Brief mindfulness exposure interventions in acute and chronic pain

Abstract

Mindfulness-based interventions (MBIs) have been shown to be efficacious in the management of chronic pain, but some forms of MBIs are very intensive. This thesis aims to harness the benefits of mindfulness for people with pain by developing and testing a brief strategy, the mindfulness-based interoceptive exposure task (MIET), to help manage pain. The theoretical and conceptual basis of the MIET is described followed by a series of empirical studies testing the efficacy of the MIET. In the first study the MIET was administered to 15 consecutive patients with chronic pain. Results showed large within-subjects changes in outcomes, indicating that the MIET has potential as a brief strategy to improve outcomes in people with chronic pain. The second study, a randomized control trial for people with chronic pain found that the MIET resulted in reductions in pain within the session and at 2 and 12 weeks later. However, the broader benefits of the MIET found in the first study were not demonstrated in a comparison with the control group. In the final empirical study, the MIET was compared to distraction and a no-instruction control for healthy participants who then completed a cold pressor test. For acute rather than chronic pain, the MIET was not associated with differences in pain, although it was associated with large benefits for pain threshold and tolerance. To confirm the findings of the third study, a meta-analysis was conducted that confirmed that in the context of acute pain, MBIs do have an impact on pain tolerance and threshold, with little evidence for their benefit for pain severity or pain-related distress. In conclusion, the MIET does appear to be a useful strategy to reduce pain severity in people with chronic pain, but not acute pain. However, in acute pain the MIET appears to improve pain tolerance and threshold, as do other MBIs, and so MBIs likely have benefits in some acute pain settings, but large clinical trials are needed to confirm this.