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      Randomized Trial of the Effect of Mindfulness-Based Stress Reduction on Pain-Related Disability, Pain Intensity, Health-Related Quality of Life, and A1C in Patients With Painful Diabetic Peripheral Neuropathy

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          Abstract

          IN BRIEF Painful diabetic peripheral neuropathy (PDPN) has a large negative impact on patients’ physical and mental functioning, and pharmacological therapies rarely provide more than partial relief. Mindfulness-based stress reduction (MBSR) is a group psychosocial intervention that was developed for patients with chronic illness who were not responding to existing medical treatments. This study tested the effects of community-based MBSR courses for patients with PDPN. Among patients whose PDPN pharmacotherapy had been optimized in a chronic pain clinic, those randomly assigned to treatment with MBSR experienced improved function, better health-related quality of life, and reduced pain intensity, pain catastrophizing, and depression compared to those receiving usual care.

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          Neuropathic pain in the general population: a systematic review of epidemiological studies.

          O van Hecke, Sophie K Austin, Rafi A Khan … (2014)
          Most patients with neuropathic pain symptoms present and are managed in primary care, with only a minority being referred for specialist clinical assessment and diagnoses. Previous reviews have focused mainly on specific neuropathic pain conditions based in specialist settings. This is the first systematic review of epidemiological studies of neuropathic pain in the general population. Electronic databases were searched from January 1966 to December 2012, and studies were included where the main focus was on neuropathic pain prevalence and/or incidence, either as part of a specific neuropathic pain-related condition or as a global entity in the general population. We excluded studies in which data were extracted from pain or other specialist clinics or focusing on specific population subgroups. Twenty-one articles were identified and underwent quality assessment and data extraction. Included studies differed in 3 main ways: method of data retrieval, case ascertainment tool used, and presentation of prevalence/incidence rates. This heterogeneity precluded any meta-analysis. We categorised comparable incidence and prevalence rates into 2 main subgroups: (1) chronic pain with neuropathic characteristics (range 3-17%), and (2) neuropathic pain associated with a specific condition, including postherpetic neuralgia (3.9-42.0/100,000 person-years [PY]), trigeminal neuralgia (12.6-28.9/100,000 PY), painful diabetic peripheral neuropathy (15.3-72.3/100,000 PY), glossopharyngeal neuralgia (0.2-0.4/100,000 PY). These differences highlight the importance of a standardised approach for identifying neuropathic pain in future epidemiological studies. A best estimate of population prevalence of pain with neuropathic characteristics is likely to lie between 6.9% and 10%. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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            Interpreting the clinical importance of group differences in chronic pain clinical trials: IMMPACT recommendations.

            Robert H Dworkin, Dennis C Turk, Michael McDermott … (2009)
            An essential component of the interpretation of results of randomized clinical trials of treatments for chronic pain involves the determination of their clinical importance or meaningfulness. This involves two distinct processes--interpreting the clinical importance of individual patient improvements and the clinical importance of group differences--which are frequently misunderstood. In this article, we first describe the essential differences between the interpretation of the clinical importance of patient improvements and of group differences. We then discuss the factors to consider when evaluating the clinical importance of group differences, which include the results of responder analyses of the primary outcome measure, the treatment effect size compared to available therapies, analyses of secondary efficacy endpoints, the safety and tolerability of treatment, the rapidity of onset and durability of the treatment benefit, convenience, cost, limitations of existing treatments, and other factors. The clinical importance of individual patient improvements can be determined by assessing what patients themselves consider meaningful improvement using well-described methods. In contrast, the clinical meaningfulness of group differences must be determined by a multi-factorial evaluation of the benefits and risks of the treatment and of other available treatments for the condition in light of the primary goals of therapy. Such determinations must be conducted on a case-by-case basis, and are ideally informed by patients and their significant others, clinicians, researchers, statisticians, and representatives of society at large.
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              Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review.

              M Veehof, H Trompetter, E Bohlmeijer … (2016)
              The number of acceptance- and mindfulness-based interventions for chronic pain, such as acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), increased in recent years. Therefore an update is warranted of our former systematic review and meta-analysis of studies that reported effects on the mental and physical health of chronic pain patients. Pubmed, EMBASE, PsycInfo and Cochrane were searched for eligible studies. Current meta-analysis only included randomized controlled trials (RCTs). Studies were rated for quality. Mean quality did not improve in recent years. Pooled standardized mean differences using the random-effect model were calculated to represent the average intervention effect and, to perform subgroup analyses. Outcome measures were pain intensity, depression, anxiety, pain interference, disability and quality of life. Included were twenty-five RCTs totaling 1285 patients with chronic pain, in which we compared acceptance- and mindfulness-based interventions to the waitlist, (medical) treatment-as-usual, and education or support control groups. Effect sizes ranged from small (on all outcome measures except anxiety and pain interference) to moderate (on anxiety and pain interference) at post-treatment and from small (on pain intensity and disability) to large (on pain interference) at follow-up. ACT showed significantly higher effects on depression and anxiety than MBSR and MBCT. Studies' quality, attrition rate, type of pain and control group, did not moderate the effects of acceptance- and mindfulness-based interventions. Current acceptance- and mindfulness-based interventions, while not superior to traditional cognitive behavioral treatments, can be good alternatives.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Diabetes
                Journal ID (iso-abbrev): Clin Diabetes
                Journal ID (hwp): diaclin
                Journal ID (publisher-id): Clinical Diabetes
                Title: Clinical Diabetes : A Publication of the American Diabetes Association
                Publisher: American Diabetes Association
                ISSN (Print): 0891-8929
                ISSN (Electronic): 1945-4953
                Publication date (Print): December 2017
                Volume: 35
                Issue: 5
                Pages: 294-304
                Affiliations
                [1 ]University of Ottawa, Department of Anesthesiology, Ottawa, Ontario, Canada
                [2 ]Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
                [3 ]The Ottawa Hospital, Ottawa, Ontario, Canada
                [4 ]University of Ottawa, Department of Psychology, Ottawa, Ontario, Canada
                [5 ]University of Ottawa, Department of Anesthesiology and Pain Medicine, Ottawa, Ontario, Canada
                [6 ]University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, Ottawa, Ontario, Canada
                [7 ]Queen’s University, Department of Anesthesiology & Perioperative Medicine, Kingston, Ontario, Canada
                [8 ]Queen’s University, Department of Biomedical & Molecular Sciences, Kingston, Ontario, Canda
                [9 ]Queen’s University, Centre for Neuroscience Studies, Kingston, Ontario, Canada
                [10 ]University of Ottawa, Department of Medicine, Ottawa, Ontario, Canada
                [11 ]University of Ottawa, Department of Biochemistry, Microbiology, and Immunology, Ottawa, Ontario, Canada
                Author notes
                Corresponding author: Howard J. Nathan, hnathan@ 123456toh.ca
                Article
                Publisher ID: 294
                DOI: 10.2337/cd17-0077
                PMC ID: 5734176
                PubMed ID: 29263572
                SO-VID: a8ee3c52-70d1-4aea-a4f2-f0ae17bbd54d
                Copyright © © 2017 by the American Diabetes Association.
                License:

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0 for details.

                History
                Page count
                Pages: 11
                Categories
                Subject: Feature Articles

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