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Abstract
Objectives: 1) What are the methodological strengths and weaknesses of this literature? 2) Does the evidence indicate that MBSR (mindfulness based stress reduction) reduces pain severity and 3) Does the evidence indicate that MBSR makes it easier for patients to live with chronic pain?
Data sources: Medline, Cochrane Library, Web of Science, Psych INFO, ProQuest Dissertations and Abstracts, and relevant citations from selected articles. This comprehensive review includes randomized control trials, cohort studies, and case series published sincel987. Each article was reviewed independently by two co-authors using quality standards for studying treatment efficacy. Results: The available literature does not establish that MBSR reduces pain severity nor does it establish that it does not reduce pain severity. MBSR may make it easier for some patients to live with chronic pain, but the evidence for this benefit could be due to type 1 error.
Limitations: With one exception, all of the randomized trials were too small to detect a clinically significant decrease in pain severity. Most of the studies failed to account for type 1 error, and therefore benefits in psychological, quality of life, and functional measures are unproven.
Conclusions: MBSR is unlikely to reduce pain severity but may make it easier for some patients to live with chronic pain. Future studies need to take type 1 and type 2 statistical errors into account, control for predisposition to benefit from MBSR, pay close attention to which patients drop out and why, and compare MB SR to other active treatments.
Keywords: Mindfulness based stress reduction, chronic pain
Introduction
Chronic pain is a complex experience that is made worse by stress, negative thinking, anxiety and depression, lack of sleep, muscle tension, restricted movement, impaired circulation, and inflammation (1). Meditation and the mindful regulation of attention may reduce stress through down-regulation of the limbic system and hypothalamic pituitary axis, and reductions in stress may improve the affective as well as the sensory component of pain (2-5). It has been hypothesized that mindfulness based stress reduction [MBSR], as developed and taught by Jon Kabat-Zinn, may relieve pain in various ways as it relieves stress (1,6). MBSR includes three techniques: 1) a "body scan" that helps focus nonjudgmental attention on physical sensations; 2) "sitting meditation" to develop awareness of...