation was of interest to patients, as long as it maintained health autonomy and privacy and possessed key valuable features.
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Affiliation(s)
- Elana L Post
- Eshelman School of PharmacyThe University of North Carolina at Chapel Hill
| | - Keturah Faurot
- Physical Medicine and RehabilitationUniversity of North Carolina at Chapel Hill School of Medicine
| | - Zachary Kadro
- Physical Medicine and Rehabilitation, Program on Integrative MedicineUniversity of North Carolina at Chapel Hill School of Medicine
| | - Jacob Hill
- Physical Medicine and Rehabilitation, Program on Integrative MedicineUniversity of North Carolina at Chapel Hill School of Medicine
| | - Catharine Nguyen
- Eshelman School of PharmacyThe University of North Carolina at Chapel Hill
| | - Gary N Asher
- Department of Family MedicineUniversity of North Carolina at Chapel Hill School of Medicine
| | - Susan A Gaylord
- Physical Medicine and Rehabilitation, Program on Integrative MedicineUniversity of North Carolina at Chapel Hill School of Medicine
| | - Amanda Corbett
- Eshelman School of PharmacyThe University of North Carolina at Chapel Hill
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Woods-Giscombe CL, Gaylord SA, Faurot KR, Lynch C, Phillips P. It Is Not Just About Enrollment: Recognizing the Impact of RCT Recruitment Approaches on Prediabetes Awareness, Screening, and Capacity Building in African American Communities. J Urban Health 2021; 98:123-128. [PMID: 34142348 PMCID: PMC8501166 DOI: 10.1007/s11524-021-00543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Cheryl L. Woods-Giscombe
- School of Nursing, University of North Carolina at Chapel Hill, C.B.# 7460, 4103 Carrington Hall, Chapel Hill, NC USA
| | - Susan A. Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Keturah R. Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Pamela Phillips
- Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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8
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Greco CM, Gaylord SA, Faurot K, Weinberg JM, Gardiner P, Roth I, Barnhill JL, Thomas HN, Dhamne SC, Lathren C, Baez JE, Lawrence S, Neogi T, Lasser KE, Castro MG, White AM, Simmons SJ, Ferrao C, Binda DD, Elhadidy N, Eason KM, McTigue KM, Morone NE. The design and methods of the OPTIMUM study: A multisite pragmatic randomized clinical trial of a telehealth group mindfulness program for persons with chronic low back pain. Contemp Clin Trials 2021; 109:106545. [PMID: 34455111 PMCID: PMC8691659 DOI: 10.1016/j.cct.2021.106545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 01/04/2023]
Abstract
Mindfulness-based stress reduction (MBSR) is an evidence-based non-pharmacological approach for chronic low back pain (cLBP), yet it is not readily available or reimbursable within primary care clinics. Primary care providers (PCPs) who wish to avoid prescribing opioids and other medications typically have few options for their cLBP patients. We present the protocol of a pragmatic clinical trial entitled OPTIMUM (Optimizing Pain Treatment In Medical settings Using Mindfulness). OPTIMUM is offered online via telehealth and includes medical group visits (MGV) with a PCP and a mindfulness meditation intervention modeled on MBSR for persons with cLBP. In diverse health-care settings in the US, such as a safety net hospital, federally qualified health centers, and a large academic health system, 450 patients will be assigned randomly to the MGV + MBSR or to usual PCP care alone. Participants will complete self-report surveys at baseline, following the 8-week program, and at 6- and 12-month follow-up. Health care utilization data will be obtained through electronic health records and via brief monthly surveys completed by participants. The primary outcome measure is the PEG (Pain, enjoyment, and general activity) at the 6-month follow-up. Additionally, we will assess psychological function, healthcare resource use, and opioid prescriptions. This trial, which is part of the NIH HEAL Initiative, has the potential to enhance primary care treatment of cLBP by combining PCP visits with a non-pharmacological treatment modeled on MBSR. Because it is offered online and integrated into primary care, it is expected to be scalable and accessible to underserved patients. Clinical Trials.gov: NCT04129450.
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Affiliation(s)
- Carol M Greco
- Department of Psychiatry and Physical Therapy, University of Pittsburgh School of Medicine and School of Health and Rehabilitation Sciences, PA, United States of America
| | - Susan A Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Kim Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Janice M Weinberg
- Department of Biostatistics, Boston University School of Public Health, MA, United States of America
| | - Paula Gardiner
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Isabel Roth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Jessica L Barnhill
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Holly N Thomas
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, PA, United States of America
| | - Sayali C Dhamne
- Boston University School of Public Health, Boston Medical Center, MA, United States of America
| | - Christine Lathren
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Jose E Baez
- General Internal Medicine, Boston Medical Center, MA, United States of America
| | - Suzanne Lawrence
- Department of Psychiatry, University of Pittsburgh, PA, United States of America
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, United States of America
| | - Karen E Lasser
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Maria Gabriela Castro
- Siler City Community Health Center, Piedmont Health Services, Department of Family Medicine, University of North Carolina at Chapel Hill, NC, United States of America
| | - Anna Marie White
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, PA, United States of America
| | | | - Cleopatra Ferrao
- General Internal Medicine, Boston Medical Center, MA, United States of America
| | - Dhanesh D Binda
- Boston University School of Medicine, Boston, MA, United States of America
| | - Nandie Elhadidy
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Kelly M Eason
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Kathleen M McTigue
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, PA, United States of America
| | - Natalia E Morone
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America.
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Halverson TF, Meyer-Kalos PS, Perkins DO, Gaylord SA, Palsson OS, Nye L, Algoe SB, Grewen K, Penn DL. Enhancing stress reactivity and wellbeing in early schizophrenia: A randomized controlled trial of Integrated Coping Awareness Therapy (I-CAT). Schizophr Res 2021; 235:91-101. [PMID: 34332429 DOI: 10.1016/j.schres.2021.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/14/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022]
Abstract
Individuals with schizophrenia spectrum disorders (SSD) are at heightened risk for exposure to stressful life events which can lead to increased sensitivity to stress and a dysregulated stress response, which are in turn associated with poor long-term functioning. Stress reactivity is thus a promising treatment target in the early stages of SSD. Integrated-Coping Awareness Therapy (I-CAT) is a manualized intervention integrating mindfulness and positive psychology to target a dysregulated stress response in SSD. The current study is a preliminary randomized-controlled trial (RCT) comparing I-CAT (n = 18) with treatment as usual (TAU; n = 18) in individuals in the early stages of SSD. I-CAT was hypothesized to be more effective than TAU on primary outcomes: increasing positive emotions, decreasing negative emotions, reducing stress, and improving functioning and quality of life; and secondary outcomes: reducing symptoms, increasing mindfulness, and improving overall well-being. Excellent therapy attendance rates, low study attrition, and positive participant feedback demonstrated that I-CAT was a feasible and well-tolerated psychosocial intervention. Results suggest I-CAT led to greater reduction in symptoms (i.e., overall, negative, and disorganized symptoms), increased observational mindfulness, increased endorsement of a sense of purpose in life, and preservation of work abilities and school social functioning compared with TAU. Future work should replicate and extend these findings in a larger-scale RCT.
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Affiliation(s)
- Tate F Halverson
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, United States of America.
| | - Piper S Meyer-Kalos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, United States of America
| | - Diana O Perkins
- Department of Psychiatry, The University of North Carolina at Chapel Hill, United States of America
| | - Susan A Gaylord
- Department of Physical Medicine and Rehabilitation, The University of North Carolina at Chapel Hill, United States of America
| | - Olafur S Palsson
- Department of Medicine, The University of North Carolina at Chapel Hill, United States of America
| | - Lana Nye
- College of Social Work, The University of Utah, United States of America
| | - Sara B Algoe
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, United States of America
| | - Karen Grewen
- Department of Psychiatry, The University of North Carolina at Chapel Hill, United States of America
| | - David L Penn
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, United States of America; School of Behavioural and Health Sciences, Australian Catholic University, Australia
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Kelley ML, Chae JW, Bravo AJ, Milam AL, Agha E, Gaylord SA, Vinci C, Currier JM. Own soul's warning: Moral injury, suicidal ideation, and meaning in life. Psychol Trauma 2021; 13:740-748. [PMID: 34351211 DOI: 10.1037/tra0001047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Moral injury (an inner conflict [or cognitive dissonance] used to describe psychological, ethical, and/or spiritual conflict experienced when an individual's basic sense of humanity is violated) has been associated with suicidal ideation among military populations. However, mechanisms linking moral injury to suicidal ideation, particularly variables that may protect against suicidal ideation, have received limited attention. This study examined whether two domains of meaning in life (presence of meaning in life and searching for meaning in life) mediated the links between self- and other-directed moral injury and suicidal ideation. METHOD Participants were a community sample of 269 predominantly recent-era former service members who completed an online, anonymous voluntary survey. RESULTS When examined in separate models, self-directed moral injury and other-directed moral injury were found to associate with higher suicidal ideation via a lower presence of meaning in life (no significant associations with searching for meaning in life). When examined in an exploratory combined model (i.e., both self-directed and other-directed moral injury entered in the same model), only the association between self-directed moral injury and suicidal ideation via the presence of meaning in life remained statistically significant. CONCLUSIONS Our findings suggest that the presence of meaning in life may serve as a protective factor for veterans experiencing moral injury (particularly self-directed moral injury) that is associated with suicidal ideation. It is possible that guiding veterans with moral injury symptoms to develop more meaning or purpose in their lives may reduce suicidal ideation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - John W Chae
- Virginia Consortium Program in Clinical Psychology
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Ramsden CE, Zamora D, Faurot KR, MacIntosh B, Horowitz M, Keyes GS, Yuan ZX, Miller V, Lynch C, Honvoh G, Park J, Levy R, Domenichiello AF, Johnston A, Majchrzak-Hong S, Hibbeln JR, Barrow DA, Loewke J, Davis JM, Mannes A, Palsson OS, Suchindran CM, Gaylord SA, Mann JD. Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial. BMJ 2021; 374:n1448. [PMID: 34526307 PMCID: PMC8244542 DOI: 10.1136/bmj.n1448] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine whether dietary interventions that increase n-3 fatty acids with and without reduction in n-6 linoleic acid can alter circulating lipid mediators implicated in headache pathogenesis, and decrease headache in adults with migraine. DESIGN Three arm, parallel group, randomized, modified double blind, controlled trial. SETTING Ambulatory, academic medical center in the United States over 16 weeks. PARTICIPANTS 182 participants (88% women, mean age 38 years) with migraines on 5-20 days per month (67% met criteria for chronic migraine). INTERVENTIONS Three diets designed with eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and linoleic acid altered as controlled variables: H3 diet (n=61)-increase EPA+DHA to 1.5 g/day and maintain linoleic acid at around 7% of energy; H3-L6 diet (n=61)-increase n-3 EPA+DHA to 1.5 g/day and decrease linoleic acid to ≤1.8% of energy; control diet (n=60)-maintain EPA+DHA at <150 mg/day and linoleic acid at around 7% of energy. All participants received foods accounting for two thirds of daily food energy and continued usual care. MAIN OUTCOME MEASURES The primary endpoints (week 16) were the antinociceptive mediator 17-hydroxydocosahexaenoic acid (17-HDHA) in blood and the headache impact test (HIT-6), a six item questionnaire assessing headache impact on quality of life. Headache frequency was assessed daily with an electronic diary. RESULTS In intention-to-treat analyses (n=182), the H3-L6 and H3 diets increased circulating 17-HDHA (log ng/mL) compared with the control diet (baseline-adjusted mean difference 0.6, 95% confidence interval 0.2 to 0.9; 0.7, 0.4 to 1.1, respectively). The observed improvement in HIT-6 scores in the H3-L6 and H3 groups was not statistically significant (-1.6, -4.2 to 1.0, and -1.5, -4.2 to 1.2, respectively). Compared with the control diet, the H3-L6 and H3 diets decreased total headache hours per day (-1.7, -2.5 to -0.9, and -1.3, -2.1 to -0.5, respectively), moderate to severe headache hours per day (-0.8, -1.2 to -0.4, and -0.7, -1.1 to -0.3, respectively), and headache days per month (-4.0, -5.2 to -2.7, and -2.0, -3.3 to -0.7, respectively). The H3-L6 diet decreased headache days per month more than the H3 diet (-2.0, -3.2 to -0.8), suggesting additional benefit from lowering dietary linoleic acid. The H3-L6 and H3 diets altered n-3 and n-6 fatty acids and several of their nociceptive oxylipin derivatives in plasma, serum, erythrocytes or immune cells, but did not alter classic headache mediators calcitonin gene related peptide and prostaglandin E2. CONCLUSIONS The H3-L6 and H3 interventions altered bioactive mediators implicated in headache pathogenesis and decreased frequency and severity of headaches, but did not significantly improve quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT02012790.
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Affiliation(s)
- Christopher E Ramsden
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
- Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daisy Zamora
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keturah R Faurot
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beth MacIntosh
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Metabolic and Nutrition Research Core, UNC Medical Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark Horowitz
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
| | - Gregory S Keyes
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
| | - Zhi-Xin Yuan
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
| | - Vanessa Miller
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanee Lynch
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gilson Honvoh
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jinyoung Park
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Russell Levy
- Cytokine Analysis Core, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony F Domenichiello
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
| | - Angela Johnston
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sharon Majchrzak-Hong
- Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA
| | - Joseph R Hibbeln
- Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA
| | - David A Barrow
- Cytokine Analysis Core, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Loewke
- Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA
| | - John M Davis
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew Mannes
- Department of Perioperative Medicine, NIH Clinical Center, Bethesda, MD, USA
| | - Olafur S Palsson
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chirayath M Suchindran
- Department of Biostatistics, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Susan A Gaylord
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Douglas Mann
- Department of Neurology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Brintz CE, Miller S, Olmsted KR, Bartoszek M, Cartwright J, Kizakevich PN, Butler M, Asefnia N, Buben A, Gaylord SA. Adapting Mindfulness Training for Military Service Members With Chronic Pain. Mil Med 2021; 185:385-393. [PMID: 31621856 DOI: 10.1093/milmed/usz312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Rates of chronic pain in military personnel are disproportionately high. Chronic pain is often associated with mental health and substance use disorders as comorbid conditions, making treatment of chronic pain complex. Mindfulness-based interventions (MBIs) are a promising behavioral approach to managing chronic pain and psychosocial sequelae. The unique nature of the military context may require adaptations to original MBIs for successful delivery in active-duty military populations. This study adapted the mindfulness-based stress reduction (MBSR) program to create a mindfulness training program that was relevant to active-duty Army personnel experiencing chronic pain. This article delineates the adaptation process employed to modify the MBSR program to the military context and discusses the resulting training program. MATERIALS AND METHODS The adaptation process consisted of three iterative stages: 1) Drafting the preliminary intervention protocol with recommendations from stakeholders, including military healthcare providers; 2) Refining the preliminary protocol after pretesting the sessions with research team members and a military Veteran advisory committee; and 3) Delivering the preliminary protocol to one cohort of active-duty Soldiers with chronic pain, collecting feedback, and further refining the intervention protocol. RESULTS Military-related adaptations to MBSR addressed three areas: military culture, language and terminology, and practical and logistical factors relevant to implementation in the military setting. This adaptation process resulted in a live, online program with six, weekly, sessions. Feedback from a military Veteran advisory committee resulted in modifications, including increasing military-relevant examples; preliminary testing with the target population resulted in additional modifications, including shortening the sessions to 75 min and structuring discussions more efficiently. CONCLUSIONS The adaptation process was successful in generating an engaging mindfulness training program that was highly relevant to the military context. Obtaining input from stakeholders, such as military healthcare providers and active-duty soldiers, and iterative feedback and modification, were key to the process. Moreover, the program was designed to maintain the integrity and core elements of MBIs while adapting to military culture. A future randomized controlled trial design will be used to evaluate the effectiveness of the intervention in improving chronic pain in military personnel. This program is responsive to the military's call for nonpharmacologic treatments for chronic pain that are easily accessible. If effective, the mindfulness program has the potential for widespread dissemination to complement standard care for Service Members experiencing chronic pain.
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Affiliation(s)
- Carrie E Brintz
- University of North Carolina School of Medicine, 321 S. Columbia St, Chapel Hill, NC 27516
| | - Shari Miller
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27713
| | | | | | - Joel Cartwright
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27713
| | - Paul N Kizakevich
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27713
| | - Michael Butler
- Womack Army Medical Center, 2817 Reilly Rd, Fort Bragg, NC 28310
| | - Nakisa Asefnia
- University of South Carolina, Department of Psychology, 1512 Pendleton St, Columbia SC 29208
| | - Alex Buben
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27713
| | - Susan A Gaylord
- University of North Carolina School of Medicine, 321 S. Columbia St, Chapel Hill, NC 27516
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Brintz CE, Roth I, Faurot K, Rao S, Gaylord SA. Feasibility and Acceptability of an Abbreviated, Four-Week Mindfulness Program for Chronic Pain Management. Pain Med 2020; 21:2799-2810. [PMID: 32897319 PMCID: PMC7685688 DOI: 10.1093/pm/pnaa208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The Mindfulness-Based Stress Reduction program is effective at improving chronic pain outcomes, but the time demand hinders participation. This preliminary study evaluated the feasibility, acceptability, and potential effects of providing an abbreviated mindfulness program for patients with chronic pain. DESIGN A single-arm, mixed-methods, pre-post intervention study. SETTING An outpatient rehabilitation clinic at an academic medical center. SUBJECTS Participants were N = 23 adults with chronic pain who were new to mindfulness practice. METHODS Mindfulness-based Stress Reduction was adapted to shorten the program to four weekly 90-minute sessions and to focus content on pain management. Three cohorts of six to nine participants completed baseline and post-treatment measures of 1) patient-reported outcomes, including pain intensity, pain interference, physical functioning, depressive/anxiety symptoms, positive affect and well-being, and sleep disturbance; 2) pain medication dosages; 3) psychosocial variables including pain acceptance, pain catastrophizing, and perceived stress; 4) dispositional mindfulness, as well as postintervention structured interviews about their experiences. RESULTS Acceptable rates of retention and attendance and high ratings of satisfaction indicated that the intervention was feasible and acceptable. In interviews, participants found the program acceptable and beneficial and provided suggestions to improve it. From pre- to post-treatment, significant improvements were reported in all measures except physical functioning and anxiety. CONCLUSIONS In adults with chronic pain, a four-week mindfulness program is feasible and acceptable, addresses the barrier of a lengthy program, and may improve quality of life and psychological functioning. An appropriately powered randomized controlled trial with a comparison group is needed to assess the intervention's effectiveness.
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Affiliation(s)
- Carrie E Brintz
- Division of Pain Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Isabel Roth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Keturah Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Sanjana Rao
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Susan A Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Garland EL, Brintz CE, Hanley AW, Roseen EJ, Atchley RM, Gaylord SA, Faurot KR, Yaffe J, Fiander M, Keefe FJ. Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis. JAMA Intern Med 2020; 180:91-105. [PMID: 31682676 PMCID: PMC6830441 DOI: 10.1001/jamainternmed.2019.4917] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/29/2019] [Indexed: 12/15/2022]
Abstract
Importance Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients. Objective To evaluate the association of MBTs with pain and opioid dose reduction in a diverse adult population with clinical pain. Data Sources For this systematic review and meta-analysis, the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases were searched for English-language randomized clinical trials and systematic reviews from date of inception to March 2018. Search logic included (pain OR analgesia OR opioids) AND mind-body therapies. The gray literature, ClinicalTrials.gov, and relevant bibliographies were also searched. Study Selection Randomized clinical trials that evaluated the use of MBTs for symptom management in adults also prescribed opioids for clinical pain. Data Extraction and Synthesis Independent reviewers screened citations, extracted data, and assessed risk of bias. Meta-analyses were conducted using standardized mean differences in pain and opioid dose to obtain aggregate estimates of effect size with 95% CIs. Main Outcomes and Measures The primary outcome was pain intensity. The secondary outcomes were opioid dose, opioid misuse, opioid craving, disability, or function. Results Of 4212 citations reviewed, 60 reports with 6404 participants were included in the meta-analysis. Overall, MBTs were associated with pain reduction (Cohen d = -0.51; 95% CI, -0.76 to -0.26) and reduced opioid dose (Cohen d = -0.26; 95% CI, -0.44 to -0.08). Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and cognitive behavioral therapy (n = 7) interventions. Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d = -0.70), hypnosis (Cohen d = -0.54), suggestion (Cohen d = -0.68), and cognitive behavioral therapy (Cohen d = -0.43) but not for other MBTs. Although most meditation (n = 4 [80%]), cognitive-behavioral therapy (n = 4 [57%]), and hypnosis (n = 12 [63%]) studies found improved opioid-related outcomes, fewer studies of suggestion, guided imagery, and relaxation reported such improvements. Most MBT studies used active or placebo controls and were judged to be at low risk of bias. Conclusions and Relevance The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse. Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes.
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Affiliation(s)
- Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City
- College of Social Work, University of Utah, Salt Lake City
| | - Carrie E. Brintz
- Program on Integrative Medicine, Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill
| | - Adam W. Hanley
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City
- College of Social Work, University of Utah, Salt Lake City
| | - Eric J. Roseen
- Department of Family Medicine, Boston University and Boston University School of Medicine, Boston, Massachusetts
- Department of Rehabilitation Science, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts
| | - Rachel M. Atchley
- Department of Anesthesiology, Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts
| | - Susan A. Gaylord
- Program on Integrative Medicine, Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill
| | - Keturah R. Faurot
- Program on Integrative Medicine, Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill
| | - Joanne Yaffe
- College of Social Work, University of Utah, Salt Lake City
| | | | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Department of Anesthesiology, Duke University, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
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Philips KH, Brintz CE, Moss K, Gaylord SA. Didgeridoo Sound Meditation for Stress Reduction and Mood Enhancement in Undergraduates: A Randomized Controlled Trial. Glob Adv Health Med 2019; 8:2164956119879367. [PMID: 31632840 PMCID: PMC6769210 DOI: 10.1177/2164956119879367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 08/08/2019] [Accepted: 09/05/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND College students report feeling frequently stressed, which adversely impacts health. Meditation is one effective method for reducing stress, but program length and required effort are potential obstacles. Research on sound meditation, involving focused listening to sounds, is nascent but may appeal to undergraduates. The effects of listening to didgeridoo, an Australian wind instrument producing a low, resonant, droning sound, have not been studied. OBJECTIVE This study compared the effect of a 30-minute didgeridoo sound meditation versus silent meditation with focus on one's breath on acute self-perceived stress and mood in undergraduates without prior meditation experience. METHODS Seventy-four undergraduates were randomized to 2 interventions: (1) didgeridoo meditation (n = 40) performed live by a musician or (2) silent meditation (n = 34) taught by a meditation instructor. Immediate pre-post effects of the session were examined using the 4-Dimension Mood Scale and an item assessing acute self-perceived stress. Intervention acceptability was assessed postintervention. RESULTS Two-way mixed analyses of variance were performed. Both groups reported significantly increased relaxation after meditation (Group D, P = .0001 and Group S, P = .0005). Both groups reported decreased negative arousal (Group D, P = .02 and Group S, P = .02), energy (Group D, P = .0001 and Group S, P = .003), tiredness (Group D, P = .0001 and Group S, P = .005), and acute stress (Group D, P = .0001 and Group S, P = .0007). Group Didgeridoo experienced significantly more relaxation (P = .01) and less acute stress (P = .03) than Group Silent. Fifty-three percent of silent participants and 80% of didgeridoo participants agreed that they would attend that type of meditation again. Forty-seven percent of silent participants and 80% of didgeridoo participants enjoyed the meditation. CONCLUSION Didgeridoo sound meditation is as effective as silent meditation for decreasing self-perceived negative arousal, tiredness, and energy and more effective than silent meditation for relaxation and acute stress in undergraduates. Didgeridoo meditation participants reported higher levels of enjoyment and higher likelihood of attending another session. Further investigation into didgeridoo and sound meditation is warranted.
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Affiliation(s)
- Kamaira Hartley Philips
- Department of Oral and Craniofacial Health Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carrie E Brintz
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kevin Moss
- Department of Oral and Craniofacial Health Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan A Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Woods-Giscombe CL, Gaylord SA, Li Y, Brintz CE, Bangdiwala SI, Buse JB, Mann JD, Lynch C, Phillips P, Smith S, Leniek K, Young L, Al-Barwani S, Yoo J, Faurot K. A Mixed-Methods, Randomized Clinical Trial to Examine Feasibility of a Mindfulness-Based Stress Management and Diabetes Risk Reduction Intervention for African Americans with Prediabetes. Evid Based Complement Alternat Med 2019; 2019:3962623. [PMID: 31511777 PMCID: PMC6710811 DOI: 10.1155/2019/3962623] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 07/21/2019] [Indexed: 12/29/2022]
Abstract
African Americans have disproportionately high rates of stress-related conditions, including diabetes and diabetes-related morbidity. Psychological stress may negatively influence engagement in risk-reducing lifestyle changes (physical activity and healthy eating) and stress-related physiology that increase diabetes risk. This study examined the feasibility of conducting a randomized trial comparing a novel mindfulness-based stress management program combined with diabetes risk-reduction education versus a conventional diabetes risk-reduction education program among African American adults with prediabetes and self-reported life stress. Participants were recruited in collaboration with community partners and randomized to the mindfulness-based diabetes risk-reduction education program for prediabetes (MPD; n = 38) or the conventional diabetes risk-reduction education program for prediabetes (CPD; n = 30). The mindfulness components were adapted from the Mindfulness-based Stress Reduction Program. The diabetes risk-reduction components were adapted from the Power to Prevent Program and the Diabetes Prevention Program. Groups met for eight weeks for 2.5 hours, with a half-day retreat and six-monthly boosters. Mixed-methods strategies were used to assess feasibility. Psychological, behavioral, and metabolic data were collected before the intervention and at three and six months postintervention to examine within-group change and feasibility of collecting such data in future clinical efficacy research. Participants reported acceptability, credibility, and cultural relevance of the intervention components. Enrollment of eligible participants (79%), intervention session attendance (76.5%), retention (90%), and postintervention data collection attendance (83%, 82%, and 78%, respectively) demonstrated feasibility, and qualitative data provided information to further enhance feasibility in future studies. Both groups exhibited an A1C reduction. MPD participants had reductions in perceived stress, BMI, calorie, carbohydrate and fat intake, and increases in spiritual well-being. Considering the high prevalence of diabetes and diabetes-related complications in African Americans, these novel findings provide promising guidance to develop a larger trial powered to examine efficacy of a mindfulness-based stress management and diabetes risk-reduction education program for African Americans with prediabetes.
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Affiliation(s)
| | - Susan A. Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Carrie E. Brintz
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Shrikant I. Bangdiwala
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - John B. Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - John D Mann
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Chanee Lynch
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Pamela Phillips
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Sunyata Smith
- Lehman College, City University of New York, New York, NY, USA
| | - Karyn Leniek
- Health Partners Central Minnesota Clinics, Sartell, MN, USA
| | - Laura Young
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Saada Al-Barwani
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeena Yoo
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keturah Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
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Faurot KR, Gaylord SA, Mann JD. Training Family Caregivers in Hand and Foot Massage for Hospitalized Patients: Feasibility, Challenges, and Lessons Learned. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1533210107307154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Increasingly, research is demonstrating the safety, efficacy, and patient satisfaction associated with use of nonpharmacological, complementary interventions for pain management in hospital settings. One such intervention, massage, has been found to be effective for pain and anxiety reduction in limited forms, such as described here, massage is relatively easy to learn and apply. The pilot project was designed to develop and assess a clinical intervention using hand and foot massage for management of pain and anxiety in inpatients on a rehabilitation unit. Methods included formal training of staff nurses in hand and foot massage and subsequently having them teach key family caregivers of the patient how to deliver hand or foot massage in response to reports of pain and anxiety. The report describes study rationale, project development, challenges to implementation in an academic, tertiary care, inpatient rehabilitation facility, and lessons learned for future project design and implementation. The need for a community-based participatory research perspective is addressed.
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Affiliation(s)
- Keturah R. Faurot
- Department of Physical Medicine and Rehabilitation,
Program on Integrative Medicine, University of North Carolina School,
| | - Susan A. Gaylord
- Department of Physical Medicine and Rehabilitation,
UNC School of Medicine
| | - J. Douglas Mann
- UNC Integrative Medicine Consult Service and codirector
of the UNC Mindfulness-Based Stress and Pain Management Program
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Bluth K, Roberson PNE, Gaylord SA, Faurot KR, Grewen KM, Arzon S, Girdler SS. Does Self-compassion Protect Adolescents from Stress? J Child Fam Stud 2016; 25:1098-1109. [PMID: 26997856 PMCID: PMC4793986 DOI: 10.1007/s10826-015-0307-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Karen Bluth
- University of North Carolina-Chapel Hill, Chapel Hill, NC
| | | | | | | | - Karen M Grewen
- University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Samantha Arzon
- University of North Carolina-Chapel Hill, Chapel Hill, NC
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Garland EL, Kiken LG, Faurot K, Palsson O, Gaylord SA. Upward Spirals of Mindfulness and Reappraisal: Testing the Mindfulness-to-Meaning Theory with Autoregressive Latent Trajectory Modeling. Cogn Ther Res 2016. [DOI: 10.1007/s10608-016-9768-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Kiken LG, Garland EL, Bluth K, Palsson OS, Gaylord SA. From a state to a trait: Trajectories of state mindfulness in meditation during intervention predict changes in trait mindfulness. Pers Individ Dif 2015; 81:41-46. [PMID: 25914434 DOI: 10.1016/j.paid.2014.12.044] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Theory suggests that heightening state mindfulness in meditation practice over time increases trait mindfulness, which benefits psychological health. We prospectively examined individual trajectories of state mindfulness in meditation during a mindfulness-based intervention in relation to changes in trait mindfulness and psychological distress. Each week during the eight-week intervention, participants reported their state mindfulness in meditation after a brief mindfulness meditation. Participants also completed pre- and post-intervention measures of trait mindfulness and psychological symptoms. Tests of combined latent growth and path models suggested that individuals varied significantly in their rates of change in state mindfulness in meditation during the intervention, and that these individual trajectories predicted pre-post intervention changes in trait mindfulness and distress. These findings support that increasing state mindfulness over repeated meditation sessions may contribute to a more mindful and less distressed disposition. However, individuals' trajectories of change may vary and warrant further investigation.
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Affiliation(s)
- Laura G Kiken
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Karen Bluth
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Susan A Gaylord
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Bluth K, Roberson PNE, Gaylord SA. A Pilot Study of a Mindfulness Intervention for Adolescents and the Potential Role of Self-Compassion in Reducing Stress. Explore (NY) 2015; 11:292-5. [PMID: 26005198 DOI: 10.1016/j.explore.2015.04.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In this pilot study, we sought to investigate the effects of a mindfulness intervention for adolescents on a community sample of teens. Specifically, we explored the effects of mindfulness training on emotional well-being outcomes. Also, we examined the relationship between mindfulness and self-compassion at baseline-predicted outcome measures. DESIGN This design was a pre-/post-pilot intervention study. Paired t-tests were conducted to examine change in outcome measures before and after the mindfulness intervention. Multiple regression was also conducted to investigate the influence of baseline mindfulness and self-compassion on outcome measures. SETTING The study took place after school in a classroom at a local university. PARTICIPANTS Overall 28 adolescents age 10-18 years from two different cohorts participated in this study. INTERVENTION Learning to BREATHE, a mindfulness curriculum designed specifically for adolescents and taught in six 1.5h sessions, was implemented. MAIN OUTCOME MEASURES The outcome measures, life satisfaction and perceived stress, were included in an online survey before and after the mindfulness intervention. RESULTS Results indicated that mindfulness, self-compassion, perceived stress, and life satisfaction improved from pre-intervention to post-intervention. Further, self-compassion (taught within the mindfulness intervention) was negatively related to perceived stress post-intervention while controlling for baseline stress. These findings suggest that mindfulness may be an effective intervention for improving indicators of emotional well-being among an adolescent population. Additionally, self-compassion may be a pathway through which youth can lower stress. Future research should examine self-compassion as a potential factor in promoting emotional well-being.
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Affiliation(s)
- Karen Bluth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, CB 7200, Chapel Hill, NC 27599.
| | | | - Susan A Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, CB 7200, Chapel Hill, NC 27599
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Woods-Giscombé CL, Gaylord SA. The Cultural Relevance of Mindfulness Meditation as a Health Intervention for African Americans: Implications for Reducing Stress-Related Health Disparities. J Holist Nurs 2014; 32:147-60. [PMID: 24442592 DOI: 10.1177/0898010113519010] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African Americans experience a disproportionate rate of stress-related health conditions compared to European Americans. Mindfulness meditation has been shown to be effective for managing stress and various stress-related health conditions. This study explored the cultural relevance of mindfulness meditation training for African Americans adults. Fifteen African American adults with past or current experience with mindfulness meditation training were interviewed. Participants felt that mindfulness meditation helped them with enhanced stress management, direct health improvement, and enhanced self-awareness and purposefulness. They felt that they would recommend it and that other African Americans would be open to the practice but suggested that its presentation may need to be adapted. They suggested emphasizing the health benefits, connecting it to familiar spiritual ideology and cultural practices, supplementing the reading material with African American writers, increasing communication (education, instructor availability, "buddy system," etc.), and including African Americans as instructors and participants. By implementing minor adaptations that enhance cultural relevance, mindfulness meditation can be a beneficial therapeutic intervention for this population.
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Garland EL, Gaylord SA, Palsson O, Faurot K, Douglas Mann J, Whitehead WE. Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. J Behav Med 2012; 35:591-602. [PMID: 22161025 PMCID: PMC3883954 DOI: 10.1007/s10865-011-9391-z] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 11/29/2011] [Indexed: 12/11/2022]
Abstract
Irritable bowel syndrome (IBS) is a prevalent functional disorder characterized by abdominal pain and hypervigilance to gastrointestinal sensations. We hypothesized that mindfulness training (MT), which promotes nonreactive awareness of emotional and sensory experience, may target underlying mechanisms of IBS including affective pain processing and catastrophic appraisals of gastrointestinal sensations. Seventy five female IBS patients were randomly assigned to participate in either 8 weeks of MT or a social support group. A theoretically grounded, multivariate path model tested therapeutic mediators of the effect of MT on IBS severity and quality of life. Results suggest that MT exerts significant therapeutic effects on IBS symptoms by promoting nonreactivity to gut-focused anxiety and catastrophic appraisals of the significance of abdominal sensations coupled with a refocusing of attention onto interoceptive data with less emotional interference. Hence, MT appears to target and ameliorate the underlying pathogenic mechanisms of IBS.
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Affiliation(s)
- Eric L Garland
- College of Social Work, Trinity Institute for the Addictions, Florida State University, 296 Champions Way, PO Box 3062570, Tallahassee, FL, 32306-2570, USA,
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Gaylord SA, Palsson OS, Garland EL, Faurot KR, Coble RS, Mann JD, Frey W, Leniek K, Whitehead WE. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am J Gastroenterol 2011; 106:1678-88. [PMID: 21691341 PMCID: PMC6502251 DOI: 10.1038/ajg.2011.184] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This prospective, randomized controlled trial explored the feasibility and efficacy of a group program of mindfulness training, a cognitive-behavioral technique, for women with irritable bowel syndrome (IBS). The technique involves training in intentionally attending to present-moment experience and non-judgmental awareness of body sensations and emotions. METHODS Seventy-five female IBS patients were randomly assigned to eight weekly and one half-day intensive sessions of either mindfulness group (MG) training or a support group (SG). Participants completed the IBS severity scale (primary outcome), IBS-quality of life, brief symptom inventory-18, visceral sensitivity index, treatment credibility scale, and five-facet mindfulness questionnaire before and after treatment and at 3-month follow-up. RESULTS Women in the MG showed greater reductions in IBS symptom severity immediately after training (26.4% vs. 6.2% reduction; P=0.006) and at 3-month follow-up (38.2% vs. 11.8%; P=0.001) relative to SG. Changes in quality of life, psychological distress, and visceral anxiety were not significantly different between groups immediately after treatment, but evidenced significantly greater improvements in the MG than in the SG at the 3-month follow-up. Mindfulness scores increased significantly more in the MG after treatment, confirming effective learning of mindfulness skills. Participants' ratings of the credibility of their assigned interventions, measured after the first group session, were not different between groups. CONCLUSIONS This randomized controlled trial demonstrated that mindfulness training has a substantial therapeutic effect on bowel symptom severity, improves health-related quality of life, and reduces distress. The beneficial effects persist for at least 3 months after group training.
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Affiliation(s)
- Susan A. Gaylord
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Olafur S. Palsson
- Department of Medicine, Center for Functional Gastrointestinal and Motility Disorders and Division of Gastroenterology and Hepatology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eric L. Garland
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Keturah R. Faurot
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca S. Coble
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J. Douglas Mann
- Department of Neurology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William Frey
- Training and Development, Offi ce of Human Resources, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Karyn Leniek
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William E. Whitehead
- Department of Medicine, Center for Functional Gastrointestinal and Motility Disorders and Division of Gastroenterology and Hepatology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Curtis P, Gaylord SA, Park J, Faurot KR, Coble R, Suchindran C, Coeytaux RR, Wilkinson L, Mann JD. Credibility of low-strength static magnet therapy as an attention control intervention for a randomized controlled study of CranioSacral therapy for migraine headaches. J Altern Complement Med 2011; 17:711-21. [PMID: 21732734 DOI: 10.1089/acm.2010.0277] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Developing valid control groups that generate similar perceptions and expectations to experimental complementary and alternative (CAM) treatments can be challenging. The perceived credibility of treatment and outcome expectancy often contributes to positive clinical responses to CAM therapies, thereby confounding efficacy data. As part of a clinical feasibility study, credibility and expectancy data were obtained from subjects suffering from migraine who received either CranioSacral therapy (CST) or an attention-control, sham, and low-strength magnet (LSSM) intervention. OBJECTIVE The objective of this study was to evaluate whether the LSSM intervention generated similar levels of subject credibility and expectancy compared to CST. DESIGN This was a two-arm randomized controlled trial. SUBJECTS Sixty-five (65) adults with moderate to severe migraine were the subjects of this study. INTERVENTIONS After an 8-week baseline, subjects were randomized to eight weekly treatments of either CST (n=36) or LSSM (n=29). The latter involved the use of a magnet-treatment protocol using inactive and low-strength static magnets designed to mimic the CST protocol in terms of setting, visit timing, body positioning, and therapist-subject interaction. OUTCOME MEASURES A four-item, self-administered credibility/expectancy questionnaire, based on a validated instrument, was completed after the first visit. RESULTS Using a 0-9 rating scale, the mean score for perceived logicality of treatment was significantly less for LSSM (5.03, standard deviation [SD] 2.34) compared to CST (6.64, SD 2.19). Subject confidence that migraine would improve was greater for CST (5.94, SD 2.01) than for LSSM (4.9, SD 2.21), a difference that was not statistically significant. Significantly more subjects receiving CST (6.08, SD 2.27) would confidently recommend treatment to a friend than those receiving LSSM (4.69, SD 2.49). CONCLUSIONS Although LSSM did not achieve a comparable level of credibility and expectancy to the CST, several design and implementation factors may have contributed to the disparity. Based on analysis of these factors, the design and implementation of a future study may be improved.
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Affiliation(s)
- Peter Curtis
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Ramsden CE, Mann JD, Faurot KR, Lynch C, Imam ST, MacIntosh BA, Hibbeln JR, Loewke J, Smith S, Coble R, Suchindran C, Gaylord SA. Low omega-6 vs. low omega-6 plus high omega-3 dietary intervention for chronic daily headache: protocol for a randomized clinical trial. Trials 2011; 12:97. [PMID: 21496264 PMCID: PMC3096579 DOI: 10.1186/1745-6215-12-97] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 04/15/2011] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Targeted analgesic dietary interventions are a promising strategy for alleviating pain and improving quality of life in patients with persistent pain syndromes, such as chronic daily headache (CDH). High intakes of the omega-6 (n-6) polyunsaturated fatty acids (PUFAs), linoleic acid (LA) and arachidonic acid (AA) may promote physical pain by increasing the abundance, and subsequent metabolism, of LA and AA in immune and nervous system tissues. Here we describe methodology for an ongoing randomized clinical trial comparing the metabolic and clinical effects of a low n-6, average n-3 PUFA diet, to the effects of a low n-6 plus high n-3 PUFA diet, in patients with CDH. Our primary aim is to determine if: A) both diets reduce n-6 PUFAs in plasma and erythrocyte lipid pools, compared to baseline; and B) the low n-6 plus high n-3 diet produces a greater decline in n-6 PUFAs, compared to the low n-6 diet alone. Secondary clinical outcomes include headache-specific quality-of-life, and headache frequency and intensity. METHODS Adults meeting the International Classification of Headache Disorders criteria for CDH are included. After a 6-week baseline phase, participants are randomized to a low n-6 diet, or a low n-6 plus high n-3 diet, for 12 weeks. Foods meeting nutrient intake targets are provided for 2 meals and 2 snacks per day. A research dietitian provides intensive dietary counseling at 2-week intervals. Web-based intervention materials complement dietitian advice. Blood and clinical outcome data are collected every 4 weeks. RESULTS Subject recruitment and retention has been excellent; 35 of 40 randomized participants completed the 12-week intervention. Preliminary blinded analysis of composite data from the first 20 participants found significant reductions in erythrocyte n-6 LA, AA and %n-6 in HUFA, and increases in n-3 EPA, DHA and the omega-3 index, indicating adherence. TRIAL REGISTRATION ClinicalTrials.gov (NCT01157208).
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Affiliation(s)
- Christopher E Ramsden
- Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, NIAAA, NIH, Bethesda, MD, USA
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Douglas Mann
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keturah R Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanee Lynch
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Syed Taha Imam
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beth A MacIntosh
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph R Hibbeln
- Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, NIAAA, NIH, Bethesda, MD, USA
| | - James Loewke
- Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, NIAAA, NIH, Bethesda, MD, USA
| | - Sunyata Smith
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Coble
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chirayath Suchindran
- Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Susan A Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Garland EL, Gaylord SA, Boettiger CA, Howard MO. Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: results of a randomized controlled pilot trial. J Psychoactive Drugs 2010; 42:177-92. [PMID: 20648913 DOI: 10.1080/02791072.2010.10400690] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Mindfulness training may disrupt the risk chain of stress-precipitated alcohol relapse. In 2008, 53 alcohol-dependent adults (mean age = 40.3) recruited from a therapeutic community located in the urban southeastern U.S. were randomized to mindfulness training or a support group. Most participants were male (79.2%), African American (60.4%), and earned less than $20,000 annually (52.8%). Self-report measures, psychophysiological cue-reactivity, and alcohol attentional bias were analyzed via repeated measures ANOVA. Thirty-seven participants completed the interventions. Mindfulness training significantly reduced stress and thought suppression, increased physiological recovery from alcohol cues, and modulated alcohol attentional bias. Hence, mindfulness training appears to target key mechanisms implicated in alcohol dependence, and therefore may hold promise as an alternative treatment for stress-precipitated relapse among vulnerable members of society.
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Affiliation(s)
- Eric L Garland
- College of Social Work, Florida State University, University Center, Building C, Tallahassee, FL 32306-2570, USA.
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Gaylord SA, Whitehead WE, Coble RS, Faurot KR, Palsson OS, Garland EL, Frey W, Mann JD. Mindfulness for irritable bowel syndrome: protocol development for a controlled clinical trial. BMC Complement Altern Med 2009; 9:24. [PMID: 19638214 PMCID: PMC2729728 DOI: 10.1186/1472-6882-9-24] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 07/28/2009] [Indexed: 12/15/2022]
Abstract
Background Irritable bowel syndrome (IBS), a functional bowel disorder with symptoms of abdominal pain and disturbed defecation experienced by 10% of U.S. adults, results in significant disability, impaired quality of life, and health-care burden. Conventional medical care focusing on pharmacological approaches, diet, and lifestyle management has been partially effective in controlling symptoms. Behavioral treatments, such as cognitive-behavioral therapy and hypnosis, are promising. This paper describes an on-going feasibility study to assess the efficacy of mindfulness training, a behavioral treatment involving directing and sustaining attention to present-moment experience, for the treatment of IBS. Methods/Design The study design involves randomization of adult women with IBS according to Rome II criteria, to either an eight-week mindfulness training group (based on a Mindfulness-based Stress Reduction [MBSR] format) or a previously validated IBS social-support group as an attention-control condition. The primary hypothesis is that, compared to Support Group participants, those in the Mindfulness Program will demonstrate significant improvement in IBS symptoms as measured by the IBS Symptom Severity Scale [1]. Discussion 214 individuals have been screened for eligibility, of whom 148 were eligible for the study. Of those, 87 were enrolled, with 21 withdrawing after having given consent. 66 have completed or are in the process of completing the interventions. It is feasible to undertake a rigorous randomized clinical trial of mindfulness training for people with IBS, using a standardized MBSR protocol adapted for those experiencing IBS, compared to a control social-support group previously utilized in IBS studies. Trial Registration Clinical Trials.gov Identifier: NCT00680693
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Mann JD, Faurot KR, Wilkinson L, Curtis P, Coeytaux RR, Suchindran C, Gaylord SA. Craniosacral therapy for migraine: protocol development for an exploratory controlled clinical trial. Altern Ther Health Med 2008; 8:28. [PMID: 18541041 PMCID: PMC2442042 DOI: 10.1186/1472-6882-8-28] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 06/09/2008] [Indexed: 11/14/2022]
Abstract
Background Migraine affects approximately 20% of the population. Conventional care for migraine is suboptimal; overuse of medications for the treatment of episodic migraines is a risk factor for developing chronic daily headache. The study of non-pharmaceutical approaches for prevention of migraine headaches is therefore warranted. Craniosacral therapy (CST) is a popular non-pharmacological approach to the treatment or prevention of migraine headaches for which there is limited evidence of safety and efficacy. In this paper, we describe an ongoing feasibility study to assess the safety and efficacy of CST in the treatment of migraine, using a rigorous and innovative randomized controlled study design involving low-strength static magnets (LSSM) as an attention control intervention. Methods The trial is designed to test the hypothesis that, compared to those receiving usual care plus a treatment with low-strength static magnets (attention-control complementary therapy), subjects receiving usual medical care plus CST will demonstrate significant improvement in: quality-of-life as measured by the Headache Impact Test (HIT-6); reduced frequency of migraine; and a perception of clinical benefit. Criteria for inclusion are either gender, age > 11, English or Spanish speaking, meeting the International Classification of Headache Disorders (ICHD) criteria for migraine with or without aura, a headache frequency of 5 to 15 per month over at least two years. After an 8 week baseline phase, eligible subjects are randomized to either CST or an attention control intervention, low strength static magnets (LSSM). To evaluate possible therapist bias, videotaped encounters are analyzed to assess for any systematic group differences in interactions with subjects. Results 169 individuals have been screened for eligibility, of which 109 were eligible for the study. Five did not qualify during the baseline phase because of inadequate headache frequency. Nineteen have withdrawn from the study after giving consent. Conclusion This report endorses the feasibility of undertaking a rigorous randomized clinical trial of CST for migraine using a standardized CST protocol and an innovative control protocol developed for the study. Subjects are able and willing to complete detailed headache diaries during an 8-week baseline period, with few dropouts during the study period, indicating the acceptability of both interventions. Trial Registration ClinicalTrials.gov NCT00665236
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Abstract
The authors review the use of complementary and alternative medicine (CAM) in the United States. They then present and discuss the rationales used by the 15 National Center for Complementary and Alternative Medicine CAM educational grantees in their original proposals for incorporating CAM content into conventional health professions training programs. Fourteen of the grantees were from major U.S. medical and nursing schools, and one was from a medical student foundation. Awards were for five-year periods (with the exception of one three-year grant) from 2000 to 2008. Rationales for developing educational programs about CAM for conventional health professionals included (1) the prevalence and growth of CAM in the United States, (2) response to governmental, legislative, and other mandates, (3) need for enhanced communication between conventional providers and patients using CAM, (4) need to enhance safety of CAM use and interactions with conventional care, (5) CAM education's positive impact on broadening core competencies for conventional health care professionals, (6) positive impact on enhancing cultural competency, (7) need for better communication between conventional and CAM providers, (8) potential for improving health care coordination, (9) potential impact on increasing CAM research quality and capacity, and (10) potential for enhancing quality of care through informed CAM use. Integration of CAM with conventional health care requires educational venues that prepare conventionally trained caregivers with a sufficient knowledge base for assessing beneficial and detrimental interactions between CAM and conventional care approaches; development of criteria for making informed referrals to CAM practitioners; and enhanced research capacity.
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Affiliation(s)
- Susan A Gaylord
- Program on Integrative Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599, USA.
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Affiliation(s)
- S A Gaylord
- Program on Aging, University of North Carolina School of Medicine, Chapel Hill
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Abstract
OBJECTIVE To determine the usefulness of timed manual performance measurements (TMP) as predictors of health outcomes, hospitalization, and mortality in a large, heterogeneous sample of elderly people living in the community. DESIGN Prospective cohort study. SETTING Central North Carolina. PARTICIPANTS 1,286 community-dwelling older people. MEASUREMENTS Demographic background, health problems, number of prescribed medications, perceived health, quality of life, and the TMP, a 27-item test that has been shown to predict functional dependency and need of health-care services in older people. RESULTS During the 2-year follow-up period, 127 people died and 200 were hospitalized. Scores for those who were able to complete the original TMP, as well as scores for two shorter versions of the TMP, predicted mortality and, to a lesser extent, hospitalization within 2 years. For both original and shorter versions of the TMP, relative risk of death was approximately 2.5 times greater for those in the poorest performance quartile, as compared with the best performing quartile, when adjusted for age, gender, race, and number of prescribed medications. TMP tests and an index of IADL were independent predictors of death. CONCLUSIONS TMP scores may be useful in the clinical setting as a vital sign of functioning, providing a means of targeting those individuals at increased risk of mortality.
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Affiliation(s)
- M E Williams
- Program on Aging, University of North Carolina School of Medicine, Chapel Hill 27599
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Abstract
The extent of functional disability measured by performance of a series of simple manual tasks was determined in 1,286 elderly people, aged 66 to 98, who resided in central North Carolina. Missing data left 1,106 subjects for analysis. Poor manual performance was defined by either of two criteria: (1) inability to complete all the test items, or (2) taking longer than 350 seconds to complete the test. Using the first criterion, 113 persons (10.2%) were poor performers. When the two writing items were omitted from the analysis, 28 persons (2.4%) were in the poor performance group. Of the 993 persons who completed all items, 59 persons (5.9%) performed poorly. Using both criteria, the extent of functional disability was 16.1%; excluding the writing items, the extent of poor performance was 8.3%. Compared to those who performed well, those who performed poorly were older, poorer, less educated, more likely to be black, and less healthy. Because manual ability correlates highly with functional dependency and identifies those at risk for increased care needs, the magnitude of manual dysfunction noted in this survey has important implications for care providers and policy-makers.
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Affiliation(s)
- M E Williams
- Program on Aging, School of Medicine, University of North Carolina, Chapel Hill 27599-7550
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Affiliation(s)
- M E Williams
- Program on Aging, School of Medicine, University of North Carolina, Chapel Hill 27599-2750
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Minkler M, Phillips HT, Gaylord SA. Aging and Public Health. J Public Health Policy 1986. [DOI: 10.2307/3342266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Older subjects responded slower than younger subjects on a spatial task which required them to rotate mentally a perspectively drawn figure in order to judge whether it was congruent with a second figure. Decision time was partitioned into two components: (1) the time taken for the "mental rotation" process, (2) the time taken for the remaining processes such as stimulus encoding and motor output. Both components required more time in the elderly group. The increase with age in the component of decision time representing rotational processes was similar to those increases seen by other investigators examining age-dependent differences in time required for memory-scanning processes using verbal stimuli.
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