Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis

Abstract

Background: Chronic pain and its associated distress and disability are common reasons for seeking medical help. Patients with chronic pain use primary healthcare services five times more than the rest of the population. Mindfulness has become an increasingly popular self-management technique.

Aim: To assess the effectiveness of mindfulness-based interventions for patients with chronic pain.

Design and setting: Systematic review and meta-analysis including randomised controlled trials of mindfulness-based interventions for chronic pain. There was no restriction to study site or setting.

Method: The databases MEDLINE(®), Embase, AMED, CINAHL, PsycINFO, and Index to Theses were searched. Titles, abstracts, and full texts were screened iteratively against inclusion criteria of: randomised controlled trials of mindfulness-based intervention; patients with non-malignant chronic pain; and economic, clinical, or humanistic outcome reported. Included studies were assessed with the Yates Quality Rating Scale. Meta-analysis was conducted.

Results: Eleven studies were included. Chronic pain conditions included: fibromyalgia, rheumatoid arthritis, chronic musculoskeletal pain, failed back surgery syndrome, and mixed aetiology. Papers were of mixed methodological quality. Main outcomes reported were pain intensity, depression, physical functioning, quality of life, pain acceptance, and mindfulness. Economic outcomes were rarely reported. Meta-analysis effect sizes for clinical outcomes ranged from 0.12 (95% confidence interval [CI] = -0.05 to 0.30) (depression) to 1.32 (95% CI = -1.19 to 3.82) (sleep quality), and for humanistic outcomes 0.03 (95% CI = -0.66 to 0.72) (mindfulness) to 1.58 (95% CI = -0.57 to 3.74) (pain acceptance). Studies with active, compared with inactive, control groups showed smaller effects.

Conclusion: There is limited evidence for effectiveness of mindfulness-based interventions for patients with chronic pain. Better-quality studies are required.

Keywords: chronic pain; meta-analysis; mindfulness; primary health care; review.

Figure 1.

Pooling formulae. (N = sample size, M = mean, 1 = group 1, 2 = group 2, SD = standard deviation).

Figure 2.

PRISMA flowchart. MBI = mindfulness-based intervention. MBSR = mindfulness-based stress reduction. MBCT = mindfulness-based cognitive therapy. RCT= randomised controlled trial.

Figure 3.

Outcome measures with primary outcomes identified where these are the basis for power calculation. EEG = electroencephalography. RA = rheumatoid arthritis.

Figure 4:

Yates Quality Rating of Studies. Items with two cells were allocated 2 points on the Yates Scale. Items with only one cell were allocated 1 point.