Mind-Body Intervention Improves Chronic Pain Symptoms in Fibromyalgia

A Meditation-Based Lifestyle Modification (MBLM) program demonstrated relative clinical improvements for a variety of chronic pain conditions, according to a study published in Journal of Clinical Medicine.1 Investigators emphasized future controlled clinical trials should focus on the usefulness of this approach, as well as safety, using larger sample sizes. Additionally, the philosophical and ethical aspects of a yoga practice can be explored to confirm therapeutic utility.

The efficacy of an interdisciplinary multimodal pain therapy (IMPT) approach, which combines medical interventions, exercise therapy, and psychotherapy, has been endorsed in previous studies and is considered the most important intervention for relieving chronic pain. The goal of this approach is to reduce pain while also educating patients to understand their condition on a biopsychosocial level and rebuild social, phycological, and physical functions regardless of pain.²

“However, many programs are difficult to access, not integrative or patient-centered, and do not provide effective and, more importantly, long-term strategies for the overall treatment goals of IMPT,” wrote Karin Matko, PhD, Department of Psychology, Chemnitz University of Technology, Germany, and colleagues. “As a result, many patients are dissatisfied with conventional methods and, therefore, often turn to alternative treatments.”

Investigators analyzed the effects of an 8-week, yoga-based, mind-body intervention, MBLM, to determine its impact on the treatment of chronic pain in the experimental, single-case, multiple baseline study. The MBLM provided a comprehensive approach to yoga, incorporating ethical components, and encouraged participants to practice independently. The program followed a prescribed structure, incorporating set duration for the mantra meditation, yoga, and ethical teachings. Participants were randomly assigned into 3 baseline groups (10, 17, and 24 days) and the program was delivered in 8, 180-minute sessions.

The primary endpoints were pain intensity (German short form of the Brief Pain Inventory [BPI-sf]), pain self-efficacy (Pain Self-Efficacy Questionnaire [PSEQ]), and quality of life (World Health Organization Wellbeing Index [WHO-5]).

A total of 22 White, adult patients (aged 19 to 70 years) with chronic pain, including those diagnosed with fibromyalgia, migraines, and back pain, were enrolled in the study and 17 women completed the intervention program. Participants practiced an average of 20.3 minutes of yoga and 17.7 minutes of mantra meditation per day. On average, participants engaged in ethical living exercises 86% (n = 51.6/60) of all days and most attended 7 or 8 of the group sessions.

The MBLM was effective for most patients, with the largest effects demonstrated in areas of pain self-efficacy, (Tau-U = .35), average pain intensity (Tau-U = .21), quality of life (Tau-U = .23), and most severe perceived pain (Tau-U = -.14). Average pain levels improved for more than half of patients during the treatment phase. Regarding pain self-efficacy, 12 of 17 participants reported significant results, with moderate to very large effect sizes. Although wellbeing fluctuated daily, more than two-thirds of patients reported a gradual improvement in wellbeing during the intervention period compared with baseline measurements.

Investigators noted including only female participants limited the generalizability of the findings as women are both at higher risk for common pain conditions and seemingly benefit more from multimodal pain treatment. Additionally, investigators presumed participants were inherently interested in yoga and meditation and were therefore more motivated to receiving the intervention. They urged physicians to consider the individual characteristics of the patient when prescribing these practices.

“Chronic pain is a complex syndrome that requires multimodal treatment, and sometimes pain management represents a more realistic goal than achieving freedom from pain,” investigators concluded. “In this context, larger gains in pain self-efficacy than in pain reduction might be a promising pathway. Future studies could be limited to a specific type of chronic pain in order to make clearer statements about when and where MBLM could be a helpful adjunct treatment.”

References

1. ^{Matko K, Burzynski M, Pilhatsch M, Brinkhaus B, Michalsen A, Bringmann HC. How Does Meditation-Based Lifestyle Modification Affect Pain Intensity, Pain Self-Efficacy, and Quality of Life in Chronic Pain Patients? An Experimental Single-Case Study. J Clin Med. 2023;12(11):3778. Published 2023 May 31. doi:10.3390/jcm12113778}
2. ^{Borrell-Carrió, F.; Suchman, A.L.; Epstein, R.M. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Ann. Fam. Med. 2004, 2, 576–582.}