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

Abstract

QuestionThis review compares mindfulness-based stress reduction (MBSR) to cognitive-behavioural therapy (CBT) in its ability to improve physical functioning and reduce pain intensity and distress in patients with chronic pain (CP), when evaluated against control conditions.Study selection and analysisOvid MEDLINE, EmbaseClassic+Embase, PsycINFO and the Cochrane Library were searched to identify randomised controlled trials. The primary outcome measure was physical functioning. Secondary outcomes were pain intensity and depression symptoms. We used random and fixed effects (RE and FE) network meta-analyses (NMA) to compare MBSR, CBT and control interventions on the standardised mean difference scale.FindingsTwenty-one studies were included: 13 CBT vs control (n=1095), 7 MBSR vs control (n=545) and 1 MBSR vs CBT vs control (n=341). Of the 21 articles, 12 were determined to be of fair or good quality. Findings from RE NMA for change in physical functioning, pain intensity and depression revealed clinically important advantages relative to control for MBSR and CBT, but no evidence of an important difference between MBSR and CBT was found.ConclusionsThis review suggests that MBSR offers another potentially helpful intervention for CP management. Additional research using consistent measures is required to guide decisions about providing CBT or MBSR.

Sahaj Samadhi Meditation versus a Health Enhancement Program for depression in chronic pain: protocol for a Randomized Controlled Trial and Implementation Evaluation

“…Known contribution of LTOT to depression and secondary outcome of reducing opioid use/dose 13 3. Comorbid depressive symptoms of mild to moderate severity (PHQ-9 score of [10][11][12][13][14][15][16][17][18][19] People with subsyndromal depressive symptoms (PHQ-9 = 5-9) are less likely to show an effect from any intervention 4. Understanding of English language; able to sit for 20-25 minutes without significant discomfort; be willing and able to attend all 4 training sessions of SSM/HEP, as well as 75% of follow-up sessions Ensure ability to participate in interventions which will be delivered in English only and mostly in a seated position Exclusion criteria 1.…”

Self-Efficacy and the Role of Non-pharmacologic Treatment Strategies to Improve Pain and Affect in Arthritis

“…(62) A recent meta-analysis found improvements in physical function, pain intensity, and depression for patients with chronic pain treated with CBT, but no evidence of a significant difference compared to those treated with MBSR. (63) In a RCT that compared CBT, relaxation response training, and arthritis education in those with RA, significant improvements in symptoms, but not in pain, were noted at 12 month follow up. (64) There was not a significant change in levels of anxiety and depression as measured by the Rand Mental Health Inventory (MHI) in the CBT group.…”

Sahaj Samadhi Meditation versus a Health Enhancement Program for depression in chronic pain: protocol for a randomized controlled trial and implementation evaluation

“…In terms of efficacy, a recent systematic review demonstrated moderate effects for meditation and pain (effect size, 0.33), depression (effect size, 0.30) and anxiety (effect size, 0.38) [17]. Several systematic reviews examining meditation interventions specifically in the chronic pain population have reported small but consistent improvements in pain, function and depression [18][19][20][21]. Meditation is commonly sought out by diverse people living with depression and chronic pain and the intervention is well received in these populations [22][23][24].…”