Literature Review:

Mindfulness Meditation as a Treatment for Chronic Pain in Adults

Canada is an aging population; this makes it bluntly obvious to notice the increasing number of older adults that are suffering from chronic lower back pain which leads to physical impairment. This physical impairment then will affect elder’s quality of life, which ultimately affects Canada’s economy and health care system. Chronic low back pain has shown rapid increases over time, going from 3.9% in 1992 to 10.2% in 2006 (Delitto et al., 2012). In Western society, our medical system uses pharmacological treatment as primary treatment for chronic pain. Unfortunately, pharmaceutical treatment is costly and has multitude of side effects. This is why many individuals turn to alternative medicine to treat chronic lower back pain. Some alternative medicine involves mindfulness meditation, mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (Dubois et al., 2017). Mindfulness meditation aims to teach individuals how to deal with their pain, not get rid of it. This is a powerful approach to train individuals to focus on the present moment with no judgment, as well as to accept and detach from sensation. In a couple years, with more developed research done, this low-cost treatment could be a future solution to chronic pain. This paper will establish why mindfulness meditation is a suitable treatment for chronic low back pain in older adults.

Morone et al. (2008) study was done to identify the effectiveness of mindfulness meditation on older adults with chronic low back pain. This paper was a qualitative study that used daily diary entries from the participant’s in the mindfulness meditation program to get results on the progress of the study. The hypothesis the study tested was to see if mindfulness meditation could reduce chronic pain intensity and improve quality of life. All 27 participants in the study had to be 65 years and older with intact cognition and have been experiencing chronic pain for at least 3 months. In addition, the participants had to have no prior experience in any form of mindfulness meditation and be able to speak English. The participants meet up once a week for 90 minutes to do mindfulness meditation for 8 weeks. The researchers used different mindfulness meditation techniques like; body scan in a lying position as the person is guided to place their attention non-judgementally on each area of their body, focused attention breathing while sitting down and mindful meditation while walking. On top of the meditation sessions, the participants were assigned homework: they had to meditate at home for 45 minutes and spent 5 minutes writing about their mediation experience in their daily diary 6 days a week. As the weeks went by during the study, fewer participants handed their daily diaries in every week. The first 3 weeks of the study, 26 participants, the following 4 weeks, 16 participants, and the last week only 10 participants handed in their daily diaries. The method used in this study to analysis the data, which were the daily diaries, was ground theory. Ground theory states that researchers inductively examine the data through content analysis of words and phrases. Content analysis assigns codes to reoccurring words and phrases. Based on the codes that appeared in the data, key themes were spotted. The researchers found 4 reoccurring themes that reflect on health outcomes and they are: reduction in pain, improved attention skills, improved sleep, and achieving well-being. From the results based of the participant’s daily diaries, researchers found that mindfulness meditation helped in reducing pain, improved sleep quality, attention, and well-being in the senior population with chronic pain (Morone et al., 2008).

In Ardebil & Banth’s (2015) randomized control study, the researchers aim to assess the effectiveness of mindfulness based stress reduction (MBSR) as a whole intervention on the quality of life and pain severity on female patients with nonspecific chronic lower back pain (NSCLBP). Some of the mindfulness-based stress regulation techniques the first group learned was the mindfulness meditation known as Vipassana. Vipassana is a form of meditation where one focuses on their breathing and becomes more aware of their present bodily sensations. In this study, the MBSR techniques were used to attempt to “uncouple” the physical sensation of pain from the cognitive experience of pain. Through mindfulness meditation like Vipassana, the patient can be aware of the sensation of pain. After the patient becomes aware of the painful sensation, the cognitive process of what makes the sensation hurt can then be detached from the physical sensation of pain itself. By detaching the physical sensation of pain from the cognitive reaction to pain, the patient can reduce their pain severity. In the study, 88 participants were diagnosed with non-specific chronic low back pain and were put into two groups; the experimental group, which practiced MBSR in addition to their usual medical care, and the control group that continued their usual medical care without addition therapy. The duration of the trial was 8 weeks, and it used of the pre-post quasi time series experimental design to measure the efficacy of MBSR in 3 times frames; before, after, and 4 weeks after the program. The researchers used pain and quality of life questionnaires as data to assess the participants progress throughout the study. The post-study results of the randomized control trial for pain were: group one (MBSR) had a mean of 16.4, and the control group had a mean of 24.3. Post-study scores for mental quality of life were: group one (MBSR) had a mean of 28.4, and the control group had a mean of 23.45. The post-study scores for physical quality of life were: group one (MBSR) had a mean of 25 and the control group had a mean of 21.2. Finally, the conclusion of the study, based on the results, showed that group one (MBSR) had significant improvements in their overall pain severity, physical and mental quality of life scores due to the meditation based stress reduction training they had received compared to the control group who only received usual medical care.

Cherkin et al. (2016) had a unique approach on attempting to treat chronic lower back pain. His study used a randomized control trial to compare the effectiveness of mindfulness-based stress reduction (MBSR), cognitive-behavioural therapy (CBT) and usual care (UC) for adults old that suffer from chronic lower back pain. Based on prior studies, the researchers hypothesized that the participants suffering from chronic lower back pain placed in the MBSR group would experience a long-term decrease in back pain compared to the ones placed in the usual care group. The researchers also hypothesized that the MBSR group would be more successful than the CBT group. In the study, there were 342 participants between the age of 20-70 years’ old and have experienced chronic low back pain for at least 3 months. Those participants that were placed in the usual care (control) group were given $50 to get any treatment they wished. The MBSR and CBT groups had similar formats; duration (2 hours per week for 8 weeks), frequency (weekly), and number of participants per group. In both MBSR and CBT intervention, participants were also given workbooks, audio CDs, and instructions for home practice. The instructors for both the MBSR and CBT intervention were highly educated and trained in their field; 8 instructors in the MBSR had 5-29 years of experience in MBSR and 4 PhD level psychologists delivered CBT. The techniques that were used in the MBSR intervention were; didactic content and mindfulness meditation such as body scan, yoga, and meditation. Most of the CBT classes were about shifting one’s behaviours and thoughts in regard to chronic pain. Researchers collected dated via telephone interviews before randomized study, 4 (mid-treatment), 8 (post-treatment), 26, and 52 weeks post randomized study. Participants were given $20 for each interview that they had done to increase incentive. The results found that the usual care (UC) group had the highest response rates. The researchers also found that there were no significant differences between MBSR and CBT, but there was a difference between MBSR and UC group. The researchers concluded that both MBSR and CBT reported greater improvements in physical and mental health of patients, as well as low back pain reduction in older adults compared to UC group (Cherkin, 2016).

Morone et al. (2009) study also performed a randomized control trail to test the impacts of mindfulness meditation on older adults with chronic lower back pain. The researchers found that 50% of seniors (65+) suffer from chronic pain (Morone et al., 2009) and they were unable to find suitable treatment that was feasible, so they decided to try mindfulness meditation as a safe way for treating pain. The researchers hypothesized that post 8-week mindfulness meditation program, participants in treatment group would experience significant reduction in pain compared to participants in control group. In order to participate in the study, candidates must suffer from chronic lower back pain for 3 months, must be 65 years or older, and have intact cognition. This pilot study placed 40 participants randomly and evenly in either an 8-week mindfulness meditation program (intervention) or to an 8-week health education program (control). For the intervention group, each meditation session lasted 90 minutes, and it was broken down into 1 hour of meditation and 30 minutes of discussion. The techniques used were; body scanning, sitting and walking meditation. Participants also had homework: for the first week, participants had to meditate at home for 45 minutes, 6 days of the week. Participants in the intervention group also learned how to mediate doing daily actions like eating. For the control group, classes were 45-60 minutes and they were comprised of lectures and group discussion of brain exercises. Participants in the control group were also assigned homework: they were asked to play a game on Nintendo DS called “Brain Age” and read a book called “Keep Your Brain Alive”. Researchers found that a lot of people either dropped out or didn’t attend class after 4 months. On the other hand, 16 out of 20 participants (80%) from the treatment group and 19 out of 20 participants (95%) from the control group completed the program. The results from the study showed that the intervention group had a reduction in pain, and the control group got worse post completion of program, but got better at the 4 month follow up. Results also found that 81% of the participants in the intervention group and 67% of the participants in the control group reported feeling an improvement in the reduction of pain. The researchers concluded that both groups showed improvement post completion of program in measures of pain, physical and psychological function (Morone, N. 2009).

These 4 articles use different techniques to prove that mindfulness meditation can be used as treatment for chronic lower back pain. Each study used different methods to come to evocative conclusions. Each method used in the studies had strengths and weaknesses that could be compared to one another. The results concluded in each study may have been due to the limitation in the experiment.

Morone et al. (2008) qualitative study seemed like an effective way to deal with the chronic low back pain issue by having the participants record their finds in daily diaries. On the other hand, it was a self-report assessment, so there may have been some sort of response bias. Response bias occurs when participants write what they think researchers would assume them to write, but not what they truly experience. It is challenging to control environmental factors in qualitative studies and to get the participants to complete questionnaires truthfully and objectively. With that being said, these factors may be things that affected the final results of the qualitative studies.

Unfortunately, the results from Morone et al. (2009) study found that dropout rates were high at the 4-month follow-up. It seemed that participants had a ton of scheduling conflicts and began to lose interest. In Cherkin et al. (2016) study, the researchers paid the participants $20 to complete each interview. This technique was used as incentive to increase higher follow-up rates. Unfortunately, this method didn’t increase follow-up rates and the results remained unchanged.  This shows that the continuing increase in dropout rates could be another limitation affecting the study results. Another factor to consider that would affect results is the sample size used in the different studies. In the study conducted by Morone et al. (2009), the researchers had a sample size of 40 people, this was due to the fact that it was pilot study. It is very difficult to generalize results to the totally population with a smaller sample size. In Morone et al. (2008), Morone et al. (2009) and Ardebil & Banth’s (2015) study, the inclusion criteria to select participants were exclusive and this could also be a reason as to why the same sizes for the studies were small. However, the exclusive inclusion criteria could be seen as a strength of the study because these criteria would make the sample of people selected similar, which would make it more accurate at targeting specific groups. Since the target population was older adults, the sample was accurate in representing that population.

Another strength of the studies that contributed to the results found would be the way the participants were positioned into each group. Morone et al. (2009), Ardebil & Banth’s (2015) and Morone et al. (2009) used the method of randomized controlled trial in selecting their participants. A randomized controlled trial is a way of randomly places participants into the treatment group or control group. This method avoids researcher having a sample bias, or an observer bias. The last strength I found was that, both Cherkin et al. (2016) and Morone et al. (2009) had instructed that were well-trained individuals. Since the participants were instructed by experienced individuals, they would have a better understanding of the concepts of mindfulness mediation and a greater improvement compared to the control group.

Throughout the years, chronic lower back pain has become a prevalent problem in older adults that affects their daily lives, Canada’s health care and economy. Research shows that pharmacological treatment in the long run does not successfully cure or manage chronic lower back pain. Because of this, research is now directed towards alternative medicine like mindfulness meditation. Alternative medicine aims to help individuals manage their pain, so that they can live with it. Unfortunately, this area of research is very new and requires more studies to be done. These 4 studies summarized have found that mindfulness meditation is a great treatment plan to reduce chronic lower back pain.

Work Cited

• Morone, N., Lynch, C., Greco, C., Tindle, H., & Weiner, D. (2008). “I Felt Like a New Person.” The Effects of Mindfulness Meditation on Older Adults with Chronic Pain: Qualitative Narrative Analysis of Diary Entries.
  
  The Journal of Pain, 9
  
  (9), 841-848. doi: 10.1016/j.jpain.2008.04.003.
• Morone, N., Rollman, B., Moore, C., Qin, L., & Weiner, D. (2009). A Mind-Body Program for Older Adults with Chronic Low Back Pain: Results of a Pilot Study.
  
  Pain Medicine, 10
  
  (8), 1395-1407. doi: 10.1111/j.1526-4637.2009.00746.x.
• Ardebil, M. and Banth, S. (2018). Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain. IJOY International Journal of Yoga, 8(2), 128-133. doi:
  
  
  10.4103/0973-6131.158476
  
  
• Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., Turner, J. A. (2016). Effects of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy and Usual Care on Back Pain and Functional Limitations among Adults with Chronic Low Back Pain: A Randomized Clinical Trial.
  
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  (12), 1240–1249.
  
  http://doi.org.ezproxy.library.yorku.ca/10.1001/jama.2016.2323
  
• Delitto, A., George, S. Z., Van Dillen, L., Whitman, J. M., Sowa, G. A., Shekelle, P., Godges, J. J. (2012). Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association.
  
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  http://doi.org.ezproxy.library.yorku.ca/10.2519/jospt.2012.42.4.A1
  
• Dubois, J., Scala, E., Faouzi, M., Decosterd, I., Burnand, B., & Rodondi, P.-Y. (2017). Chronic low back pain patients’ use of, level of knowledge of and perceived benefits of complementary medicine: a cross-sectional study at an academic pain center.
  
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  http://doi.org.ezproxy.library.yorku.ca/10.1186/s12906-017-1708-1