The Vicious Cycle of Chronic Pain in Aging Requires Multidisciplinary Non-pharmacological Approach to Treatment

Shpaner, Marina; Tulipani, Lindsey J.; Bishop, James; Naylor, Magdalena R.

doi:10.1007/s40473-017-0126-5

Cited by 5 publications

(2 citation statements)

References 159 publications

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“…Although knee OA is a complex condition that remains incompletely understood [ 75 ], multiple interrelated factors likely contribute to the etiology and progression of OA. These include physical, neurobiological, and physiologic factors (e.g., altered neurologic structure and function, inflammation, joint degeneration, obesity, deterioration in muscular strength and cardiovascular fitness, and pain sensitization) as well as psychosocial and behavioral factors (e.g., sleep impairment, mood disturbance, low social support, pain-related fear, avoidant coping strategies, and sedentary behavior) [ 31 , 76 – 78 ]. OA pain and dysfunction have been bidirectionally linked to distressful states and maladaptive behaviors, including psychologic stress [ 8 , 79 – 81 ], depression and anxiety [ 79 , 82 – 84 ], sleep impairment [ 7 , 9 , 85 – 87 ], fatigue [ 8 , 84 , 88 ], pain-related fear, [ 79 , 89 , 90 ], and catastrophizing [ 79 , 91 – 94 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of Mantra Meditation versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults with Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (RCT)

Innes

Selfe

Kandati

et al. 2018

Evidence-Based Complementary and Alternative Medicine

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Objective Disease-modifying treatments for OA remain elusive, and commonly used medications can have serious side effects. Although meditation and music listening (ML) have been shown to improve outcomes in certain chronic pain populations, research in OA is sparse. In this pilot RCT, we explore the effects of two mind-body practices, mantra meditation (MM) and ML, on knee pain, function, and related outcomes in adults with knee OA. Methods Twenty-two older ambulatory adults diagnosed with knee OA were randomized to a MM (N=11) or ML program (N=11) and asked to practice 15-20 minutes, twice daily for 8 weeks. Core outcomes included knee pain (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Numeric Rating Scale), knee function (KOOS), and perceived OA severity (Patient Global Assessment). Additional outcomes included perceived stress (Perceived Stress Scale), mood (Profile of Mood States), sleep (Pittsburgh Sleep Quality Index), and health-related quality of life (QOL, SF-36). Participants were assessed at baseline and following completion of the program. Results Twenty participants (91%) completed the study (9 MM, 11 ML). Compliance was excellent; participants completed an average of 12.1±0.83 sessions/week. Relative to baseline, participants in both groups demonstrated improvement post-intervention in all core outcomes, including knee pain, function, and perceived OA severity, as well as improvement in mood, perceived stress, and QOL (Physical Health) (p's≤0.05). Relative to ML, the MM group showed greater improvements in overall mood and sleep (p's≤0.04), QOL-Mental Health (p<0.07), kinesiophobia (p=0.09), and two domains of the KOOS (p's<0.09). Conclusions Findings of this exploratory RCT suggest that a simple MM and, possibly, ML program may be effective in reducing knee pain and dysfunction, decreasing stress, and improving mood, sleep, and QOL in adults with knee OA.

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Section: Discussionmentioning

confidence: 99%

Effects of Mantra Meditation versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults with Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (RCT)

Innes

Selfe

Kandati

et al. 2018

Evidence-Based Complementary and Alternative Medicine

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“…Together, the triad of behavioral, psychological, and physical disturbances facilitate a positive feedback loop potentiating disability over time [47]. CBT targets these maladaptive traits by modifying emotional, behavioral, and cognitive imbalances through goal-oriented, "problem-focused" intervention.…”

Section: Introductionmentioning

confidence: 99%

Structural Neuroplasticity Following Cognitive Behavioral Therapy for the Treatment of Chronic Musculoskeletal Pain: A Randomized Controlled Trial with Secondary MRI Outcomes

Bishop

Shpaner

Kubicki

et al. 2021

Preprint

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The extent of white matter (WM) and Grey matter (GM) structural neuroplasticity following cognitive behavioral therapy for chronic pain management remains undetermined. In the current study, we investigated structural alterations in GM morphometry, as well as WM complexity and connectivity, before and after an 11-week group CBT for the treatment of chronic musculoskeletal pain. We hypothesized that effective pain management would influence WM structural metrics indicative of brain plasticity, particularly within cognitive and limbic circuitry as well as GM volume within pain matrix structures. To determine this, patients were randomized into two groups: 1) CBT group that received CBT once-weekly for 11-weeks, or 2) EDU group consisting of an active patient control group that received educational materials by mail. All subjects completed behavioral assessments and underwent neuroimaging at: baseline prior to any intervention (TP1), 11-weeks following either CBT or EDU (TP2), and four months following completion of the intervention (TP3). CBT resulted in significant clinical improvements, assessed via behavioral self-reports, compared to EDU. Compared to EDU, region of interest WM analysis revealed several fiber tracts that had significantly increased WM complexity following CBT intervention, including the bilateral posterior internal capsule and the left cingulum within the temporal lobe. Conversely, several tracts exhibited a decrease in WM complexity including the right external capsule, the left posterior internal capsule, and the right cingulum within the temporal lobe. Changes in clinical outcomes were predictive of alterations in WM complexity metrics immediately following intervention and at long-term follow-up. No between-group differences were observed in either WM connectivity or GM volume. In conclusion, psychotherapeutic interventions such as group CBT influence coping strategies for effective pain relief that influence WM microstructure, however, the mechanisms of these changes remain undetermined. Future studies will be required to uncover the biological underpinnings of these alterations in pain populations.

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Yogic Interventions in Clock Dysfunction, Neurodegeneration and Ageing

Jagota,

Khan,

Sharma

et al. 2024

Neuroscience of Yoga

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The Vicious Cycle of Chronic Pain in Aging Requires Multidisciplinary Non-pharmacological Approach to Treatment

Cited by 5 publications

References 159 publications

Effects of Mantra Meditation versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults with Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (RCT)

Effects of Mantra Meditation versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults with Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (RCT)

Structural Neuroplasticity Following Cognitive Behavioral Therapy for the Treatment of Chronic Musculoskeletal Pain: A Randomized Controlled Trial with Secondary MRI Outcomes

Yogic Interventions in Clock Dysfunction, Neurodegeneration and Ageing

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