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Cost savings of Mindfulness Based Cognitive Therapy in cancer care

Posted 06.22.2017 | by AMRA

One in five breast cancer survivors report significant pain that persists years after the conclusion of medical treatment. Persistent post-treatment pain reduces cancer survivors’ quality of life and contributes to greater health care costs due to increased medical visits and medication usage. While mindfulness-based interventions have been shown to reduce pain in cancer survivors, little is known about the overall cost effectiveness of these interventions.

Johannsen et al. [Psycho-Oncology] analyzed data from a previously published randomized, controlled trial of Mindfulness-Based Cognitive Therapy (MBCT) to reduce pain in breast cancer survivors, in order to explore its cost effectiveness.

The researchers randomly assigned 129 Danish female breast cancer patients who had completed treatment and reported persistent pain to either an 8-week trial of MBCT or a wait-list control group. Health care utilization and cost analyses were performed only for a subset of 84 patients for whom there was no missing data. The MBCT intervention followed the standard weekly two-hour group protocol. Subjective pain ratings were collected from the patients at baseline, immediately at the end of the intervention, and at 3 and 6-month follow-up.

The treatment was deemed a success if a patient decreased her pain by at least two points on a 10-point rating scale, which was deemed to be the minimal clinically meaningful difference. A Danish national health registry was the source of information about healthcare utilization and prescription medication usage and costs during the 6-month follow-up period.

As previously reported, 53% of the MBCT patients reduced their pain by at least two points, whereas only 29% of the wait list controls did. MBCT patients made significantly fewer visits to general practitioners, medical specialists, physical therapists […]

June 22nd, 2017|News|

Breast cancer survivors find pain and pill relief with MBCT

Posted 07.25.2016 | by AMRA

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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 […]

July 25th, 2016|News|

Pinpointing the unique impact of mindfulness meditation on pain

Posted 12.15.2015 | by AMRA

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Pain is a common and often complex medical complaint. Previous studies demonstrate the possible pain-reducing effects of mindfulness-based interventions, but little is known about how these interventions actually work. Is mindful awareness their “active ingredient,” or is it slowed breathing, or even just the expectancy of a benefit?

Zeidan et al. [The Journal of Neuroscience] compared the changes in pain sensitivity resulting from a genuine mindfulness intervention with the changes resulting from a sham mindfulness intervention and two other control conditions. Participants rated their subjective pain in response to an unpleasant heat stimulus while undergoing functional Magnetic Resonance Imaging (fMRI). They also completed the Freiburg Mindfulness Inventory prior to initial training and at the end of their final fMRI session.

A racially diverse cohort of 75 healthy, meditation-naive young adult men and women were randomly assigned to either mindfulness meditation, a sham mindfulness meditation, placebo conditioning, or listening to an audio book. Genuine mindfulness meditation training consisted of four 20-minute sessions involving a breath-focused sitting meditation along with didactic instruction in non-judgmental attention. Sham meditation training involved four 20-minute sessions of alleged “mindfulness meditation” that consisted of merely sitting upright and taking a deep breath every few minutes without any didactic instruction.

Placebo conditioning involved four 20-minute conditioning sessions in which an alleged “analgesic cream” (in actuality, only petrolatum jelly) was applied to the skin and participants were exposed to a series of heat stimuli that were covertly and progressively lowered in temperature over the course of the sessions. Control participants listen to four 20-minute audio recordings from a book.

In a separate final assessment session after training completion, all the participants underwent fMRI scanning while […]

December 15th, 2015|News|

Mindfulness training shows promise for MS patients

Posted 04.20.2015 | by AMRA

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Multiple Sclerosis (MS) is an autoimmune disease that damages the integrity of nerve cells in the brain and spinal cord resulting in a variety of sensory and motor deficits and often leading to mobility impairment, pain, and fatigue. MS patients frequently suffer from depression and anxiety, and there is some evidence that stress may play a role in precipitating tissue damage. MS can manifest as either a relapsing and remitting disease with symptoms that wax and wane, or as a progressive disease with a degenerative course.

Bogosian et al. [Multiple Sclerosis Journal] completed a pilot study of the effectiveness of a mindfulness-based intervention (MBI) for reducing distress in patients with progressive MS. The intervention, adapted from Mindfulness-Based Cognitive Therapy (MBCT) and tailored to the specific needs of MS patients, was delivered via eight teleconferenced one-hour group sessions. Meditations were kept brief (10-20 minutes) and the mindful movement component was eliminated.

Forty British patients with progressive MS were randomly assigned to either the MBI or a waitlist control. They completed a variety of self-report measures at baseline, immediate post-intervention, and three-month follow-up. The cohort was 90% Caucasian and 55% female (average age = 53 years).

The MBI participants reported significantly lower rates of distress at immediate post-intervention (moderate effect size) and three-month follow-up (large effect size) compared to the waitlist controls. They also reported significantly greater reductions in depression and the psychological impact of their MS (moderate to large effect sizes) at both assessment points. Anxiety was significantly lower (moderate effect size) at three month follow-up, but not at post-intervention.

Group differences in physical symptoms (e.g., pain and fatigue) tended to be non-significant except for pain […]

April 20th, 2015|News|

MBI versus Cognitive Behavioral Therapy (CBT) for treating chronic pain

Posted: 12.18.2014 | by AMRA

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Are mindfulness-based interventions (MBIs) as effective as cognitive behavioral therapy (CBT) in treating chronic pain? Davis et al. [Journal of Consulting and Clinical Psychology] analyzed data from a 2008 study of the relative effectiveness of CBT, a mindful acceptance intervention (MBI), and rheumatoid arthritis education (AE) on pain, fatigue, and stress in 144 rheumatoid arthritis patients.

The predominantly female (68%), White (85%), middle-aged (mean = 54 years) participants were randomly assigned to one of the three treatments. Patients rated their pain in daily diaries 30 days before and 30 days after the intervention.

All the intervention conditions were delivered in once-weekly 2-hour groups over an 8-week period and were co-led by clinical psychologist/graduate student teams trained in CBT and MBI approaches to pain. The CBT intervention emphasized reappraising maladaptive thoughts, relaxation training, and activity pacing. The MBI focused on nonjudgmental moment-to-moment awareness and savoring pleasant experiences. The AE served as an education control, presenting medical information about rheumatoid arthritis.

MBI patients showed greater reductions in their pain-related catastrophizing, morning stiffness, fatigue and anxiety than did CBT and AE patients. MBI and CBT patients both catastrophized less compared with AE patients, but only MBI patients reduced their catastrophizing when confronted with severe pain. CBT patients, on the other hand, experienced greater increases in their sense of perceived pain control.

Mindful acceptance and cognitive reappraisal strategies each appear to have specific benefits and limitations. Arthritis patients with histories of recurrent depression, for example, benefited more from the MBI than CBT. Mindful acceptance seems to be more effective when pain is severe and cognitive resources are taxed. Cognitive reappraisal has the advantage of giving patients the perception of […]

December 18th, 2014|News|

MBSR trainees reduce their healthcare utilization

Posted: 11.21.2014 | by AMRA

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Since stress often contributes to medical illness, it is possible that mindfulness-based interventions (MBIs) that contain a stress reduction component might reduce the need for subsequent medical services. Few studies actually measure post-MBI medical utilization however, probably due to the difficulty in gathering data from an often fragmented healthcare delivery system.

Integrated healthcare systems offer better opportunities for such research. At Kaiser Permanente Colorado, McCubbin et al. [The Permanente Journal] studied the impact of Mindfulness Based Stress Reduction (MBSR) on self-reported physical and mental health, work productivity, and objectively measured healthcare utilization using an uncontrolled pre-post design.

The 38 participants were mostly female (79%) and Hispanic (68%) with an average age of 53 years. Participants being treated for chronic pain, chronic illness, or stress-related disorders were referred to the study by their primary care physicians. Participants were evaluated at baseline, on the final day of the 8-week program, and one year following their last class.

Health care utilization by the study participants was assessed using Kaiser Permanente Colorado electronic administrative and claims data for a six-month period prior to starting the program, and for a 6-month period following the 1-year anniversary of completing the program. Participants showed significant reductions from baseline in their self-rated pain, depression, anxiety, and somatization at the end of the 8-week program. All of these improvements were maintained at one-year follow-up, with some symptoms (pain, depression, anxiety) showing continued significant improvement beyond the initial gains.

Compared to the six-month period prior to the program, in the six-month period following the one year anniversary of program completion, participants made significantly fewer primary care visits (1.8 vs. 0.9), specialty care visits (7.8 vs. […]

November 21st, 2014|News|

Meditation Reduces Pain Elaboration

Posted from archive: 01.02.2014 | by AMRA

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Grant [Annals of the New York Academy of Sciences] reviewed recent experimental studies of the effects of focused attention (FA) and open monitoring (OM) meditation on pain perception. FA meditations require sustained attention on a focal stimulus (e.g., the breath or a mantra), whereas OM meditations involve sustained attention on the monitoring process itself (e.g., dzogchen or choiceless awareness). Experimental support for FA’s analgesic effect is somewhat weak and inconsistent. However, there is mounting support for OM’s ability to attenuate pain.

Studies from three independent laboratories demonstrated that OM meditators show increased neural activity in their pain processing centers (e.g., the somatosensory cortex, anterior cingulate cortex, and insula) and decreased activity in brain regions associated with elaborative mental processes (e.g., the various prefrontal cortical regions) when confronted with a painful stimulus. One study of Zen practitioners also showed that experienced meditators had decreased functional connectivity between these brain regions, and the less the functional connectivity, the lower their pain sensitivity.

An analysis of pain ratings and neural activity indicated that OM-mediated analgesia is due neither to distraction nor to opioid system activation, but to decreased elaborative cognitive activity. The author argued that sustained present-moment attention to sensory processes precludes the formation of mental narratives, cognitive appraisals, and self-related processes that exacerbate pain. He also noted that increases in parasympathetic activity and decreases in limbic-mediated fear conditioning may also underlie OM’s analgesic effects.

Reference:

Grant, J. A. (2013). Meditative analgesia: The current state of the field. Annals of the New York Academy of Sciences, 1307:55-63. [PMID: 24673150]

[Link to abstract]

January 26th, 2014|News|

Stress But Not Pain Perception Reduced from Focused Attention

Posted from archive: 12.24.2013 | by AMRA

 

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Is mindfulness then more effective in reducing pain and stress than simple relaxation alone? Feuille and Pargament [Journal of Health Psychology] conducted a randomized controlled trial comparing standardized mindfulness (STM), spiritualized mindfulness (SPM), and simple relaxation in a cohort of 74 migraine sufferers. Participants underwent a brief, single-session training in STM, SPM, or simple relaxation, in which they received only 5 to 7 minutes of guided practice and then practiced their assigned technique at home for 20 minutes a day over two weeks. The STM and SPM conditions were identical, except for the inclusion of a spiritually oriented rationale in the SPM condition, which was untied to theism or the beliefs of any specific religion.

Both meditation groups employed focused attention to the breath without an open monitoring component. At the study’s 
conclusion, 
participants’ 
pain tolerance 
was evaluated 
by a cold 
pressor task 
assessing their 
ability to 
maintain their 
hand in icy cold 
water for as long 
as they could tolerate, and their pain, stress, and mindfulness (as measured by the Toronto Mindfulness Scale) were rated during the procedure. Both meditation groups reported significantly lower stress than the simple relaxation group, but none of the groups differed in their pain perception or tolerance. SPM participants had a greater sense of connection to the sacred and experienced higher levels of mindfulness, but the STM and simple relaxation participants failed to differ from each other on those measures.

Very brief meditation training did not alter pain perception and tolerance in this study, which is consistent with findings that focused attention is not as effective as open monitoring in reducing pain, but it may also […]

January 25th, 2014|News|