Review articleMindfulness-based interventions for chronic pain: Evidence and applications
Introduction
Chronic pain, or pain that lasts more than three months, can become progressively worse and reoccur intermittently, outlasting the usual healing process (Merskey and Bogduk, 1994). Such pain is often associated with disability, financial loss, decrease in productivity, absenteeism, emotional and social problems, and poor well-being (Waddell, 1996)
Chronic pain places an enormous burden on individuals and society. Estimates show that every 5th person suffers from pain; according to the World Health Organization every 1 in 10 adults is diagnosed with having chronic pain each year (Goldberg and McGee, 2011). Chronic pain is not exclusive to adults; it is found in adolescents and children as well, with a reported prevalence of 25% (Perquin et al., 2000). Within the United States (U.S.), the prevalence of chronic pain is estimated at 12% to 25% (Center for Health Statistics, 2006); it is around 20% in Europe (Breivik et al., 2006), and between 34%–41% in low and middle-income countries (LMICs) (Jackson et al., 2016, Tsang et al., 2008).
The Global Burden of Disease study 2015 presents the years lived with disability (YLDs) for 310 diseases and injuries (Global Burden of Disease Study Collaborators et al., 2015). YLDs captures the burden of living with a disease or disability in terms of quality of life lost and is not an economic measure. Of the 20 top causes of YLDs, chronic pain accounts for six: low back pain (#1), neck pain (#5), migraine (#7), other musculosketal disorders, which are often accompanied by chronic pain (#8), osteoarthritis (#13) and medication overdose headache (#18).
These pain conditions are also found in the top 20 leading causes of YLDs in both the U.S. and Europe, with minor variations in their ranking position (Global Burden of Disease Study Collaborators et al., 2015). Major depression and anxiety disorders are the third and ninth leading causes of YLDs and are often associated with or are the result of chronic pain conditions (Woo, 2010).
Chronic pain also has a direct economic impact on health care systems (direct costs) and in loss of productivity at work (indirect costs). It is clear that it poses a significant cost to the health-care systems and work-force internationally (Dagenais et al., 2008). For the U.S. in the year 2010, the total financial cost incurred from chronic pain was estimated to be between $560 to $635 billion—approximately 4% of the gross domestic product (GDP) (Institute of Medicine, 2011).
Similarly in Europe, direct and indirect costs of chronic pain amount to billions of Euros, estimated between 3 and 10% of various countries’ GDP (Breivik et al., 2013). With an aging population, the burden of chronic pain conditions is likely to rise (Fayaz et al., 2016). Thus, there is a great need to find treatment strategies that are efficacious, safe and cost effective.
For the past two decades, opiates have been the mainstay in the treatment of non-malignant chronic pain disorders in the United States (Kalso et al., 2003). It was widely believed, taught and practiced that opiates were usually non-addictive when used to treat chronic pain (Weissman and Haddox, 1989). Aggressive marketing and promotional strategies from pharmaceutical companies, and this maxim, led to almost exponential growth in the use of prescription opiate medications for the treatment of pain (Rudd et al., 2016). Since the beginning of the 21st century, opiate prescription rates have quadrupled, with a parallel increase in overdose deaths, with no decrease in the prevalence of pain (Daubresse et al., 2013). Center for Disease Control (CDC) guidelines for treatment of chronic pain now encourage the use of non-opiate pharmacological treatments and alternative therapies as first-line treatment for chronic pain (Dowell et al., 2016).
Section snippets
Alternative treatments for chronic pain
Many non-pharmacological treatments have proven to be effective in the treatment of chronic pain. Mindfulness-based interventions, cognitive behavioral therapy, acceptance and commitment therapy, and hypnosis are psychotherapies that can reduce perception of pain and increase mobility and functioning (Kabat-Zinn et al., 1985, Majeed and Sudak, 2017, Hughes et al., 2017, Elkins et al., 2012). In addition, physical therapy, occupational therapy and exercise have been effective for the treatment
Discussion
There is consistent evidence in support of MBIs, such as MM, MBSR, MBP and MBCT in the treatment of several chronic pain conditions. These techniques were found to be efficacious in treatment of chronic low back pain, migraine and headache, and musculoskeletal pain. In most of these conditions there was a significant improvement in the symptoms and treatment gains were often comparable with other standard treatment options such as CBT. These strategies can alleviate pain, improve functioning
Conclusion
MBIs have persistently demonstrated moderate success in the treatment of several chronic pain disorders. The advantages of MBIs include no risk of addiction or abuse, better treatment outcomes, and improvement in co-morbid conditions such as anxiety and depression. Moreover, MBI can be used as a stand-alone treatment or in conjunction with other treatment modalities. When MBIs are integrated in a comprehensive pain management plan, consumption of pain-related medications is reduced, pain
Conflict of interests
None.
Conflict of interest
None of the authors has any conflict of interest to disclose and there are no financial conflicts to disclose.
Prior publication
None.
Prior abstract publication/presentation
None.
Funding
This study was performed independently of any financial support.
Acknowledgement
Authors have no acknowledgements to report.
References (43)
- et al.
Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment
Eur. J. Pain
(2006) - et al.
A systematic review of low back pain cost of illness studies in the United States and internationally
Spine J.
(2008) - et al.
Mindfulness-based cognitive therapy for the treatment of headache pain
Clin. J. Pain
(2013) - et al.
Mindfulness-based stress reduction and health benefits
J. Psychosom. Res.
(2004) An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results
Gen. Hosp. Psychiatry
(1982)- et al.
Recommendations for using opioids in chronic non-cancer pain
Eur. J. Pain
(2003) - et al.
Pain in children and adolescents: a common experience
Pain
(2000) - et al.
Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice
J. Psychosom. Res.
(2010) - et al.
Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain
Pain
(2010) - et al.
Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders
J. Pain
(2008)
Opioid pseudoaddiction – an iatrogenic syndrome
Pain
The effectiveness of mindfulness-Based stress reduction on perceived pain intensity and quality of life in patients with chronic headache
Glob. J. Health Sci.
the individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care
BMC Public Health
Psychobiological correlates of improved mental health in patients with musculoskeletal pain after a mindfulness-based pain management program
Clin. J. Pain
Brief mindfulness-based therapy for chronic tension-type headache: a randomized controlled pilot study
Behav. Cogn. Psychother.
Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain
JAMA
Two-year follow-up of a randomized clinical trial of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care for chronic low back pain
JAMA
Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline
Ann. Intern. Med.
Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000–2010
Med. Care
CDC guideline for prescribing opioids for chronic pain—United States, 2016
JAMA
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