Abstract
The present study investigated the effectiveness of a mindfulness-based pain management program developed to increase accessibility and acceptability for a severe chronic pain population seeking help in two tertiary level hospital pain clinics. Sixty chronic pain patients completed a 12-week Mindfulness-Based Chronic Pain Management program, while 59 individuals on the waiting list served as a control group. Ages ranged from 32 to 79 (mean age 52), and classes contained a mix of on-site and distant-site participants connected via a telemedicine link. Quality of life, pain catastrophizing, usual pain levels, and pain-related suffering were measured at two points during the study period. Program participants showed significant improvements in mental health, pain catastrophizing, and suffering levels, while the controls remained relatively unchanged. Neither group showed significant changes in the physical quality of life measures or usual pain levels. The present study lends support for the effectiveness of mind–body interventions in improving mental health and suffering in chronic pain sufferers seeking help in tertiary pain clinic settings. It also provides evidence for the usefulness of a mindfulness-based program modified specifically for the chronic pain population, and supports its delivery through telemedicine.
References
Büchi, S., & Sensky, T. (1999). PRISM: Pictorial Representation of Illness and Self Measure—a brief non-verbal measure of illness impact and therapeutic aid in psychosomatic medicine. Psychosomatics, 40, 314–320.
Büchi, S., Sensky, T., Sharpe, L., & Timberlake, N. (1998). Graphic representation of illness: a novel method of measuring patients’ perceptions of the impact of illness. Psychotherapy and Psychosomatics, 67, 222–225.
Büchi, S., Villiger, P., Kauer, Y., Klaghofer, R., Sensky, T., & Stoll, T. (2000). PRISM (Pictorial Representation of Illness and Self Measure)—a novel visual method to assess the global burden of illness in patients with systemic lupus erythamatosis. Lupus, 9, 368–373.
Büchi, S., Buddeberg, C., Klaghofer, R., Russi, E. W., Brändli, O., Schlösser, C., Stoll, T., Villiger, P. M., & Sensky, T. (2002). Preliminary validation of PRISM (Pictorial Representation of Illness and Self Measure)-A brief method to assess suffering. Psychotherapy and Psychosomatics, 71, 333–341.
Cassell, E. J. (1982). The nature of suffering and the goals of medicine. The New England Journal of Medicine, 306, 639–645.
Chiesa, A., & Serretti, A. (2011). Mindfulness-based interventions for chronic pain: a systematic review of the evidence. Journal of Alternative and Complementary Medicine, 17, 83–93.
Cho, S., Heiby, E. M., McCracken, L. M., Lee, S., & Moon, D. (2010). Pain-related anxiety as a mediator of the effects of mindfulness on physical and psychosocial functioning in chronic pain patients in Korea. The Journal of Pain, 11, 789–797.
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.
Cusens, B., Duggan, G. B., Thorne, K., & Burch, V. (2010). Evaluation of the breathworks mindfulness-based pain management programme: effects on well-being and multiple measures of mindfulness. Clinical Psychology & Psychotherapy, 17, 63–78.
Dean, S. A. (1995). Outcome differences among participants in a chronic pain program. Dissertation Abstracts International: Section B: The Sciences and Engineering, 56, 5165–5289.
Des Jarlais, D. C., Lyles, C., & Crepaz, N. (2004). Improving the reporting quality of nonrandomized evaluations of behavioural and public health interventions: the TREND statement. American Journal of Public Health, 94, 361–366.
Edwards, R. R., Smith, M. T., Kudel, I., & Haythornthwaite, J. (2006). Pain-related catastrophizing as a risk factor for suicidal ideation in chronic pain. Pain, 126, 272–279.
Farrar, J. T., Young, J. P., Jr., LaMoreaux, L., Werth, J. L., & Poole, R. M. (2001). Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain, 94, 149–158.
Gardner-Nix, J., & Costin-Hall, L. (2009). The mindfulness solution to pain. Oakland, CA: Harbinger.
Gardner-Nix, J., Backman, S., Barbati, J., & Grummitt, J. (2008). Evaluating distance education of a mindfulness-based meditation programme for chronic pain management. Journal of Telemedicine and Telecare, 14, 88–92.
George, S. Z., Wittmer, V. T., Fillingim, R. B., & Robinson, M. E. (2007). Sex and pain-related psychological variables are associated with thermal pain sensitivity for patients with chronic low back pain. The Journal of Pain, 8, 2–10.
Grant, J. A., Duncan, G. H., & Rainville, P. (2010). Cortical thickness and pain sensitivity in Zen meditators. Emotion, 10, 43–53.
Grant, J. A., Courtemanche, J., & Rainville, P. (2011). A non-elaborative mental stance and decoupling of executive and pain-related cortices predicts low pain sensitivity in Zen meditators. Pain, 152, 150–156.
Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: a meta-analysis. Journal of Psychosomatic Research, 57, 35–43.
Grossman, P., Tiefenthaler-Gilmer, U., Raysz, A., & Kesper, U. (2007). Mindfulness training as an intervention for fibromyalgia: evidence of post-intervention and 3-year follow-up benefits in well being. Psychotherapy and Psychosomatics, 76, 226–233.
Hoffman, B. M., Papas, R. K., Chatkoff, D. K., & Kerns, R. D. (2007). Meta-analysis of psychological intervention for chronic low back pain. Health Psychology, 26, 1–9.
Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry, 4, 33–47.
Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your mind to face stress, pain and illness. New York: Dell.
Kabat-Zinn, J., Lipworth, L., Burney, R., & Sellers, W. (1987). Four-year follow-up of a meditation-based program for the self-regulation of chronic pain: treatment outcomes and compliance. The Clinical Journal of Pain, 2, 159–173.
Kassardjian, C., Gardner-Nix, J. S., Dupak, K., Barbati, J., & Lam-McCulloch, J. (2008). Validation of PRISM method of assessing global burden of illness and self measure in non cancer pain patients. The Journal of Pain, 9, 1135–1143.
Lackner, J. M., & Quigley, B. M. (2005). Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome. Behavior Research and Therapy, 43, 943–957.
McCaffrey, R., Frock, T. L., & Garguilo, H. (2003). Understanding chronic pain and the mind–body connection. Holistic Nursing Practice, 17, 281–289.
Michael, E. S., & Burns, J. W. (2004). Catastrophizing and pain sensitivity among chronic pain patients: moderating effects of sensory affect focus. Annals of Behavioral Medicine, 27, 185–194.
Morone, N. E., Greco, C. M., & Weiner, D. K. (2008). Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study. Pain, 134, 310–319.
Munce, S. E. P., & Stewart, D. E. (2007). Gender differences in depression and chronic pain conditions in a national epidemiologic survey. Psychosomatics, 48, 394–399.
Plews-Ogan, M., Owens, J. E., Goodman, M., Wolfe, P., & Schorling, J. (2005). A pilot study evaluating mindfulness-based stress reduction and massage for the management of chronic pain. Journal of General Internal Medicine, 20, 1136–1138.
Schutze, R., Rees, C., Preece, M., & Schutze, M. (2010). Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. Pain, 148, 120–127.
Seminowicz, D. A., & Davis, D. (2006). Cortical responses to pain in healthy individuals depends on pain catastrophizing. Pain, 120, 297–306.
Sephton, S. E., Salmon, P., Weissbecker, I., Ulmer, C., Floyd, A., Hoover, K., & Studts, J. L. (2007). Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: results of a randomized clinical trial. Arthritis and Rheumatism, 57, 77–85.
Sherbourne, J. W. C. (1992). The MOS 36-item short-form health survey (SF-36). Medical Care, 30, 473–483.
Smeets, R. J. E. M., Vlaeyen, J. W. S., Kester, A. D. M., & Knottnerus, J. A. (2006). Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioural treatment in chronic low back pain. The Journal of Pain, 7, 261–271.
Sullivan, M. J. (1995). The pain catastrophizing scale clinical applications/user manual. Montreal, ON: University Center for Research on Pain and Disability.
Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: development and validation. Psychological Assessment, 7, 524–532.
Sullivan, M. J., Stanish, W., Waite, H., Sullivan, M., & Tripp, D. A. (1998). Catastrophizing, pain, and disability in patients with soft-tissue injuries. Pain, 77, 253–260.
Thorn, B. E., Pence, L. B., Ward, L. C., Kilgo, G., Clements, K. L., Cross, T. H., Davis, A. M., & Tsui, P. W. (2007). A randomized clinical trial of targeted cognitive behavioural treatment to reduce catastrophizing in chronic headache sufferers. The Journal of Pain, 8, 938–949.
Vowles, K. E., McCracken, L. M., & Eccleston, C. (2008). Patient functioning and catastrophizing in chronic pain: the mediating effects of acceptance. Health Psychology, 27, S136–S143.
Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). Medical Care, 30, 473–483.
Zeidan, F., Gordon, N. S., Merchant, J., & Goolkasian, P. (2010). The effects of brief mindfulness meditation training on experimentally induced pain. The Journal of Pain, 11, 199–209.
Zeidan, F., Martucci, K. T., Kraft, R. A., Gordon, N. S., McHaffle, J. G., & Coghill, R. C. (2011). Brain mechanisms supporting the modulation of pain by mindfulness meditation. The Journal of Neuroscience, 31, 5540–5548.
Acknowledgments
We would like to thank the volunteers of the MBCPM program, the Ontario Telemedicine staff and site coordinators for their support, and Dr Patricia Houston and Dr Gil Faclier, heads of the Anesthesia Departments of the host hospitals, for supporting the introduction of the MBCPM courses. We gratefully acknowledge support from the Summer Student Scholarship program of St Michael’s hospital for support of authors J.B and J.G.
Conflict of Interest
No author of this publication is involved in conflict of interest issues in this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gardner-Nix, J., Barbati, J., Grummitt, J. et al. Exploring the Effectiveness of a Mindfulness-Based Chronic Pain Management Course Delivered Simultaneously to On-Site and Off-Site Patients Using Telemedicine. Mindfulness 5, 223–231 (2014). https://doi.org/10.1007/s12671-012-0169-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12671-012-0169-3