Posted 07.25.2016 | by AMRA
Up to one-in-five breast cancer survivors experience persistent moderate-to-severe pain five years after treatment. Pain may result from surgery, radiation, or chemotherapy-induced tissue and nerve damage. Since pain can be both exacerbated and modulated by psychological factors, breast cancer survivors with persistent pain may potentially benefit from psychosocial interventions to lessen pain and improve quality of life.
Johannsen et al. [Journal of Clinical Oncology] conducted a randomized, controlled trial to test the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) on reducing pain and improving quality of life in breast cancer survivors who reported persistent pain.
One hundred and twenty-nine Danish breast cancer survivors (average age = 57) who were at least 3 months post-surgery and had continuing pain ratings ≥ 3 on a 0-10 numerical rating scale were randomly assigned to either MBCT or a wait-list control. Self-report measures of pain, quality of life, and psychological distress were completed at baseline, after intervention, and at 3- and 6-month follow-up.
The MBCT protocol was the standard 8-week protocol used in treating recurrent depression, but modified to meet the needs of breast cancer survivors: session lengths were cut to 2 hours each, meditations were shortened to ≤ 30 minutes each, the yoga was “gentler,” and the all-day session was omitted.
MBCT participants showed significantly greater reductions than controls in pain intensity (Cohen’s d = .61) on a 0-10 numerical rating scale. Average pain intensity ratings decreased from 5.5 at baseline to 4.0 post-intervention, then dropped further to 3.6 at 3-month follow-up. In contrast, wait-list control pain intensity remained essentially unchanged (5.3 at baseline, 5.3 at post-intervention, 5.0 at 3-month follow-up).
MBCT participants improved significantly more on quality of life (d = .42), with MBCT participants showing a 10% improvement and controls a 3% improvement. MBCT participants also significantly decreased their use of nonprescription pain medication (d =.40) by 20% at post-intervention, while controls showed no change.
The magnitude of improvements in pain intensity and quality of life was associated with the participants’ degree of MBCT program participation. Participants who attended more sessions had less pain intensity (d = .44) and a better quality of life (d = .38). In addition, the more time participants spent practicing meditation at home, the better their quality of life (d = .49).
The study findings show that MBCT participation results in clinically meaningful decreases in pain intensity, increases in quality of life, and decreases in non-prescription pain medication use for breast cancer survivors with persistent post-treatment pain. These improvements continue up to 6-months after program completion. The more breast cancer survivors participate in the program and engage in meditation practice at home, the better their outcomes.
As the control group was a wait-list control, it is not possible to say whether the observed improvements were due to mindfulness practice or to other factors such as group support, cognitive therapy, or expectancy effects.
Johannsen, M., OConnor, M., OToole, M. S., Jensen, A. B., Højris, I., & Zachariae, R. (2016). Efficacy of mindfulness-based cognitive therapy on late post-treatment pain in women treated for primary breast cancer: A randomized controlled trial. Journal of Clinical Oncology.