Mindfulness-based intervention in patients with persistent pain in chest (MIPIC) of non-cardiac cause: a feasibility randomised control study

Abstract

ObjectiveThe study evaluated the feasibility of mindfulness-based cognitive therapy (MBCT) in patients with non-cardiac chest pain by assessing their willingness to participate and adhere to the programme, and for these data to help further refine the content of MBCT for chest pain.Patients and methodsThis prospective 2:1 randomised controlled trial compared the intervention of adapted MBCT as an addition to usual care with just usual care in controls. Among 573 patients who attended the rapid access chest pain clinic over the previous 12 months and were not diagnosed with a cardiac cause but had persistent chest pain were invited. The intervention was a 2-hour, weekly, online guided 8-week MBCT course. Compliance with attendance and the home practice was recorded. Enrolled patients completed the Seattle angina questionnaire (SAQ), Hospital Anxiety and Depression Scale, Cardiac Anxiety Questionnaire, Five-Facet Mindfulness Questionnaire, and Euro Quality of Life–5 Dimensions–5 Level at baseline assessment and after 8-week period.ResultsPersistent chest pain was reported by 114 patients. Of these, 33 (29%) patients with a mean age of 54.2 (±12.2) years and 68% women, consented to the study. Baseline questionnaires revealed mild physical limitation (mean SAQ, 76.8±25), high levels of anxiety (76%) and depression (53%), modest cardiac anxiety (CAQ,1.78±0.61) and mindfulness score (FFMQ, 45.5±7.3). Six patients subsequently withdrew due to bereavement, caring responsibilities and ill health. Of the remaining 27 participants, 18 in the intervention arm attended an average of 5 sessions with 61% attending ≥6 sessions. Although not statistically powered, the study revealed a significant reduction in general anxiety, improved mindfulness and a trend towards improvement in SAQ scores in the intervention arm.ConclusionOne-third of patients with persistent non-cardiac chest pain were willing to participate in mindfulness-based therapy. An improvement in anxiety and mindfulness was detected in this feasibility study. A larger trial is required to demonstrate improvement in chest pain symptoms.

Chest pain as an interdisciplinary problem – emphasis on somatoform disorders

“…В настоящее время наиболее изучено использование психотерапевтических подходов для коррекции соматоформной болевой симптоматики в области грудной клетки. В частности, доступны работы, которые свидетельствуют в пользу эффективности терапии осознанности (mindfulness) [42], проводимой через интернет когнитивно-поведенческой терапии [43], когнитивноповеденческой терапии, проводимой по телефону [44], классической когнитивно-поведенческой терапии [45] и психообразования [46].…”

A Systematic Review of the Adherence to Home-Practice Meditation Exercises in Patients with Chronic Pain

“…An aspect of interest in this type of study is the way in which home practices are assigned. On the one hand, studies that used the Internet as a resource to facilitate audio or video with guided practices stand out, such as through YouTube [34], email [35], web pages developed specifically for the study [36,37], and download platforms [38]. On the other hand, some studies used physical books, CDs, and DVDs, and in which the practices that the participants had to carry out at home were compiled [26,[39][40][41][42][43][44][45][46][47].…”

“…Only one study used both daily (during the intervention) and weekly (during follow-up) recordings of the home practice [41]. Fourteen studies used daily logs, of which two studies specified doing so online [35,52]; another two studies used pen and paper [55,59]; one study used both depending on the resources of the participants [42]; the others did not specify how they collected information [26,34,43,44,49,53,56,60,61]. Three studies used the weekly logs as a strategy to collect practice time at home [39,40,48].…”