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ORIGINAL ARTICLE
Year : 2020  |  Volume : 18  |  Issue : 2  |  Page : 120-124

Does Mindfulness-based meditation improve the psychosocial well-being among patients with chronic pain conditions? A pilot study from Chennai


1 Department of Community Medicine, ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India
2 Department of Community Medicine, ESIC Medical College and PGIMSR, Hyderabad, Telangana, India

Date of Submission13-Feb-2020
Date of Decision29-Feb-2020
Date of Acceptance26-Mar-2020
Date of Web Publication17-Apr-2020

Correspondence Address:
Dr. Vijayaprasad Gopichandran
Department of Community Medicine, ESIC Medical College and PGIMSR, KK Nagar, Chennai - 600 078, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_14_20

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  Abstract 

Background: Mindfulness-based meditation has been shown to reduce stress and even reduce pain in chronic pain conditions. Objective: To study the effect of mindfulness-based meditation on pain and psychosocial wellbeing among patients living with chronic musculoskeletal pain conditions. Methods: We conducted a quasi-experimental pre-post comparison study among 15 patients suffering from various musculoskeletal chronic pain conditions to assess the impact of mindfulness-based meditation on chronic pain. The participants were given an audio recording which gives specific instructions about the method of practicing the mindfulness-based meditation for a period of 2 weeks. The Brief Pain Inventory was used to measure pain and associated psycho-social wellbeing at baseline and after two weeks of the practice of meditation. The scores on the inventory were compared before and after the meditation using the paired sample t test. Results: There was a statistically significant reduction in the overall Brief Pain Inventory score of 11.6 units (95% CI= 8.2 to 15.0; P < 0.05). The reduction in score was not significant in the pain subscale but was significant in the psycho-social wellbeing subscale. Conclusions: Mindfulness-based meditation can be a useful adjuvant to pain management protocols in patients living with chronic musculoskeletal pain conditions.

Keywords: Chronic musculoskeletal pain, mindfulness-based meditation, psychosocial well-being


How to cite this article:
Pradeep NS, Kannan S S, Gopichandran V. Does Mindfulness-based meditation improve the psychosocial well-being among patients with chronic pain conditions? A pilot study from Chennai. Curr Med Issues 2020;18:120-4

How to cite this URL:
Pradeep NS, Kannan S S, Gopichandran V. Does Mindfulness-based meditation improve the psychosocial well-being among patients with chronic pain conditions? A pilot study from Chennai. Curr Med Issues [serial online] 2020 [cited 2020 Nov 26];18:120-4. Available from: https://www.cmijournal.org/text.asp?2020/18/2/120/282776




  Introduction Top


Chronic pain is one of the most substantial contributors to the Global Burden of Diseases.[1] Chronic pain has a deep impact on the quality of life of patients. Not only do conditions such as osteoarthritis, low back pain, cervical spondylosis, and other such musculoskeletal conditions affect many people, but they also remain for long periods of time, thus affecting the numbers affected as well as the duration. Chronic pain affects the mood and is often associated with depression and anxiety. It also disturbs sleep, which further contributes to compromised quality of life. Thus, living with chronic musculoskeletal pain conditions has a serious impact on the psychosocial well-being of the patient.[2]

Although there is no clear consensus on a concise definition of well-being, it has been defined as “…. diverse and interconnected dimensions of physical, mental, and social well-being that extend beyond the traditional definition of health. It includes choices and activities aimed at achieving physical vitality, mental alacrity, social satisfaction, a sense of accomplishment, and personal fulfilment.”[3] From this definition, it is clear that well-being extends beyond physical and mental health. Chronic pain conditions have a major impact on the levels of well-being among patients who suffer from them.

Several research studies have established the effectiveness of mindfulness-based meditation techniques in the improvement of psychological well-being among patients with depression, anxiety, and chronic pain conditions.[4],[5],[6],[7],[8],[9] In some studies, mindfulness-based meditation lowered the perception of chronic pain, improved mood, and created a sense of overall well-being.[9] One systematic review and meta-analysis demonstrated a modest effect of mindfulness-based meditation in relieving chronic pain.[10]

Most research on mindfulness-based meditation and its impact on chronic pain have been done in the Western sociocultural context and have looked at its impact on pain. There is a scarcity of studies on its impact on the well-being and quality of life, especially from the Indian context. We designed and conducted a quasi-experimental pre–post comparison pilot study as an undergraduate student research project to understand the effectiveness of an audio instruction delivered mindfulness-based meditation practice for 2 weeks on the intensity of pain and psychosocial well-being of patients suffering from musculoskeletal chronic pain conditions attending a tertiary care hospital in Chennai.


  Methods Top


The pre–post comparison quasi-experimental study was conducted at the department of orthopedic surgery between August and October 2019. A previous systematic review revealed a standardized mean difference (SMD) in chronic pain score of 0.19 after mindfulness-based meditation.[10] For a 90% confidence level and 80% power, using this SMD, the sample size was calculated to be 22.[11] The medical student researcher recruited patients from the orthopedic outpatient department. She identified patients with chronic pain conditions defined as pain lasting ≥3 months with the help of the orthopedic doctors. She approached 30 patients in total to reach a required sample size of 22. The student researcher obtained a standardized audio instruction on mindfulness-based meditation technique in the digital format, which can be played on a mobile phone, tablet, or laptop. This was in English as well as the local vernacular Tamil. She transferred this audio file on to the patients' mobile phones and gave clear instructions to the patients about the practice of the meditation technique. The student also noted the mobile numbers of these participants and obtained permission to call them once a week to reinforce the meditation technique.

Each mindfulness-based meditation session would last 15 min. The participants were asked to find a comfortable and isolated space of convenience in their homes and practice the meditation based on the audio-based instructions. They were required to practice this for 2 weeks. The student made two phone calls to each participant, once a week, to ensure that they were practicing the meditation and were doing it correctly.

We used the Brief Pain Inventory (BPI), which is validated for the use in chronic noncancer pain conditions and captures the intensity of pain as well as the impact of pain on well-being in an accurate manner.[12] We assessed the pain characteristics and psychosocial well-being at baseline and then again during a repeat visit at the end of 2 weeks of practicing mindfulness-based meditation. We compared the score on the BPI before and after the practice of mindfulness-based meditation using the paired sample t-test. We made subgroup comparisons based on gender and age. We also compared the pain scores and well-being scores before and after the meditation.

The study was approved after review by the Institutional Ethical Committee of the Institution. Participation was voluntary and written informed consent was obtained from all participants before the study.


  Results Top


We approached a total of 30 consecutive patients attending the orthopedics outpatient department for chronic musculoskeletal pain conditions. Of these 30, 21 provided informed consent. Six of them dropped out of the study after a few days of meditation, as they could not incorporate the routine in their everyday life. Only 15 participants completed the 2-week study, and we could assess the pain and well-being after the practice of 2 weeks of mindfulness meditation. All the 15 participants who completed the study were fully compliant with the practice of meditation as per their self-report during the telephonic follow-up. This is shown in [Figure 1]. Six of them were men and nine women. Seven of them were aged above 50 years. Three had low back pain, five had osteoarthritis of the knee, three had cervical spondylosis, and four had other forms of nonspecific chronic musculoskeletal pain. These characteristics are shown in [Table 1]. All patients received treatment with nonsteroidal anti-inflammatory medications and physiotherapy as per the standard treatment protocols in addition to the intervention.
Figure 1: Flow diagram of participants in the study. Of a total of 30 participants approached, 21 consented to participate and 15 completed the study.

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Table 1: Characteristics of the study sample

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The normality of the pre- and post-test scores on the BPI was tested using the Kolmogorov–Smirnov test and Shapiro–Wilk test and both the scores were found to be normally distributed. The mean score on the BPI decreased by 11.6 units (95% confidence interval [CI] = 8.2–15.0) after 2 weeks of mindfulness-based meditation. This reduction was tested by paired t-test, which showed P < 0.001, which is statistically significant.

Subgroup analysis revealed that the reduction in the score on BPI was more prominent for men compared to women (mean difference = 1.5 units; P > 0.05) and more prominent for those older than 50 years of age compared to those younger (mean difference = 5.3 units; P > 0.05). These graphs are shown in [Figure 2].
Figure 2: Subgroup analysis based on gender showed more prominent reduction in Brief Pain Inventory score in men (Panel A) and more prominent reduction in persons older than 50 years of age (Panel B). These differences were not statistically significant.

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Further analysis showed that the reduction in the intensity of pain was not statistically significant (mean difference – 5.1 points; 95% CI: 2.9–7.3; P> 0.05), but the improvement in well-being (mean difference – 4.9 points; 95% CI: 3.5–6.3; P < 0.05) is shown in [Figure 3].
Figure 3: There was no statistically significant difference in the intensity of pain (Panel A), but there was a substantial difference in the well-being score (Panel B) after the mindfulness-based meditation.

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  Discussion Top


This pilot study revealed that mindfulness-based meditation techniques give rise to a statistically significant improvement in well-being among patients suffering from chronic musculoskeletal pain conditions. Further, it also showed a trend toward better response among men and older individuals.

The BPI which was used in this study, itself has two sections – one section with eight questions on pain, its distribution and severity and a second section on psychosocial impact of pain on the well-being of the individual comprising seven items.[12] In combination, it was seen that the overall score on the BPI was statistically significantly lower after the meditation. However, the section which improved substantially was the psychosocial well-being and not the pain, its distribution and severity.

There are many studies which have established the impact of mindfulness-based meditation on reducing psychological stress.[13],[14],[15],[16] An 8-week mindfulness-based relaxation program significantly reduced the stress levels and increased levels of relaxation.[17] Among college students, the mindfulness-based meditation app that was distributed to them on their mobile phones improved their stress levels.[18]

There are also a few studies which have looked at the impact of this meditation on illnesses such as cancers, migraine, and neuropathic pains.[19],[20] All these studies have demonstrated a significant reduction of pain after meditation. They have also demonstrated improvements in the quality of life of patients with chronic pain conditions.

Researches from India have also demonstrated the effectiveness of mindfulness-based meditation in reducing pain in chronic pain conditions.[21] However, a well-conducted systematic review revealed that mindfulness-based meditation only influenced the psychological aspects of living with chronic pain and not the pain in itself.[10],[22]

The findings of this study were concordant with the findings of the systematic review. In the small sample that was closely studied, it was noted that rather than the pain, it was the psychosocial aspects of the well-being which were improved by the practice of meditation.

This key finding has important implications. While the medical management of chronic pain is often handled by the use of analgesics and physiotherapy, the psychosocial impact of pain is often neglected. This study provides supporting evidence for the use of mindfulness-based meditation to improve the psychosocial aspects of living with chronic pain conditions.

There are several important limitations in this study, the most important being the small and nonrandom sample. A larger, more systematically selected sample will help confirm the findings. The lack of a control group further limits the findings. There was a 28% dropout rate in our study due to the constraints of practicing mindfulness-based meditation on an everyday basis. This is a reflection of the real-life picture when such therapy is advised to the patients in the clinic. Therefore, the findings are more closely reflective of the effectiveness of such interventions in real-life practice. Despite these important limitations, the findings are instructive in that they give us a direction for further research.


  Conclusions Top


Mindfulness-based meditation is a useful adjuvant to pain management protocols in patients living with chronic musculoskeletal pain conditions by providing an improvement in the psychosocial dimension of living with chronic pain.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethical statement

This study was approved by the Institutional Ethics Committee of ESIC Medical College and PGIMSR, KK Nagar, Chennai with IEC No. IEC/2019/1/17 dated 15.05.2019. Written informed consent was obtained from all participants.



 
  References Top

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Kurita GP, Sjøgren P, Juel K, Højsted J, Ekholm O. The burden of chronic pain: A cross-sectional survey focussing on diseases, immigration, and opioid use. Pain 2012;153:2332-8.  Back to cited text no. 1
    
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Dodge R, Daly A, Huyton J, Sanders L. The challenge of defining wellbeing. International Journal of Wellbeing 2012;2:222-235. doi:10.5502/ijw.v2i3.4.  Back to cited text no. 3
    
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Carlson LE, Ursuliak Z, Goodey E, Angen M, Speca M. The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: 6-month follow-up. Support Care Cancer 2001;9:112-23.  Back to cited text no. 14
    
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Astin JA. Stress reduction through mindfulness meditation. Effects on psychological symptomatology, sense of control, and spiritual experiences. Psychother Psychosom 1997;66:97-106.  Back to cited text no. 15
    
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Kang YS, Choi SY, Ryu E. The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. Nurse Educ Today 2009;29:538-43.  Back to cited text no. 16
    
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Masih T, Dimmock JA, Epel E, Guelfi KJ. An 8-week relaxation program consisting of progressive muscle relaxation and mindfulness meditation to reduce stress and attenuate stress-driven eating. Appl Psychol Health Well Being 2020;12:188-211.  Back to cited text no. 17
    
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Seng EK, Singer AB, Metts C, Grinberg AS, Patel ZS, Marzouk M, et al. Does mindfulness-based cognitive therapy for migraine reduce migraine-related disability in people with episodic and chronic migraine? A phase 2b pilot randomized clinical trial. Headache 2019;59:1448-67.  Back to cited text no. 19
    
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Hussain N, Said ASA. Mindfulness-based meditation versus progressive relaxation meditation: Impact on chronic pain in older female patients with diabetic neuropathy. J Evid Based Integr Med 2019;24:2515690X19876599.  Back to cited text no. 20
    
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Maglione MA, Hempel S, Maher RA, Apaydin E, Ewing B, Hilton L, et al. Mindfulness meditation for chronic pain: A systematic review. RAND Corporation, Santa Monica, CA, 2016. Available from: https://www.rand.org/pubs/research_reports/RR1317.html. [Last accessed on 2020 Apr 04].  Back to cited text no. 22
    


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