Examining the Effectiveness of Mindfulness Meditation for Chronic Pain Management in Combat Veterans with Traumatic Brain Injury.

摘要

One in three Americans suffer from chronic pain, a condition more prevalent and costly than heart disease, diabetes, and cancer. Patients and providers report dissatisfaction with standard medical care, prompting the need for further research on effective chronic pain treatments. This pilot study examined the effectiveness of mindfulness meditation (iRest) for managing chronic pain in U.S. Veterans deployed to Afghanistan or Iraq. iRest is used clinically at Veterans Affairs (VA) hospitals nationwide. However, few studies have investigated the health benefits of iRest, and no study has examined this intervention s effectiveness for chronic pain. Veterans at the War Related Illness and Injury Study Center at the Washington, DC VA Medical Center were randomly assigned to receive iRest (n=4) or routine medical treatment (n=5) for 8 weeks. Self-reported pain intensity and interference was assessed at baseline (B), endpoint (E) and 4-week follow-up (F); patient ratings of improvement at E and F; and cognitive functioning and biochemical measures at B and E. Veterans in the iRest group showed clinically meaningful reductions in pain intensity (23-42%) on the numeric rating scale and visual analog scale (VAS), and lowered pain interference (34-41%) on the Brief Pain Inventory and Defense and Veterans Pain Rating Scale. Effect sizes were large from B-E and B-F for pain interference (d=1.09 1.21) and medium to large for intensity (d=0.76 1.19). VAS pain intensity decreased from B-F (p=.041) and pain interference improved from B-E and B-F for both measures (p=.041) and pain interference improved from B-E and B-F for both measures (p<.05). Among controls, no improvements in pain were detected, and changes were less than minimally significant (<20%). At E and F, iRest participants reported 'moderately better' to 'a definite improvement' in activity limitations, symptoms, and emotions related to their pain compared to 'hardly any change at all' among controls. From B-E, iRest participants improved in vigilance, the ability to sustain attention on the Conners' Continuous Performance Test II, compared to no difference among controls. Urinary cortisol and serum interleukin-6 remained unchanged from B-E in both groups. iRest is a promising self-management approach for pain in Veterans. Further research is warranted to confirm its effectiveness as a viable treatment for chronic pain.