Are mindfulness treatments effective for pain in cancer patients? A systematic review and meta‐analysis

Abstract

Background and objective Mindfulness‐based interventions (MBIs) have been recently applied in pain management and cancer care. However, inconsistencies exist concerning the effectiveness of MBIs on pain control among cancer patients. Therefore, this study aimed to examine the efficacy of MBIs on pain in cancer patients via a systematic review and meta‐analysis of randomized controlled trials (RCTs). Methods Databases (MEDLINE, PubMed, Embase, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov) were searched using key terms related to pain, cancer and mindfulness. The primary outcome was pain intensity. Standardized mean difference (SMD) of each outcome with 95% confidence interval (95% CI) was calculated. The quality of evidence was assessed by GRADE assessment. Results Ten RCTs with 843 participants were included. Significant pooled effects of MBIs on pain intensity were found at both short‐term (SMD = −0.19, 95% CI [−0.33 to −0.04]) and long‐term (SMD = −0.20, 95% CI [−0.35 to −0.05]) follow‐up, whereas no significance was observed for pain interference. In subgroup analyses, significant intervention effects were only seen in clinic‐based MBIs compared to remote MBIs, and pooled effects of MBIs in attenuating pain were discovered relative to passive rather than active comparators. GRADE ratings showed moderate certainty of evidence in MBIs for pain intensity but low for pain interference. Conclusions The efficacy of MBIs in reducing pain intensity among cancer patients was revealed in this meta‐analysis, albeit with a small effect size. Future research is warranted to optimize mindfulness treatment for pain control in cancer patients with high methodological quality and a large sample size. Significance The effect of MBIs on pain in cancer patients was demonstrated in our analysis, albeit with small effect sizes. High‐quality RCTs are needed to verify the efficacy of MBIs on cancer patients or survivors with pain complaints. Future trials should take into account the specific pain outcome measures (pain intensity or pain interference), the approach of intervention provision (clinic‐based or remote MBI, group or individual practice), the duration and frequency of interventions and the comparators (passive or active control arms).

Evidence Mapping Based on Systematic Reviews of Cognitive Behavioral Therapy for Neuropathic Pain

“…According to the evaluation of treatments, 11SRs [ 37 – 47 ] only evaluated CBT-related techniques, 11 SRs [ 34 , 48 – 57 ] also evaluated other psychological therapies, 5 SRs [ 58 – 62 ] evaluated nonpharmacological interventions in addition to psychological therapies, 2 SRs [ 35 , 63 ] evaluated pharmacological and nonpharmacological interventions, and 5 SRs [ 36 , 64 – 67 ] evaluated various interventions. Of the available data, 15 SRs [ 38 – 40 , 43 – 45 , 47 , 50 , 53 – 57 , 63 , 65 ] included migraine, 7 SRs [ 34 , 35 , 52 , 60 , 64 , 66 , 67 ] included burning mouth syndrome, 4 SRs [ 36 , 42 , 46 , 62 ] included cancer-related neuropathic pain, 3 SRs [ 51 , 59 , 61 ] included diabetic peripheral neuropathy, 3 SRs [ 48 , 49 , 58 ] included pain after spinal cord injury, and 2 SRs [ 37 , 41 ] included patients with NP of different causes.…”

Examining the interrelationships between mindfulness‐based interventions, depression, inflammation, and cancer survival

“…Another recent meta‐analysis by Feng and colleagues 66 demonstrated that MBIs were associated with significant improvements in pain intensity among patients with cancer at both short‐term and long‐term follow‐up, albeit with a small effect size. The improvements were more significant in face‐to‐face settings than with internet‐based or remote delivery 66 . Still, there may be a role for app‐delivered MBIs in pain reduction.…”

“…Only four studies in that meta‐analysis reported on analgesic use as an outcome, and results were mixed, with two studies showing a decrease in analgesic use after an MBI 64 . Another recent meta‐analysis by Feng and colleagues 66 demonstrated that MBIs were associated with significant improvements in pain intensity among patients with cancer at both short‐term and long‐term follow‐up, albeit with a small effect size. The improvements were more significant in face‐to‐face settings than with internet‐based or remote delivery 66 .…”

“…MBAs have also shown modest potential as modalities for pain and perceived social support, two factors associated with inflammation and possibly survival (Table 4). 39,[64][65][66][67] Ngamkham et al 39 conducted a systematic review and found that MBIs resulted in a statistically significant improvement in pain severity in four of six studies included. The authors propose that mindfulness helps to turn attention away from unpleasant symptoms, thereby improving pain tolerance.…”

“…The improvements were more significant in face-to-face settings than with internet-based or remote delivery. 66 Still, there may be a role for app-delivered MBIs in pain reduction. Mascaro et al 65 conducted an RCT to evaluate the effects of 6 weeks of self-guided, informal mindfulness app use on pain severity and pain catastrophizing.…”