APNA 30th Annual Conference Session 2044: October 20, 2016 Advancing - - PDF document

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APNA 30th Annual Conference Session 2044: October 20, 2016 Benson 1

Advancing treatment. Transforming lives.

Mindfulness as an Adjunctive Treatment for Chronic Pain: An Evidence‐based Practice Project

John Benson, BSN, RN Erica Cuscina, BSN, RN Stephen Morocco, BSN, RN Jane Mahoney, PhD, RN, PMHCNS‐BC

Advancing treatment. Transforming lives.

Disclosure Statement

Financial Disclosure Statement:

• John Benson, Erica Cuscina, Jane Mahoney and Stephen

Morocco have no financial disclosures that would be a potential conflict of interest with this presentation.

Presentation Objectives:

• Discuss how thoughts and emotions influence the

pain experience (via the gate control theory of pain.)

• Describe at least one aspect of how mindfulness

influences the pain experience.

• Describe the effectiveness of mindfulness as an

adjunctive therapy for treating chronic pain.

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APNA 30th Annual Conference Session 2044: October 20, 2016 Benson 2

Advancing treatment. Transforming lives. Advancing treatment. Transforming lives. Advancing treatment. Transforming lives.

Mindfulness

• Mindfulness addresses the psychological aspects of pain.
• Mindfulness = Awareness in the moment

– Self regulation of attention to immediate experience. – A specific orientation to experience in the present moment (curiosity, openness, acceptance).

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APNA 30th Annual Conference Session 2044: October 20, 2016 Benson 3

Advancing treatment. Transforming lives. Advancing treatment. Transforming lives.

PICO Questions

Population, Intervention, Comparison, Outcome

• Among patients with chronic pain, is

mindfulness + standard of care superior to standard of care alone in reducing pain intensity?

• Among patients with chronic pain, is

mindfulness + standard of care superior to standard of care alone in improving quality of life?

Gotlink et al., 2015

Level I Systematic Review & Meta‐analysis Validity:

• Detailed description of the

search strategy.

• Extracted data based on

PRISMA guidelines for systematic reviews.

• Standard mean difference

combined for meta‐ analysis.

• Clear steps to reduce the

chance of double counting any individual study.

• Steps taken to obtain

missing data from study reports described. Results: Mindfulness and Chronic Pain

• Significant improvement:
• Depressive symptoms
• Pain burden
• Physical health
• Significant decrease in:
• Pain intensity
• Pain disability

Compared with wait‐list control (but not with health education)

• In fibromyalgia, improved:
• Quality of life
• Depression

Aim: Systematic overview of the effectiveness of MBSR and MBCT in different patient populations in order to identify the patient categories in which these interventions are indicated. Studies related to mindfulness and chronic pain:

• 3 systematic reviews met

inclusion criteria

• 13 unique

randomized control trials

• 722 unique patients

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APNA 30th Annual Conference Session 2044: October 20, 2016 Benson 4

Lakhan & Schofield, 2013

Level I Systematic Review & Meta‐ analysis Validity:

• Search strategy detailed.
• Valid psychometric measures.
• Most common and

comparable outcomes measures from individual studies assessed.

• Used Cochrane and PRISMA

Guidelines to ensure validity

• f the study
• Limited conclusions can be

drawn due to small number of studies with small sample sizes

• High level of heterogeneity

(multiple conditions)

• However, expected given

the heterogeneity of somatization disorders and variability of MBT programs.

Results: Mindfulness and pain

• SMD = ‐0.21 , 95%

CI = ‐0.37, ‐ 0.03

• Significantly in favor of the

experimental group (p <0.05)

• In subgroup analysis:

Significance for the IBS group only (p < 0.001) Mindfulness & quality of life

• SMD = 0.39, 95%

CI = 0.19, 0.59

• Significantly in favor of the

experimental group (p <0.001)

• In subgroup analysis:

Significance for the IBS group only (p <0.001). Aim: To test the efficacy of mindfulness‐based therapies in treating somatization disorders. 13 randomized controlled trials

Esmer, et al., 2010

Level 2 Randomized Control Trial Validity Strengths

• No statistical difference

between intervention and control group

• Subjects were randomized

to intervention

• 12 and 40 week follow up

Threats

• Chosen arbitrarily –

indicating bias

• Reliability and validity of

measures used was not reported

• Power analysis not

performed a priori to determine sample size

• No intent to treat

Results Pain Acceptance & QOL

• 4 point increase (on an 18

point scale) p <0.014 Physical Function

• 3 point decrease (on a 24

point scale) p <0.005 Pain Intensity

• 5 point decrease (on a 30

point scale) p <0.021 Sleep Quality

• 1 point decrease (on a 5

point scale) p <0.047 Analgesic Medication Log

• 1 point decrease (on a 4

point scale) p <0.001 Aim: To evaluate short term efficacy of MBSR therapy for improving QOL in adults with failed back surgery Method: Prospective, randomized, single‐blind, parallel group clinical trial Feasibility study Sample: N = 25 patients with failed back surgery syndrome (FBSS) (MBSR [N = 15]; TAU [N = 10])

Results

• Mindfulness is likely to be a somewhat effective

adjunctive therapy for patients with chronic pain.

• Shown to potentially improve pain and quality of life.
• There is indication that mindfulness may be useful

and not harmful.

• There is indication that mindfulness can decrease

analgesic use.