How the practice of Mindfulness influences the treatment of patients with chronic non-cancer pain associated or not with other therapies: systematic review

HIGHLIGHTS

• Mindfulness practice for chronic pain has a positive effect on reducing the perception of pain.

• Studies have shown that there are changes in neural activations during and after mindfulness practice that have an impact on nociceptive sensation.

• Mindfulness therapy for chronic pain can reduce the use of drugs such as opioids.

ABSTRACT

BACKGROUND AND OBJECTIVES:

Chronic pain has a significant impact on patients’ quality of life and the use of drug therapy is often insufficient. Therapies based on Mindfulness come in different forms and have been used as a strategy to manage this condition. Practices can guide attention to the present, help reinterpret pain and improve physical and emotional control skills via the cingulate cortex, somatosensory cortex, parietal operculum, cuneus, and anterior insula. This study seeks to evaluate the results of Mindfulness in terms of its influence on the quality of life of patients with chronic non-cancer pain and the neural changes that this practice promotes, such as greater or lesser activation or variation in size of areas as insula and cingulate cortex, and how these interfere with the perception of pain, with the aim of verifying the applicability of Mindfulness as a complementary method to treatment in this group of patients.

CONTENTS:

Systematic Review submitted to PROSPERO datadase under number 359011. The search was carried out in the Pubmed, Medline, LILACS and DIALNET databases between 2019 and 2022 with the descriptors and Boolean operator [(MINDFULNESS) AND (CHRONIC PAIN)]. The selection of articles includes randomized clinical trials, cohort studies and case control studies in English, Spanish and Portuguese languages. The risk of bias was assessed using ROB2 and the quality of evidence using GRADE. After analysis, ten studies were assessed as essential for this review. Articles that addressed Mindfulness intervention for chronic pain that responded and added information to the research question were included and articles that did not focus on “Mindfulness” and “chronic pain”, studies without free access and texts whose results were not published up to the date of the search were excluded. To analyze Mindfulness therapies, the majority of studies cover more than 50 patients and use scales such as the Brief Pain Inventory (BPI-DPN Q4), Patient Global Impression of Change (PGIC), Five Facet Mindfulness Questionnaire (FFMQ), Chronic Pain Acceptance Questionnaire (CPAQ) and Pain Catastrophizing Scale (PCS).

CONCLUSION:

The practice of Mindfulness can reduce chronic pain and improving its perception, acceptability and quality of life by enabling the reduction of suffering, anxiety and stress associated with pain through neural changes. As there are limitations in the studies regarding the specific target population and standardization of assessment, it is recommended that future articles address the practice in children, the elderly and athletes with chronic pain, in addition to a detailed methodology to evaluate and promote the sessions. It should be noted that Mindfulness is not a cure for chronic pain, however it presents safety and effectiveness in its different application protocols, with a level of evidence similar to cognitive behavioral therapy.

Keywords
Chronic pain; Meditation; Mindfulness; Pain.