Education and Mindfulness – Research Evidence

• Systematic Review to evaluate the evidence for the effectiveness of neuroscience education (NE) for pain, disability, anxiety, and stress in chronic musculoskeletal (MSK) pain.
• Conclusions:
  • For chronic MSK pain disorders, there is compelling evidence that an educational strategy addressing neurophysiology and neurobiology of pain can have a positive effect on pain, disability, catastrophization, and physical performance.

• Design:
  • Double-blind RCT
• Thirty Fibromyalgia patients were randomly allocated to either the experimental (receiving pain physiology education) or the control group (receiving pacing self-management education).
• The primary outcome was the efficacy of the pain inhibitory mechanisms.
• Secondary outcome measures included pressure pain threshold measurements and questionnaires assessing pain cognitions, behavior, and health status.
• Assessments were performed at baseline, 2 weeks, and 3 months follow-up.
• Results:
  • After the intervention the experimental group:
    • Had improved knowledge of pain neurophysiology.
    • Worried less about their pain in the short term.
    • Long-term improvements in physical functioning, vitality, mental health, and general health perceptions were observed.
    • In addition, the intervention group reported lower pain scores and showed improved endogenous pain inhibition compared with the control group.
  • Discussion:
    • These results suggest that FM patients are able to understand and remember the complex material about pain physiology.
    • Pain physiology education seems to be a useful component in the treatment of FM patients as it improves health status and endogenous pain inhibition in the long term.

Mindfulness-Based Therapy

Schutze et al (2010)

Hofmann et al (2010)

• Meta-Analytic Review
• Although mindfulness-based therapy has become a popular treatment, little is known about its efficacy.
• Aim:
  • To conduct an effect size analysis of this popular intervention for anxiety and mood symptoms in clinical samples.
• The search identified 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions, including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions.
• Results:
  • Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety and mood symptoms from pre to post-treatment.
  • These effect sizes were robust, unrelated to publication year or number of treatment sessions, and were maintained over follow-up.
• Conclusion:
  • These results suggest that mindfulness-based therapy is a promising intervention for treating anxiety and mood problems in clinical populations.

Fjorback et al (2011)

Marchand (2012)

• This paper provides an overview of three mindfulness interventions that have demonstrated effectiveness for psychiatric symptoms and/or pain.
• The goal of this review is to provide a synopsis that practicing clinicians can use as a clinical reference concerning Zen meditation, mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT).
• Mindfulness has been described as a practice of learning to focus attention on moment-bymoment experience with an attitude of curiosity, openness, and acceptance.
• Studies indicate that MBSR and MBCT have broad-spectrum antidepressant and antianxiety effects and decrease general psychological distress.
• MBCT is strongly recommended as an adjunctive treatment for unipolar depression.
• The evidence suggests that both MBSR and MBCT have efficacy as adjunctive interventions for anxiety symptoms.
• MBSR is beneficial for general psychological health and stress management in those with medical and psychiatric illness as well as in healthy individuals.
• Finally, MBSR and Zen meditation have a role in pain management.

References:

Fjorback LO, Arendt M, Ornbøl E, Fink P, Walach H. Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials. Acta Psychiatr Scand. 2011 Aug;124(2):102-19.

Hofmann SG, Sawyer AT, Witt AA and Oh D. The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review. J Consult Clin Psychol. 2010 April ; 78(2): 169–183.

Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011 Dec;92(12):2041-56.

Marchand WR. Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress. J Psychiatr Pract. 2012 Jul;18(4):233-52.

Schütze R, Rees C, Preece M, Schütze M. Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. Pain. 2010 Jan;148(1):120-7.

Van Oosterwijck J, Meeus M, Paul L, De Schryver M, Pascal A, Lambrecht L, Nijs J. Pain Physiology Education Improves Health Status and Endogenous Pain Inhibition in Fibromyalgia: A Double-Blind Randomized Controlled Trial. Clin J Pain. 2013 Jan 30. [Epub ahead of print]