The Efficacy of Mindfulness-based Interventions in Acute Pain

A Systematic Review and Meta-analysis

Alice Shires; Louise Sharpe; Jonathan N. Davies; Toby R.O. Newton-John

Disclosures

Pain. 2020;161(8):1698-1707. 

In This Article

Abstract and Introduction

Abstract

Recent meta-analyses have shown mindfulness-based interventions (MBIs) to be effective for chronic pain, but no pooled estimates of the effect of MBIs on acute pain are available. This meta-analysis was conducted to fill that gap. A literature search was conducted in 4 databases. Articles were eligible if they reported on randomized controlled trials of MBIs for people with acute pain and one of the following outcomes: pain severity, pain threshold, pain tolerance, or pain-related distress. Two authors independently extracted the data, assessed risk of bias, and provided GRADE ratings. Twenty-two studies were included. There was no evidence of an effect of MBIs on the primary outcome of pain severity in clinical {Hedges' g = 0.52; (95% confidence interval [CI] −0.241 to 1.280)} or experimental settings (Hedges' g = 0.04; 95% CI [−0.161 to 0.247]). There was a beneficial effect of MBIs on pain tolerance (Hedges' g = 0.68; 95% CI [0.157–1.282]) and pain threshold (Hedges' g = 0.72; 95% CI [0.210–1.154]) in experimental studies. There was no evidence of an effect of MBIs compared to control for pain-related distress in clinical (Hedges' g = 0.16; 95% CI [−0.018 to 0.419]) or experimental settings (Hedges' g = 0.44; 95% CI [−0.164 to 0.419]). GRADE assessment indicated that except for pain tolerance, the data were of low or very low quality. There is moderate evidence that MBIs are efficacious in increasing pain tolerance and weak evidence for pain threshold. However, there is an absence of good-quality evidence for the efficacy of MBIs for reducing the pain severity or pain-related distress in either clinical or experimental settings.

Introduction

Mindfulness is an effective intervention for a range of indications.[3,23,24] Meta-analyses confirm that mindfulness-based interventions (MBIs) are efficacious for managing stress,[3,24] depression,[16,22] and physical health problems.[19] A systematic review[5] and 2 meta-analyses[13,41] show that MBIs are efficacious for managing chronic pain; however, their efficacy for acute pain has not been robustly demonstrated. Given concerns about the prescription of opioids for acute pain, establishing the efficacy of psychosocial interventions in the management of pain is a priority.[42] However, in acute pain, research on MBIs is mixed with some studies finding evidence for their efficacy[25,35] and others finding either no benefits[34] or benefits to only certain patient subgroups.[31] It is likely that variation in the type of MBI, the dose, duration and intensity of practice, the type of participants, or methodological issues such as the nature of the control group might all contribute to these mixed results.[39] It is imperative to synthesize available research to draw firm conclusions about what is known about the efficacy of MBIs in acute pain and/or to highlight gaps in the literature.

There are 3 review articles relevant to the efficacy of mindfulness in acute pain.[13,28,33] Reiner et al. investigated the effect of MBIs on pain severity in acute or chronic pain. Only half of those trials (n = 16) were randomized controlled trials (RCTs) and only one RCT was in acute pain.[33] McClintock et al.[28] reviewed brief MBIs (<1.5 hours). Of the 20 studies they included, 14 were in acute pain (all experimental) and 4 of those were not RCTs. Furthermore, neither study meta-analysed the data and so quantitative estimates of the effect of MBIs on pain outcomes are absent.[28,33] Similarly, Garland et al.[13] examined the effect of meditation or acceptance-commitment therapy on pain but only one study of mindfulness in acute pain was included. Although all reviews concluded that MBIs showed promise in the treatment of pain, because none were specific to acute pain, this severely limits the confidence that we can have in the conclusions specifically in relation to acute pain.

The goal of the present meta-analysis was to synthesize and quantify the effect of MBIs on acute pain (<3 months duration) in clinical or experimental settings. This meta-analysis examined the efficacy of MBIs on the primary outcome of pain severity, and secondary outcomes of pain tolerance (the duration for which a painful stimulus can be withstood), pain threshold (the point at which a stimulus is reported to become painful), and pain-related distress. We chose pain severity as the primary outcome because (1) clinically in acute pain settings, the aim is typically to reduce the severity of pain; and (2) to be consistent with previous reviews in which pain severity was investigated.[13,28,33] Furthermore, we aimed to investigate the role of a range of relevant moderators, including sample characteristics, type and dose of MBI, and nature of the control group. Although our a priori hypotheses were based on combining clinical and experimental samples, we opted to report these separately due to heterogeneity.

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