Mindfulness Therapy Not So Great in Fibromyalgia -Possible Reasons

Though an earlier uncontrolled study suggested Mindfulness medication could be helpful in FM, a randomized trial did not.  Maybe becoming aware of surroundings, some of which you don’t like, is not helpful?

Pain. 2011 Feb;152(2):361-9.
Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial.
Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H.   abstract here

  • 177 female patients were randomized to one of the following:
    (1) Mindfulness Based Stress Reduction 
    (2) an active control procedure controlling for nonspecific effects of MBSR, or
    (3) a wait list
  • The intervention :
    8-week structured program
    one 2.5-h session every week
    additional 7-h all-day session on a weekend day.
  • Admitted ” clearly negative findings”.
  • Subjects were submitted to difficult observational requirements wherein frequently throughout the day they had to record their pain levels etc. – this requirement may have made the subjects zero in on their pains too much and could have derailed the project I think…

An earlier study by the same authors:
Psychother Psychosom. 2007;76(4):226-33.
Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being.
Grossman P, Tiefenthaler-Gilmer U, Raysz A, Kesper U.  abstract here

Suggested some benefits but was more quasi-experimental and less well controlled.

A discussion of the top article
 Mindfulness Therapy No Help in Fibromyalgia Trial
suggested the following:

  •  did not ” specifically address the role psychological stress and emotions can play in triggering pain” – ie did not address what you do with things you are now aware of and don’t like.
  • Perhap only a subgroup benefits and this needs to be teased out
  • In a study using mindfulness meditation with Rheumatoid arthritis, those with prior depression benefited most:
    J Consult Clin Psychol. 2008 Jun;76(3):408-21.
    Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression.
    Zautra AJ, Davis MC, Reich JW, Nicassario P, Tennen H, Finan P, Kratz A, Parrish  B, Irwin MR.
    abstract here
  • Another study with MS subjects found benefits:
    Neurology. 2010 Sep 28;75(13):1141-9.
    MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial.
    Grossman P, Kappos L, Gensicke H, D’Souza M, Mohr DC, Penner IK, Steiner C.  abstract here
    “improved HRQOL[health related quality of life], fatigue, and depression up to 6 months postintervention” – note no mention of help with pain which I believe is a more multidimensional illness.

Comment – I went to a meeting in which a Toronto based Mindfulness based stress reduction program was discussed. It was played up over some improvements of qualilty of life but the actual benefits on pain were just not great. The reasons for this have been known for years; only a multidimensional program can make a big enough imprint on chronic pain to overcome ceiling effect (that fact it only takes one problem in many to bring someone to full pain level).

People with FM have multiple physical aliments that some of use have but deal with because we don’t have something that magnifies the pain.  Take TMJ – there are men that have clicking jaws but they don’t necessarily hurt. If you ever go to a physiotherapy course you will find that Type II vertebral rotations/lockings and SI joint issues occur in many of the participants but they don’t necessarily hurt – if you have FM they do. They all require attention  – and to be ignored, because one can just look at one’s day instead, – is asking for failure. 

I think the verdict is still out re mindfulness meditation in FM but it has to be an add-on to other treatments to shine. I do meditation – it can years to be good at it – and I haven’t reached that yet….

Mr. Roger Batholomew has an offiice in my Lakeshore Medical Clinic in Regina and teaches Shinay Meditation to subjects, many of those in chronic pain. He will be starting a group training program and there are no costs involved.

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