NU560-8D Unit7 Discussion2-REPLY1
Mindfulness-Based Stress Reduction in Practice to Reduce Chronic Pain
Name
Herzing Univeristy
NU560: Research Methods and Evidence-Based Practice
Instructor
Date
My name is Ansley Vialpando, and throughout my time in this course I have researched mindfulness-based stress reduction as a treatment for chronic pain in adults.
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The Problem
Chronic Pain(CP) affects 1 in 5 adults (Khoo et al., 2019)
CP affects all dimensions of a person’s well-being
Medicines are often ineffective or have negative side effects
CP is a financial drain on health-care systems and providers (Williams et al., 2015)
CP is often exacerbated by stress and requires a psychological approach (Williams et al., 2015)
Chronic pain is a massive concern among providers and healthcare workers in today’s field. 1 in 5 adults suffer from some sort of chronic pain, and all dimensions of a person’s well-being is affected when chronic pain is involved. While some medications help, others are often ineffective or have negative side effects associated with them. Not only is chronic pain an inconvenience financially to those that possess it, but also to those that are attempting to manage or treat it. We know stress has negative impacts on many body systems, and chronic pain is no exception. Many times the pain is exacerbated by stressful situations.
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The Solution
Mindfulness-based stress reduction (MBSR) is a meditative-like practice that can be an essential nonpharmacological approach for disease management, including chronic pain (Williams et al., 2015)
MBSR is a psychological approach to treating chronic pain symptoms, and can be used in conjunction with other traditional therapies. Using a meditation based therapy, an 8 week course of MBSR can improve pain symptoms and empower sufferers to control their response to their pain.
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What is MBSR?
Concepts:
Awareness, Attention, Acceptance, Reperceiving (Williams et al., 2015)
Mindfulness techniques:
Breath awareness, Body scan, Yoga practices (Williams et al., 2015)
Group-based therapy
Usually 8 week course
MBSR has several components that differ it from other psychological treatments such as cognitive behavioral therapy. It is group-based in weekly sessions. The mindfulness aspect is a major concept of most meditation practices, and focuses on bringing awareness and attention to the present moment and current state of body. Acceptance occurs when clients allow their feelings and perceptions to exist without judgment. Reperceiving pain is a shift in perspective or detaching oneself from the situation. Breath awareness and body scan promote feeling sensations and emotions that do not need to be suppressed or fought, but accepted. Yoga increases flexibility and strength to bring a physical factor into the therapy. This image is an example of what topics are entailed in an 8-week MBSR course.
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PICOT Question
In adults suffering from chronic pain, how does treatment complemented with mindfulness-based stress reduction compared to traditional medical routes affect the overall quality of life and pain levels of patients after an MBSR 8-week course?
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Stillwell et al. (2010) describe a PICOT question as patient population (P), intervention or issue of interest (I), comparison intervention (C), outcome(s) (O), and the time required to meet outcomes (T). In my topic of MBSR relating to pain, the patient population in is adults coping with chronic pain. The intervention is MBSR as a complementary treatment, and the comparison intervention is usual care, or traditional treatment, of chronic pain. The ideal outcomes are increased quality of life, decreased perception of pain, and pain management tools. An 8-week course of MBSR therapy is the timeframe in place for the outcomes to occur.
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Articles
Systematic review and network meta-analysis comparing MBSR and CBT for CP
RCT on MBSR vs CBT or usual care on chronic low back pain
RCT on MBSR as a treatment for IC/BPS
Quantitative study on MBSR’s impact on endocrine, physical, and psychological functions related to chronic low back pain
Mixed-methods study on MBSR for HIV-related chronic pain
The five articles I reviewed to produce evidence for my PICOT question included one meta-analysis, two randomized controlled trials, another quantitative study, and a mixed methods study. Each of the articles referenced chronic pain in relation to different ailments: lower back pain, HIV, and interstitial cystitis/bladder pain syndrome.
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Meta-Analysis
Khoo et al. (2019) reviewed 21 studies
MBSR, cognitive behavioral therapy (CBT), and usual care compared in the treatment of CP
Interventions:
8 week MBSR or CBT course
Usual care
Variables tested:
Physical functioning
Pain intensity
Depression symptoms
Results:
MBSR and CBT improved physical functioning and pain intensity
CBT offered more depression symptom relief
MBSR offers another helpful intervention for chronic pain management
This study produced a systematic review and meta-analysis of 21 publications, and among the studies, participants with musculoskeletal disorders, arthritis, fibromyalgia, and lower back pain were included. The studies included tested MBSR to CBT and usual care through 8-week courses. They determined efficacy through levels of physical function, pain intensity, and depression symptoms. The authors concluded MBSR offers another potentially successful intervention for chronic pain management; the practices show promise to improve the severity of pain, as well as reduce pain’s interference and distress in daily activities.
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RCT 1
Low Back Pain
Cherkin et al. (2016) studied 342 participants
MBSR, CBT, or usual care groups
Interventions:
8 week MBSR or CBT course
Usual care
Variables:
Functional limitations
Back pain bothersomeness
Results:
MBSR and CBT resulted in greater improvements
No significant difference between MBSR and CBT
MBSR an effective treatment option for chronic low back pain
The initial randomized controlled trial I reviewed contained 342 participants with chronic low back pain. The researchers placed them into 3 groups: MBSR, CBT, or usual care; each received an 8 week course of that therapy or continued their usual treatments. Functional limitations and self-reported back pain bothersomeness determined the results of this research. In conclusion, 60.5% of the mindfulness-based stress reduction group had clinically meaningful improvement (at least 30% improvement from baseline) after the trial. Findings showed that both MBSR and CBT improved back pain and limitations than usual care alone.
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RCT 2
Interstitial Cystitis/Bladder Pain Syndrome
Kanter et al. (2019) researched 20 participants
MBSR vs. usual care groups
Interventions:
8 week MBSR course + usual care
Usual care
Variables:
Pain scale/bothersomeness
Quality of life
Sexual function
Pain self-efficacy
Results:
MBSR resulted in greater improvements in pain, self-efficacy, and bothersomeness
MBSR is a promising therapy for IC/BPS
The next randomized controlled trial study I examined contained 20 women with interstitial cystitis/bladder pain syndrome. 11 were randomized into an MBSR group that received an 8-week course, and the remaining 9 continued their usual care. Many questionnaires were used with this study, including ones that gauged pain, quality of life, sexual function, and pain self-efficacy. The surveys completed showed 87.5% of the MBSR group improved, versus 36.4% of the usual care group. The authors concluded that MBSR's benefit might result from patients' empowerment and the learned ability to cope with their symptoms.
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Quantitative Evidence
Ardito et al. (2017) studied 28 participants with chronic low back pain
MBSR vs. control waitlist groups
Interventions:
8 week MBSR course
Variables tested:
Pain severity
Quality of life
Psychological function/depression
Cortisol levels
Results:
Pain severity and quality of life were positively impacted by MBSR
Cortisol levels increased post-treatment
MBSR shows promise for treating low back pain
The next quantitative study took 28 participants with chronic low back pain and sequentially placed them in an MBSR group that took an 8-week course, or a control waitlist group that continued their normal routines. Pain severity, quality of life, depression, as well as cortisol levels were tested to determine efficacy. Morning and evening salivary cortisol levels were assessed in the MBSR group throughout the study, as cortisol is a stress-related biomarker that decreases in the presence of stress-induced symptoms. Both pain severity and quality of life were positively impacted by the MBSR course, and the increased cortisol levels were a promising finding.
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Mixed-Methods
George et al. (2015) had 32 HIV-infected participants
MBSR groups vs. health promotion classes
Interventions:
8 week MBSR course
8 weekly health education classes
Variables tested:
Autonomic function
HIV-related pain symptom levels
Perceived stress
Audiotaped focus groups
Results:
MBSR improved pain measures and perceived stress
Strong sense of community from group settings
In this mixed-methods study, 32 HIV-infected adults with chronic pain were assessed. They were randomly divided into MBSR or health promotion groups, both of which received 8-week courses. The quantitative elements studied were autonomic function, pain levels, and perceived stress. Audiotaped focus groups served as the qualitative aspect of the study. Through the focus groups, the researchers learned that the group settings of MBSR provided a strong sense of community. Data showed improvements in pain measures and perceived stress, but not in autonomic function.
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Search Strategies
PubMed and EBSCO host databases
Keywords: mindfulness-based stress reduction; chronic pain
Filtered for articles within the last 5 years
Screened for full-text articles only
Browsed cited works in interesting articles
To start my journey in researching this topic, I started with the databases EBSCO host and PubMed. In the search bar, I typed "mindfulness-based stress reduction" and ”chronic pain". Next, I refined the search to articles published from 2016 to the present and screened the remaining list to only full-text articles. After browsing the articles in the list, I found more relevant titles in the cited works of interesting articles. After further appraisal, I narrowed down the articles to the ones included in this review.
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Promising Changes
Adding MBSR as a complementary therapy for CP
Providing an alternative to traditional routes
Lowering pain levels
Providing tools to manage pain independently
Improving the participants' quality of life
The articles' consensus is that MBSR is an effective tool for the symptom management of chronic pain that originates from several disorders. The studies prove its effectiveness and, when used in conjunction with traditional therapies, can be a valuable tool when treating adults with chronic pain. The benefits of MBSR for chronic pain are lowering actual pain levels, providing tools to manage pain successfully, and improving the participants' quality of life. Advanced practice providers can greatly benefit from utilizing MBSR in their practice of caring for people with chronic pain.
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Strategies for Change
Educating providers on access to MBSR
Educating patients on the benefits of psychosocial treatments
Becoming a certified MBSR instructor
Additional research
To implement the findings in these studies, more providers should be aware and promote MBSR to their patients suffering from chronic pain. In doing so, more people will become educated about the benefits of MBSR, and hopefully reap the rewards of its practices. Advanced practice providers have the opportunity to become certified MBSR instructors to comprehensively treat their patient population in a new way. More research with MBSR as a focal point is essential to continue enforcing the credibility of the practice.
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Future Research
MBSR is a relatively recent addition to psychological treatments
Additional research is needed to make it a staple for practitioners
Each article reiterates the need for more studies
Opportunity for individualized studies on certain types of pain
Valid, credible research is essential
Since MBSR is a relatively new treatment in the psychological field, additional research is vital to make it a standard suggestion that practitioners offer. Each article in this review states that more studies should be done to further solidify their findings. As evidenced by some of the research here, there is opportunity for more individualized studies with MBSR as a treatment for various types of pain from different origins. The strength or validity of the best research evidence in any given area depends on the studies' quality and quantity conducted regarding that topic, so credible studies are essential to progress MBSR as a practice.
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Conclusion
Advanced practice providers can greatly benefit from utilizing MBSR for CP
Additional research with consistent and strengthened methods is encouraged
The consensus of MBSR is positive among studies
MBSR is an efficient way to manage pain symptoms
Mindfulness-based stress reduction has proven to be an advantageous nonpharmacologic treatment to manage chronic pain. The reviewed studies suggest that MBSR is an efficient way to manage pain symptoms. However, most of the studies reviewed suggest additional research with consistent and strengthened methodologies to draw definitive conclusions about the topic to inform guidelines.
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References
Ardito, R. B., Pirro, P. S., Re, T. S., Bonapace, I., Menardo, V., Bruno, E., & Gianotti, L. (2017). Mindfulness-Based Stress Reduction Program on Chronic Low-Back Pain: A Study Investigating the Impact on Endocrine, Physical, and Psychologic Functioning. The Journal of Alternative and Complementary Medicine, 23(8), 615–623. https://doi.org/10.1089/acm.2016.0423
Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., Hansen, K. E., & Turner, J. A. (2016). 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, 315(12), 1240. https://doi.org/10.1001/jama.2016.2323
[Eight week MBSR outline]. (n.d.). Habits for Wellbeing. https://www.habitsforwellbeing.com/distance-learning-8-week-mindfulness-based-stress-reduction-course/
George, M. C., Wongmek, A., Kaku, M., Nmashie, A., & Robinson-Papp, J. (2015). A Mixed-Methods Pilot Study of Mindfulness-Based Stress Reduction for HIV-Associated Chronic Pain. Behavioral Medicine, 43(2), 108–119. https://doi.org/10.1080/08964289.2015.1107525
Kanter, G., Komesu, Y. M., Qaedan, F., Jeppson, P. C., Dunivan, G. C., Cichowski, S. B., & Rogers, R. G. (2016). Mindfulness-based stress reduction as a novel treatment for interstitial cystitis/bladder pain syndrome: a randomized controlled trial. International Urogynecology Journal, 27(11), 1705–1711. https://doi.org/10.1007/s00192-016-3022-8
References
Khoo, E.-L., Small, R., Cheng, W., Hatchard, T., Glynn, B., Rice, D. B., Skidmore, B., Kenny, S., Hutton, B., & Poulin, P. A. (2019). Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: A systematic review and network meta-analysis. Evidence Based Mental Health, 22(1), 26–35. https://doi.org/10.1136/ebmental-2018-300062
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Asking the Clinical Question. AJN, American Journal of Nursing, 110(3), 58–61. https://doi.org/10.1097/01.naj.0000368959.11129.79
Williams, H., Simmons, L. A., & Tanabe, P. (2015). Mindfulness-Based Stress Reduction in Advanced Nursing Practice. Journal of Holistic Nursing, 33(3), 247–259. https://doi.org/10.1177/0898010115569349
Mindfulness-Based Stress Reduction (MBSR). (2018, January 9). [Photograph]. Center for Integrative Medicine. https://www.gwcim.com/services/mindfullness-based-stress-reduction-mbsr/
MBSR. (2016, August 26). [Photograph]. Insight Community of the Desert. https://desertinsight.org/2017/09/26/8-week-mindfulness-mbsr-class-with-beth-mulligan-and-ian-challis/