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.

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Mindfulness Meditation for Chronic Pain

A Systematic Review

by Margaret A. Maglione, Susanne Hempel, Alicia Ruelaz Maher, Eric Apaydin, Brett Ewing, Lara Hilton, Lea Xenakis, Roberta M. Shanman, Sydne J. Newberry, Benjamin Colaiaco, et al.

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Research Question

  1. What are the efficacy and safety of mindfulness meditation interventions, as an adjunctive or monotherapy, for adults with chronic pain due to migraine, headache, back pain, osteoarthritis, or neuralgic pain compared with treatment as usual, waitlists, no treatment, or other active treatments?

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.

Key Findings

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.

Recommendations

  • More well-designed, rigorous, and large trials are needed in order to develop an evidence base that can more decisively provide estimates of the efficacy of mindfulness meditation for chronic pain.
  • Given published case reports of adverse events during meditation, including psychosis, future trials should actively collect adverse event data. In addition, a systematic review of observational studies and case reports would shed additional light on adverse events during mindfulness meditation.
  • Further research examining the effect of mindfulness meditation on chronic pain should also focus on better understanding whether there is a minimum frequency or duration of meditation practice for it to be effective. Future trials should monitor adherence (meditation practice) both during the intervention program and after the program ends if long-term results are to be assessed.

Table of Contents

  • 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

Research conducted by

This research was sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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