An increasing number of studies consider the specific processes by which distressing sensations, thoughts, and emotional experiences exert their influence on the daily functioning of those who suffer with chronic pain. Clinical methods of mindfulness and the processes that underlie them appear to have clear implications in this area, but have not been systematically investigated to this point in time. The purpose of the present study was to examine mindfulness in relation to the pain, emotional, physical, and social functioning of individuals with chronic pain. The present study included 105 consecutive patients attending a clinical assessment for treatment of chronic pain. Each completed a standardized battery of questionnaires, including a measure of mindfulness, the Mindful Attention Awareness Scale [Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol 2003;84:822–48]. Correlation analyses indicated that mindfulness was unrelated to age, gender, education, or chronicity of pain, but was significantly related to multiple measures of patient functioning. In multiple regression analyses, after controlling for patient background variables, pain intensity, and pain-related acceptance, mindfulness accounted for significant variance in measures of depression, pain-related anxiety; physical, psychosocial, and “other” disability. In each instance greater mindfulness was associated with better functioning. The combined increments of variance explained from acceptance of pain and mindfulness were at least moderate and, in some cases, appeared potentially meaningful. The behavioral processes of mindfulness and their accessibility to scientific study are considered.
One current psychological model of chronic pain suggests that patients with chronic pain suffer and are disabled particularly by process of restricted awareness, overwhelming influences of distressing thoughts and emotions, and from habitual patterns of ineffective avoidance (McCracken, 2005). Some chronic pain sufferers become overly focused on their pain, think in negative terms about their situation, suffer emotionally from both their thoughts and events outside their thoughts, and become fixed in recurrent patterns of unsuccessful struggling with pain in ways that limit their functioning. This general, contextual, cognitive-behavioral model is gaining increasing support, particularly its component processes of acceptance of pain (e.g., McCracken, 1998, McCracken et al., 1999, Viane et al., 2003 and McCracken et al., 2004) and values (McCracken and Yang, 2006).
There are specific treatment methods for chronic pain designed to address the processes of suffering and disability outlined above. Mindfulness-based methods are one example. These methods are intended to reduce the contribution of restricted awareness and some of the emotional and behavioral impact of distressing psychological experiences (Baer and Krietemeyer, 2006). Mindfulness can be defined as the practice of broad, present-focused, and behaviorally neutral awareness. It is a way to observe experiences, such as physical symptoms, emotions, or thoughts, such that some of the otherwise automatic behavioral influences attached to these experiences are reduced, leading to more balance, non-reactive, and realistic contact with situations, and more effective action. Although mindfulness-based methods appear effective for chronic pain in uncontrolled studies (e.g., Kabat-Zinn, 1982, Kabat-Zinn et al., 1985 and Kaplan et al., 1993), and have been the basis for recent quantitative reviews (Baer, 2003 and Grossman et al., 2004), there are few studies attempting to directly measure the processes of mindfulness, and no empirical studies of this type in relation to chronic pain.
The goal of mindfulness is not to alter the content of what is experienced but to change how it is experienced and the influences it exerts on behavior. In this way, mindfulness is best understood within a functional and contextual framework, as opposed to a framework that advocates the challenging or modifying of thoughts and feelings. This functional aspect of mindfulness appears well suited as a treatment method for intractable chronic pain, where changing what is felt appears dramatically more difficult than changing behavior in relation to what is felt.
The purpose of this investigation was to examine the role of mindfulness in relation to the functioning of persons with chronic pain. In this study, measures of patient functioning included pain, emotional distress, disability, and pain-related medication use. It was predicted that the greater neutral and present-focused awareness implied by mindfulness would be associated with more healthy and less distressed functioning on these measures. An additional purpose of the current study is to examine the relationship between acceptance of pain and mindfulness. It was expected that mindfulness would be positively associated with acceptance of pain but also that mindfulness, as a more general process of awareness and non-reactivity, would predict patient functioning independent of acceptance of pain.
