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Mindfulness Meditation Is Associated with a Small Effect of Improved Pain Symptoms, but the Quality of Evidence is Low

• Of 28 included randomized controlled trials on the efficacy of mindfulness meditation for chronic pain, 24 reported continuous pain measures. Results of pooled analysis indicated a statistically significant reduction of pain symptoms, but the quality of evidence that mindfulness meditation is associated with a decrease in chronic pain compared with control is low overall.
• In subgroup analyses of comparators, mindfulness meditation significantly reduced pain scale scores compared with treatment as usual, but not compared with passive controls, such as waitlists, or with education or support groups.
• There is high quality evidence that mindfulness meditation to treat chronic pain significantly reduced depressive symptoms, and there is moderate quality evidence that it improves physical and mental health-related quality of life.
• The efficacy of mindfulness meditation did not differ significantly when given as monotherapy or adjunctive therapy or by type of intervention, medical condition, or frequency or duration of treatment.

RAND researchers conducted a systematic review that synthesized evidence from randomized controlled trials of mindfulness meditation interventions — used adjunctively or as monotherapy — to provide estimates of their efficacy and safety in alleviating chronic pain in adults.

Outcomes of interest included changes in pain symptomatology, use of analgesics, functional status, health-related quality of life, functional impairment (disability measures), and adverse events. Meta-analyses for efficacy outcomes were conducted using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (or GRADE) approach.

In total, 28 studies met inclusion criteria. Mindfulness meditation was associated with a small effect of improved pain symptoms compared with control groups in a meta-analysis of 24 randomized controlled trials. However, there was evidence of substantial heterogeneity among studies, resulting in a low quality of evidence assessment for this outcome. We were unable to determine which patient subgroups or intervention characteristics were associated with greater efficacy. Mindfulness meditation statistically significantly improved depression and health-related quality of life. Adverse events were rare and not serious, but the vast majority of studies did not collect adverse event data. The low quality of evidence prevents any strong conclusions about mindfulness meditation for chronic pain. Additional trials with adequate power, greater efforts to prevent attrition, monitoring of adherence to meditation practice, active collection of adverse events, and better reporting of methods are suggested.

• Chapter One

  Introduction

• Chapter Two

  Methods

• Chapter Three

  Results

• Chapter Four

  Discussion

• Appendix A

  Search Strategy

• Appendix B

  Excluded Full-Text Articles

• Appendix C

  Evidence Table of Included Studies

• Appendix D

  Studies Included in the Most Recent Systematic Review