2.16: Mindfulness-Based Interventions

What are Mindfulness-Based Interventions?

Mindfulness-based interventions include slow controlled breathing, mindfulness meditation, cognitive–behavioral therapies, biofeedback, guided imagery and physical activities such as yoga, tai chi, and qigong. These activities may be used to increase self-awareness, relieve stress, and improve interoception. Interoception refers to the representation of the internal world, and includes the processes by which an organism senses, interprets, integrates, and regulates signals from within itself (Chen et al., 2021; Weng et al., 2021).

Mindfulness-Based Interventions and Pain Management

There are many ways that people can practice mindfulness-based interventions, some common ways are through yoga classes, meditation classes, exercise and even mindful coloring. The practice of mindfulness has been around for a long time, but the practice has not received much scientific attention. New research into mindfulness-based interventions show that it can be a helpful adjunct in managing pain and other stress related noncommunicable diseases by fostering resilience through self-care (Shires et al., 2020; Skelly et al., 2020). Preliminary findings also suggest that integrating these tools into the health care system may reduce health care utilization and may be cost-effective (Stahl et al., 2015).

Research describing various neurological and physiological changes associated with mindfulness-based interventions, including activation of specific brain regions, increased heart-rate variability, and suppression of stress-induced inflammatory pathways (Dossett et al., 2020; Wells et al., 2020). Mindfulness is not a panacea, but it is an evidence-based option for patients who are willing to explore non-pharmacological options for pain management (Cherkin et al., 2016; Shires et al., 2020; Skelly et al., 2020).

Key Takeaways

Increasingly people are looking for alternative pain management strategies. The difficulty with mindfulness-based interventions is that it is not a one size fits all, what works for one person may not work for another, so it is important to try different approaches. The next step for researchers is to investigate what sort of dosage and duration would be needed to optimize the effects of this non-pharmacological approach.

References and Sources

Bower, J. E., & Irwin, M. R. (2016). Mind-body therapies and control of inflammatory biology: A descriptive review. Brain, behavior, and immunity, 51, 1–11. doi:10.1016/j.bbi.2015.06.012

Chen, W. G., Schloesser, D., Arensdorf, A. M., Simmons, J. M., Cui, C., Valentino, R., Gnadt, J. W., Nielsen, L., Hillaire-Clarke, C. S., Spruance, V., Horowitz, T. S., Vallejo, Y. F., & Langevin, H. M. (2021). The Emerging Science of Interoception: Sensing, Integrating, Interpreting, and Regulating Signals within the Self. Trends in neurosciences, 44(1), 3–16. https://doi.org/10.1016/j.tins.2020.10.007

Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., Hansen, K. E., & Turner, J. A. (2016). Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA, 315(12), 1240–1249. https://doi.org/10.1001/jama.2016.2323

Chou, R., Wagner, J., Ahmed, A. Y., Blazina, I., Brodt, E., Buckley, D. I., Cheney, T. P., Choo, E., Dana, T., Gordon, D., Khandelwal, S., Kantner, S., McDonagh, M. S., Sedgley, C., & Skelly, A. C. (2020). Treatments for Acute Pain: A Systematic Review. Agency for Healthcare Research and Quality (US). https://doi.org/10.23970/AHRQEPCCER240

Dossett, M. L., Fricchione, G. L., & Benson, H. (2020). A New Era for Mind-Body Medicine. The New England journal of medicine, 382(15), 1390–1391. https://doi.org/10.1056/NEJMp1917461

Furman, D., Campisi, J., Verdin, E., Carrera-Bastos, P., Targ, S., Franceschi, C., Ferrucci, L., Gilroy, D. W., Fasano, A., Miller, G. W., Miller, A. H., Mantovani, A., Weyand, C. M., Barzilai, N., Goronzy, J. J., Rando, T. A., Effros, R. B., Lucia, A., Kleinstreuer, N., & Slavich, G. M. (2019). Chronic inflammation in the etiology of disease across the life span. Nature medicine, 25(12), 1822–1832. https://doi.org/10.1038/s41591-019-0675-0

Garland, E. L., Brintz, C. E., Hanley, A. W., Roseen, E. J., Atchley, R. M., Gaylord, S. A., … Keefe, F. J. (2019). Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis. JAMA internal medicine, e194917. Advance online publication. doi:10.1001/jamainternmed.2019.4917

Jinich-Diamant, A., Garland, E., Baumgartner, J., Gonzalez, N., Riegner, G., Birenbaum, J., Case, L., & Zeidan, F. (2020). Neurophysiological Mechanisms Supporting Mindfulness Meditation-Based Pain Relief: an Updated Review. Current pain and headache reports, 24(10), 56. https://doi.org/10.1007/s11916-020-00890-8

Pascoe, M. C., Thompson, D. R., & Ski, C. F. (2020). Meditation and Endocrine Health and Wellbeing. Trends in endocrinology and metabolism: TEM, 31(7), 469–477. https://doi.org/10.1016/j.tem.2020.01.012

Sharon, H., Maron-Katz, A., Ben Simon, E., Flusser, Y., Hendler, T., Tarrasch, R., & Brill, S. (2016). Mindfulness Meditation Modulates Pain Through Endogenous Opioids. The American journal of medicine, 129(7), 755–758. https://doi.org/10.1016/j.amjmed.2016.03.002

Shires, A., Sharpe, L., Davies, J. N., & Newton-John, T. (2020). The efficacy of mindfulness-based interventions in acute pain: a systematic review and meta-analysis. Pain, 161(8), 1698–1707. https://doi.org/10.1097/j.pain.0000000000001877

Skelly, A.C., Chou, R., Dettori, J.R., Turner, J.A., Friedly, J.L., Rundell, S.D., … Ferguson, A.J.R. (2020). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Agency for Healthcare Research and Quality (US). DOI: https://doi.org/10.23970/AHRQEPCCER227

Stahl, J. E., Dossett, M. L., LaJoie, A. S., Denninger, J. W., Mehta, D. H., Goldman, R., Fricchione, G. L., & Benson, H. (2015). Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization. PloS one, 10(10), e0140212. https://doi.org/10.1371/journal.pone.0140212

Sud, A., Lai, K., Cheng, D. K., Chung, C., Pico-Espinosa, O. J., & Rice, D. B. (2021). Mind-Body Interventions for Depressive Symptoms in Chronic Pain: A Systematic Review of Meta-Analyses. Pain physician, 24(1), 61–72.

Wells, R. E., Collier, J., Posey, G., Morgan, A., Auman, T., Strittmatter, B., Magalhaes, R., Adler-Neal, A., McHaffie, J. G., & Zeidan, F. (2020). Attention to breath sensations does not engage endogenous opioids to reduce pain. Pain, 161(8), 1884–1893. https://doi.org/10.1097/j.pain.0000000000001865

Wells, R. E., Seng, E. K., Edwards, R. R., Victorson, D. E., Pierce, C. R., Rosenberg, L., Napadow, V., & Schuman-Olivier, Z. (2020). Mindfulness in migraine: A narrative review. Expert review of neurotherapeutics, 20(3), 207–225. https://doi.org/10.1080/14737175.2020.1715212

Wells, R. E., O’Connell, N., Pierce, C. R., Estave, P., Penzien, D. B., Loder, E., Zeidan, F., & Houle, T. T. (2020). Effectiveness of Mindfulness Meditation vs Headache Education for Adults With Migraine: A Randomized Clinical Trial. JAMA internal medicine, e207090. Advance online publication. https://doi.org/10.1001/jamainternmed.2020.7090

Weng, H. Y., Feldman, J. L., Leggio, L., Napadow, V., Park, J., & Price, C. J. (2021). Interventions and Manipulations of Interoception. Trends in neurosciences, 44(1), 52–62. https://doi.org/10.1016/j.tins.2020.09.010

Zeidan, F., & Vago, D. R. (2016). Mindfulness meditation-based pain relief: a mechanistic account. Annals of the New York Academy of Sciences, 1373(1), 114–127. https://doi.org/10.1111/nyas.13153