کاهش استرس مبتنی بر حضور ذهن برای شرایط درد مزمن: تنوع در نتایج درمان و نقش مراقبه خانگی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|31810||2010||8 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Psychosomatic Research, Volume 68, Issue 1, January 2010, Pages 29–36
Objective This study compared changes in bodily pain, health-related quality of life (HRQoL), and psychological symptoms during an 8-week mindfulness-based stress reduction (MBSR) program among groups of participants with different chronic pain conditions. Methods From 1997-2003, a longitudinal investigation of chronic pain patients (n=133) was nested within a larger prospective cohort study of heterogeneous patients participating in MBSR at a university-based Integrative Medicine center. Measures included the Short-Form 36 Health Survey and Symptom Checklist-90-Revised. Paired t tests were used to compare pre–post changes on outcome measures. Differences in treatment effect sizes were compared as a function of chronic pain condition. Correlations were examined between outcome parameters and home meditation practice. Results Outcomes differed in significance and magnitude across common chronic pain conditions. Diagnostic subgroups of patients with arthritis, back/neck pain, or two or more comorbid pain conditions demonstrated a significant change in pain intensity and functional limitations due to pain following MBSR. Participants with arthritis showed the largest treatment effects for HRQoL and psychological distress. Patients with chronic headache/migraine experienced the smallest improvement in pain and HRQoL. Patients with fibromyalgia had the smallest improvement in psychological distress. Greater home meditation practice was associated with improvement on several outcome measures, including overall psychological distress, somatization symptoms, and self-rated health, but not pain and other quality of life scales. Conclusion MBSR treatment effects on pain, HRQoL and psychological well-being vary as a function of chronic pain condition and compliance with home meditation practice.
An estimated one in three people suffer from chronic pain, a condition frequently associated with decreased health-related quality of life (HRQoL) and high levels of psychological distress . Despite conventional healthcare utilization, nearly half of patients with chronic pain report their pain as not under control . Limitations of drug therapy for chronic pain reflect the complex pathophysiology of the condition, as well as the profound contribution of psychosocial factors to the perpetuation of pain and suffering  and . Mind–body medicine is defined by a range of therapies intended to enhance the mind's capacity to improve bodily function and symptoms . Despite consensus that mind–body therapies can be effectively incorporated into comprehensive management of chronic pain, only 20% of chronic pain patients report using such interventions in the past year  and . A better understanding of the effectiveness of particular mind–body therapies for specific patient subpopulations may support wider and more successful integration of mind–body medicine with conventional pain management . Mindfulness-based stress reduction (MBSR) is a group intervention that appears to be a promising adjunct to treating chronic pain and attendant reduction in physical functioning and psychological well-being ,  and . The core of MBSR is intensive training in mindfulness meditation and its applications for daily living and coping with stress, illness, and pain  and . Mindfulness meditation is the practice of paying attention, on purpose, moment-to-moment, in a way that is nonjudgmental and nonreactive. Practitioners report greater equanimity and less distress secondary to uncomfortable sensations, thoughts, and emotions ,  and . A series of early treatment outcome studies found that MBSR program participants with various self-reported chronic pain conditions demonstrated significant changes in pain intensity, medical symptoms, psychological symptoms, coping ability, and inhibition of daily activity by pain, most of which were superior to standard medical care alone and persisted up to four years later ,  and . Another descriptive study of patients with heterogeneous chronic pain conditions reported significant changes in self-report measures of pain, pain beliefs, and psychological symptoms following MBSR combined with conventional medical treatment . The mean posttreatment effect size (d=.15) in the latter study, however, was substantially smaller than the MBSR effect sizes reported previously for chronic pain patients (.36<d<.70) . Therefore, it remains to be determined whether the health benefits of MBSR in mixed diagnosis pain cohorts generalize across study sites. Investigators have also studied MBSR for groups of patients diagnosed with a common chronic pain condition. Studies of fibromyalgia patients have demonstrated improvements in pain, anxiety, depression, somatic complaints, sense of coherence, global well-being, coping, sleep quality, and fatigue , ,  and . A waitlist controlled trial of rheumatoid arthritis patients reported no difference in disease activity but did not include pain as an outcome measure . A randomized trial of patients with chronic musculoskeletal pain found that MBSR effects on pain intensity did not differ significantly from massage therapy or standard medical care; however, MBSR uniquely improved psychological well-being at follow-up . Finally, a randomized clinical trial of MBSR for older adults with chronic low back pain found significant improvement in pain acceptance, and for one of three measures of physical functioning, but not for pain intensity . Given these mixed empirical findings, more needs to be known about the effectiveness of MBSR in chronic pain conditions, especially in relation to specific pain conditions. A neglected but potentially important methodological consideration is whether or not MBSR is taught to a medically heterogeneous or homogeneous patient population. MBSR programs generally serve mixed cohorts of patients who may or may not have chronic pain or share a medical condition. Studying MBSR for medically homogeneous cohorts may introduce unmeasured, confounding group effects. The primary aim of this study, therefore, was to compare MBSR treatment effects among subgroups of patients with different chronic pain conditions who participated in an MBSR program offered to a medically heterogeneous community population. Outcomes were HRQoL, including an index of bodily pain and pain-related limitations in daily functioning, and psychological distress, including measures of anxiety, depressive symptoms, somatization, and overall psychological distress level. Secondarily, because relatively little is known about the processes of therapeutic change during MBSR, the relationship between intervention outcomes and adherence to formal home meditation practice was assessed.