Mindfulness is theorized to decrease the affective amplification of chronic pain by facilitating a shift from emotionally-laden, catastrophic pain appraisals of nociceptive input to reappraising chronic pain as an innocuous sensory signal that does not signify harm. Understanding of these hypothetical psychological mechanisms of mindfulness-based analgesia has been limited by a lack of direct measures. We conducted a series of psychometric and experimental studies to develop and validate the Mindful Reappraisal of Pain Sensations Scale (MPRS).
After item generation, we conducted exploratory and confirmatory factor analyses of the MRPS in samples of opioid-treated chronic pain patients both before (n = 450; n = 90) and after (n = 222) participating in Mindfulness-Oriented Recovery Enhancement (MORE). We then examined the convergent and divergent validity of the MRPS. Finally, in data from a randomized clinical trial (n = 250), the MRPS was tested as a mediator of the effects of MORE on reducing chronic pain severity.
Exploratory and confirmatory factor analyses demonstrated the single-factor structure of the MRPS. The MRPS also evidenced convergent and divergent validity. Mindfulness training through MORE significantly increased MRPS scores relative to supportive psychotherapy (F4,425.03 = 16.15, p < .001). Changes in MRPS scores statistically mediated the effect of MORE on reducing chronic pain severity through 9-month follow-up.
Taken together, these studies demonstrate that the MRPS is a psychometrically sound and valid measure of novel analgesic mechanisms of mindfulness including attentional disengagement from affective pain appraisals and interoceptive exposure to pain sensations.
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This research was supported by R01DA042033 (PI: Garland) from the National Institute on Drug Abuse and W81XWH-16–1-0522 from the Department of Defense (PI: Garland). ELG and FZ were also supported by R01AT011772-01A1 (MPI: Garland, Zeidan) from the National Center for Complementary and Integrative Health during the preparation of this manuscript.
The University of Utah IRB provided approval for the study.
Participants provided written informed consent for this study.
Conflict of Interest
ELG is the Director of the Center on Mindfulness and Integrative Health Intervention Development. The Center provides Mindfulness-Oriented Recovery Enhancement (MORE), mindfulness-based therapy, and cognitive behavioral therapy in the context of research trials for no cost to research participants; however, Dr. Garland has received honoraria and payment for delivering seminars, lectures, and teaching engagements (related to training clinicians in mindfulness) sponsored by institutions of higher education, government agencies, academic teaching hospitals, and medical centers. Dr. Garland also receives royalties from the sale of books related to MORE. Dr. Garland has also been a consultant and licensor to BehaVR, LLC. No other authors have any related conflicts of interest to disclose.
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Garland, E.L., Roberts, R.L., Hanley, A.W. et al. The Mindful Reappraisal of Pain Scale (MRPS): Validation of a New Measure of Psychological Mechanisms of Mindfulness-Based Analgesia. Mindfulness 14, 192–204 (2023). https://doi.org/10.1007/s12671-022-02034-y
- Chronic pain
- Interoceptive exposure
- Pain appraisal