The effectiveness of a mindfulness based stress reduction (MBSR) program in a mixed chronic pain population

Abstract

Objective: To investigate the effectiveness of a mindfulness based stress reduction (MBSR) program on self reported pain, acceptance, resilience and quality of life in a mixed chronic pain population. Design: A single cohort observational study with pre-post measures. Setting: Community based program located in the Sunshine Coast, Queensland, Australia. Participants: Fifteen volunteers (1 male, 14 female; mean age=52.9y) with a history of chronic musculoskeletal pain referred from local healthcare providers. Methods: People who experienced chronic pain of a musculoskeletal origin and/or mild to moderate rheumatoid arthritis and who were interested in exploring the potential health benefits of mindfulness meditation were enrolled in the study. Participants were enrolled in an 8-week program of Mindfulness Based Stress Reduction (MBSR). Participants were required to attend a 2-hour group session once a week led by a qualified MBSR teacher and complete home practice in addition to daily mindfulness. Participants completed electronic questionnaires for each of the outcome measures at baseline, post intervention and 1, 2, and 3 months post intervention. Results: Perceived pain intensity: Clinically significant changes (>5 points) in the median MPQ score was observed at pre – post, 1 and 3 month contrasts. A 60% reduction in pain intensity scores was observed in pre and post measures. SF-36: The physical health subcategories improved in 4 out of 5 subcategories. Similarly the mental health subcategories demonstrated change in the anticipated direction on 3 out of 5 subcategories, with 2 significant changes being observed in 2 out of the 3 subcategories. The SF-36 total component scores (combined physical and mental health sub-scales) increased between the pre intervention median (Mdn=45) to the immediate 8-week post-intervention follow-up (Mdn=67.5) (difference in Mdn 22.5-points; z=-1.99, p=.046, r=-.63). Improvement in pre and post intervention medians was maintained at 1-month (Mdn=60, z=1.57, p=.116, r=-.52) and 2- months (Mdn=53, z=1.60, p=.109, r=-.66). A significant difference was observed between the pre and 3-month comparison (Mdn=68.5, z=-2.19, p=.028, r=-.70). There was no substantial change in the chronic pain acceptance or resilience scores between pre-intervention and all post-intervention time points. Conclusion: The findings of this study indicate that the mindfulness based stress reduction program has potential health benefits on a mixed chronic pain population. Moderate to large effect sizes were observed on the health related quality of life, and large effect sizes were observed on the perceived pain levels in this mixed cohort of people experiencing chronic pain. The beneficial effects were maintained at 3-month follow up for the majority of participants in both quality of life and pain. No change in acceptance and resilience was detected. Further research in a specific New Zealand health care environment should be undertaken, due to the unique differences in the prevalence and management of chronic pain in different cultures and health care models.