The impact of a meditation-based stress reduction program on fibromyalgia
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Fibromyalgia is a chronic illness characterized by widespread pain, fatigue, sleep disturbance, and resistance to treatment. The purpose of this study was to evaluate the effectiveness of a meditation-based stress reduction program on fibromyalgia.
Seventy-seven patients meeting the 1990 criteria of the American College of Rheumatology for fibromyalgia took part in a 10-week group outpatient program. Therapists followed a carefully defined treatment approach and met weekly to further promote uniformity. Patients were evaluated before and after the program. Initial evaluation included a psychiatric structured clinical interview (SCID).
Outcome measures included visual analog scales to measure global well-being, pain, sleep, fatigue, and feeling refreshed in the morning. Patients also completed a medical symptom checklist, SCL-90-R, Coping Strategies Questionnaire, Fibromyalgia Impact Questionnaire, and the Fibromyalgia Attitude Index.
Although the mean scores of all the patients completing the program showed improvement, 51% showed moderate to marked improvement and only they were counted as “responders.”
These preliminary findings suggest that a meditation-based stress reduction program is effective for patients with fibromyalgia.
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Authors
Kenneth H. Kaplan
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Don L. Goldenberg
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Maureen Galvin-Nadeau
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Journal
General Hospital Psychiatry
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Author's primary institution
Boston University School of Medicine, Boston, Massachusetts, USA
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The efficacy of mindfulness meditation plus Qigong movement therapy in the treatment of fibromyalgia: a randomized controlled trial.
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
OBJECTIVE:
To test the short and long term benefits of an 8 week mind-body intervention that combined training in mindfulness meditation with Qigong movement therapy for individuals with fibromyalgia syndrome (FM).
METHODS:
A total of 128 individuals with FM were randomly assigned to the mind-body training program or an education support group that served as the control. Outcome measures were pain, disability (Fibromyalgia Impact Questionnaire), depression, myalgic score (number and severity of tender points), 6 minute walk time, and coping strategies, which were assessed at baseline and at 8, 16, and 24 weeks.
RESULTS:
Both groups registered statistically significant improvements across time for the Fibromyalgia Impact Questionnaire, Total Myalgic Score, Pain, and Depression, and no improvement in the number of feet traversed in the 6 minute walk. However, there was no difference in either the rate or magnitude of these changes between the mind-body training group and the education control group. Salutary changes occurring by the eighth week (which corresponded to the end of the mind-body and education control group sessions) were largely maintained by both groups throughout the 6 month follow up period.
CONCLUSION:
While both groups showed improvement on a number of outcome variables, there was no evidence that the multimodal mind-body intervention for FM was superior to education and support as a treatment option. Additional randomized controlled trials are needed before interventions of this kind can be recommended for treatment of FM.
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Authors
John A Astin
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Brian M Berman
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Barker Basell
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Wen-Lin Lee
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Marc Hochberg
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Kelly L Forys
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Journal
The journal of Rheumatology
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Author's primary institution
California Pacific Medical Center Research Institute, San Francisco, United States
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Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: Results of a randomized clinical trial
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Objective:
Depressive symptoms are common among patients with fibromyalgia, and behavioral intervention has been recommended as a major treatment component for this illness. The objective of this study was to test the effects of the Mindfulness-Based Stress Reduction (MBSR) intervention on depressive symptoms in patients with fibromyalgia.
Methods:
This randomized controlled trial examined effects of the 8-week MBSR intervention on depressive symptoms in 91 women with fibromyalgia who were randomly assigned to treatment (n = 51) or a waiting-list control group (n = 40). Eligible patients were at least 18 years old, willing to participate in a weekly group, and able to provide physician verification of a fibromyalgia diagnosis. Of 166 eligible participants who responded to local television news publicizing, 49 did not appear for a scheduled intake, 24 enrolled but did not provide baseline data, and 2 were excluded due to severe mental illness, leaving 91 participants. The sample averaged 48 years of age and had 14.7 years of education. The typical participant was white, married, and employed. Patients randomly assigned to treatment received MBSR. Eight weekly 2.5-hour sessions were led by a licensed clinical psychologist with mindfulness training. Somatic and cognitive symptoms of depression were assessed using the Beck Depression Inventory administered at baseline, immediately post program, and at follow up 2 months after the conclusion of the intervention.
Results:
Change in depressive symptoms was assessed using slopes analyses of intervention effects over time. Depressive symptoms improved significantly in treatment versus control participants over the 3 assessments.
Conclusion:
This meditation-based intervention alleviated depressive symptoms among patients with fibromyalgia.
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Authors
Sandra E. Sephton
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Paul Salmon
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Inka Weissbecker
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Christi Ulmer
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Andrea Floyd
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Katherine Hoover
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Jamie L. Studts
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Journal
Arthritis Care & Research
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Author's primary institution
University of Louisville, Louisville, Kentucky
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Mindfulness-Based Stress Reduction and Sense of Coherence Among Women with Fibromyalgia
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Sense of Coherence (SOC) is conceptualized as a disposition to experience life as meaningful and manageable. Research suggests a protective effect of SOC on psychological health in stressful circumstances. This study assessed the capacity of SOC to buffer the effect of illness symptoms on psychological distress among patients with fibromyalgia.
Self-reported changes in SOC after participation in a Mindfulness-Based Stress Reduction (MBSR) program were also examined. Ninety-one women with fibromyalgia provided baseline data pertaining to illness symptoms, perceived stress, and depression prior to participation in a randomized trial of MBSR. SOC and fibromyalgia symptoms were independently related to perceived stress and depression at baseline.
SOC was not a statistically significant moderator of symptom effects on psychological distress. In comparison with wait-listed controls, program participants reported a significant increase in SOC after MBSR participation.
These results provide the first demonstration from a randomized trial that SOC may be enhanced via intervention.
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Authors
Inka Weissbecker
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Paul Salmon
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Jamie K. Studts
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Andrea R. Floyd
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Eric A. Dedert
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Sandra E. Sephton
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Journal
Journal of Clinical Psychology in Medical Settings
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Author's primary institution
Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
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Treating fibromyalgia with mindfulness-based stress reduction: Results from a 3-armed randomized controlled trial
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Mindfulness-based stress reduction (MBSR) is a structured 8-week group program teaching mindfulness meditation and mindful yoga exercises. MBSR aims to help participants develop nonjudgmental awareness of moment-to-moment experience. Fibromyalgia is a clinical syndrome with chronic pain, fatigue, and insomnia as major symptoms. Efficacy of MBSR for enhanced well-being of fibromyalgia patients was investigated in a 3-armed trial, which was a follow-up to an earlier quasi-randomized investigation.
A total of 177 female patients were randomized to one of the following: (1) MBSR, (2) an active control procedure controlling for nonspecific effects of MBSR, or (3) a wait list.
The major outcome was health-related quality of life (HRQoL) 2 months post-treatment. Secondary outcomes were disorder-specific quality of life, depression, pain, anxiety, somatic complaints, and a proposed index of mindfulness. Of the patients, 82% completed the study.
There were no significant differences between groups on primary outcome, but patients overall improved in HRQoL at short-term follow-up (P = 0.004). Post hoc analyses showed that only MBSR manifested a significant pre-to-post-intervention improvement in HRQoL (P = 0.02). Furthermore, multivariate analysis of secondary measures indicated modest benefits for MBSR patients. MBSR yielded significant pre-to-post-intervention improvements in 6 of 8 secondary outcome variables, the active control in 3, and the wait list in 2.
In conclusion, primary outcome analyses did not support the efficacy of MBSR in fibromyalgia, although patients in the MBSR arm appeared to benefit most. Effect sizes were small compared to the earlier, quasi-randomized investigation. Several methodological aspects are discussed, e.g., patient burden, treatment preference and motivation, that may provide explanations for differences.
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Authors
Stefan Schmidt
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Paul Grossman
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Barbara Schwarzer
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Susanne Jena
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Author's primary institution
Department of Environmental Health Sciences, University Medical Center, Freiburg, Germany
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A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
A mounting body of literature recommends that treatment for fibromyalgia (FM) encompass medications, exercise and improvement of coping skills. However, there is a significant gap in determining an effective counterpart to pharmacotherapy that incorporates both exercise and coping. The aim of this randomized controlled trial was to evaluate the effects of a comprehensive yoga intervention on FM symptoms and coping.
A sample of 53 female FM patients were randomized to the 8-week Yoga of Awareness program (gentle poses, meditation, breathing exercises, yoga-based coping instructions, group discussions) or to wait-listed standard care. Data were analyzed by intention to treat.
At post-treatment, women assigned to the yoga program showed significantly greater improvements on standardized measures of FM symptoms and functioning, including pain, fatigue, and mood, and in pain catastrophizing, acceptance, and other coping strategies.
This pilot study provides promising support for the potential benefits of a yoga program for women with FM.
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Authors
James W. Carson
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Kimberly M. Carson
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Kim D. Jones
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Robert M. Bennett
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Cheryl L. Wright
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Scott D. Mist
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Author's primary institution
School of Nursing, Oregon Health & Science University, Portland, OR, USA
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Effects of Yoga and the Addition of Tui Na in Patients with Fibromyalgia
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Objectives:
This study aimed to verify whether techniques of yoga with and without the addition of Tui Na might improve pain and the negative impact of fibromyalgia (FMS) on patients' daily life.
Design:
Forty (40) FMS women were randomized into two groups, Relaxing Yoga (RY) and Relaxing Yoga plus Touch (RYT), for eight weekly sessions of stretching, breathing, and relaxing yogic techniques. RYT patients were further submitted to manipulative techniques of Tui Na.
Outcome measure:
Outcome measures comprised the Fibromyalgia Impact Questionnaire (FIQ), pain threshold at the 18 FMS tender points, and a verbal graduation of pain assessed before treatment and on the follow-up. The visual analog scale (VAS) for pain was assessed before and after each session and on the follow-up.
Results:
Seventeen (17) RYT and 16 RY patients completed the study. Both RY and RYT groups showed improvement in the FIQ and VAS scores, which decreased on all sessions. The RYT group showed lower VAS and verbal scores for pain on the eighth session, but this difference was not maintained on the follow-up. Conversely, RY VAS and verbal scores were significantly lower just on the follow-up.
Conclusions:
These study results showed that yogic techniques are valid therapeutic methods for FMS. Touch addition yielded greater improvement during the treatment. Over time, however, RY patients reported less pain than RYT. These results suggest that a passive therapy may possibly decrease control over FMS symptoms.
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Authors
Gerson D. da Silva
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Geraldo Lorenzi-Filho
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Lais V. Lage
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Journal
The Journal of Alternative and Complementary Medicine
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Author's primary institution
Faculty of Medicine, University of Sao Paulo, Brazil
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Mindfulness Meditation for Symptom Reduction in Fibromyalgia: Psychophysiological Correlates
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Objectives:
Fibromyalgia, a chronic pain syndrome, is often accompanied by psychological distress and increased basal sympathetic tone. In a previous report it was shown that mindfulness-based stress-reduction (MBSR) reduced depressive symptoms in patients with fibromyalgia with gains maintained at two months follow-up (Sephton et al., Arthr Rheum 57:77–85, 2007). This second study explores the effects of MBSR on basal sympathetic (SNS) activation among women with fibromyalgia.
Methods:
Participants (n = 24) responded to a television news appearance, newspaper, and radio advertisements. Effects on anxiety, depressive symptoms, and SNS activation measures were tested before and after MBSR using a within-subjects design.
Results:
The MBSR treatment significantly reduced basal electrodermal (skin conductance level; SCL) activity (t = 3.298, p = .005) and SCL activity during meditation (t = 4.389, p = .001), consistent with reduced SNS activation.
Conclusions:
In this small sample, basal SNS activity was reduced following MBSR treatment. Future studies should assess how MBSR may help reduce negative psychological symptoms and attenuate SNS activation in fibromyalgia. Further clarification of psychological and physiological responses associated with fibromyalgia may lead to more beneficial treatment.
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Authors
Elizabeth Lush
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Paul Salmon
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Andrea Floyd
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Jamie L. Studts
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Inka Weissbecker
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Sandra E. Sephton
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Journal
Journal of Clinical Psychology in Medical Settings
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Author's primary institution
Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
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An eight-week yoga intervention is associated with improvements in pain, psychological functioning and mindfulness, and changes in cortisol levels in women with fibromyalgia
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Objectives:
Fibromyalgia (FM) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, depression, and hypocortisolism. To date, published studies have not investigated the effects of yoga on cortisol in FM. This pilot study used a time series design to evaluate pain, psychological variables, mindfulness, and cortisol in women with FM before and after a yoga intervention.
Methods:
Participants (n = 22) were recruited from the community to participate in a 75 minute yoga class twice weekly for 8 weeks. Questionnaires concerning pain (intensity, unpleasantness, quality, sum of local areas of pain, catastrophizing, acceptance, disability), anxiety, depression, and mindfulness were administered pre-, mid- and post-intervention. Salivary cortisol samples were collected three times a day for each of two days, pre- and post-intervention.
Results:
Repeated measures analysis of variance (ANOVA) revealed that mean ± standard deviation (SD) scores improved significantly (p < 0.05) from pre- to post-intervention for continuous pain (pre: 5.18 ± 1.72; post: 4.44 ± 2.03), pain catastrophizing (pre: 25.33 ± 14.77; post: 20.40 ± 17.01), pain acceptance (pre: 60.47 ± 23.43; post: 65.50 ± 22.93), and mindfulness (pre: 120.21 ± 21.80; post: 130.63 ± 20.82). Intention-to-treat analysis showed that median AUC for post-intervention cortisol (263.69) was significantly higher (p < 0.05) than median AUC for pre-intervention levels (189.46). Mediation analysis revealed that mid-intervention mindfulness scores significantly (p < 0.05) mediated the relationship between pre- and post-intervention pain catastrophizing scores.
Discussion:
The results suggest that a yoga intervention may reduce pain and catastrophizing, increase acceptance and mindfulness, and alter total cortisol levels in women with FM. The changes in mindfulness and cortisol levels may provide preliminary evidence for mechanisms of a yoga program for women with FM. Future studies should use an RCT design with a larger sample size.
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Authors
Kathryn Curtis
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Anna Osadchuk
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Joel Katz
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Journal
Journal of Pain Research
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Author's primary institution
Department of Psychology, Faculty of Health, York University, Toronto, Canada
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A protocol and pilot study for managing fibromyalgia with yoga and meditation
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Fibromyalgia is a chronic syndrome characterized by widespread pain, sleep disturbance, stiffness, fatigue, headache, and mood disorders. Recent research has resulted in an improved understanding of fibromyalgia and its possible causes. This article highlights some of the current research, discusses a strategy for using yoga and meditation as a therapy for fibromyalgia sufferers, and presents the results of a preliminary 8-week study using yoga and meditation to help manage fibromyalgia symptoms.
The study of 11 participants found significant improvement in the overall health status of the participants and in symptoms of stiffness, anxiety, and depression. Significant improvements were also seen in the reported number of days "felt good" and number of days "missed work" because of fibromyalgia. Nonsignificant improvements were seen in measures of pain, fatigue, and how one felt in the morning. Effect sizes were medium to large for most tested areas.
This study supports the benefits of yoga and meditation for individuals with fibromyalgia and encourages further research to explore their use as standard therapies for fibromyalgia.
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Journal
International Journal of Yoga Therapy
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Author's primary institution
Right Path Yoga, Plano, TX
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Follow-up of Yoga of Awareness for Fibromyalgia: Results at 3 Months and Replication in the Wait-list Group
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Objectives:
Published preliminary findings from a randomized-controlled trial suggest that an 8-week Yoga of Awareness intervention may be effective for improving symptoms, functional deficits, and coping abilities in fibromyalgia. The primary aims of this study were to evaluate the same intervention’s post treatment effects in a wait-list group and to test the intervention’s effects at 3-month follow-up in the immediate treatment group.
Methods:
Unpaired t tests were used to compare data from a per protocol sample of 21 women in the immediate treatment group who had completed treatment and 18 women in the wait-list group who had completed treatment. Within-group paired t tests were performed to compare post treatment data with 3-month follow-up data in the immediate treatment group. The primary outcome measure was the Fibromyalgia Impact Questionnaire Revised (FIQR). Multilevel random-effects models were also used to examine associations between yoga practice rates and outcomes.
Results:
Post treatment results in the wait-list group largely mirrored results seen at post treatment in the immediate treatment group, with the FIQR Total Score improving by 31.9% across the 2 groups. Follow-up results showed that patients sustained most of their post treatment gains, with the FIQR Total Score remaining 21.9% improved at 3 months. Yoga practice rates were good, and more practice was associated with more benefit for a variety of outcomes.
Discussion:
These findings indicate that the benefits of Yoga of Awareness in fibromyalgia are replicable and can be maintained.
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Authors
James W Carson
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Kimberly M Carson
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Kim D. Jones. Scott D. Mist
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Robert M. Bennett
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Journal
Clinical Journal of Pain
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Author's primary institution
Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR 97239-3011, USA
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Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
A systematic review with meta-analysis of the efficacy and safety of meditative movement therapies (Qigong, Tai Chi and Yoga) in fibromyalgia syndrome (FMS) was carried out. We screened Clinicaltrials.Gov, Cochrane Library, PsycINFO, PubMed and Scopus (through December 2010) and the reference sections of original studies for meditative movement therapies (MMT) in FMS. Randomized controlled trials (RCT) comparing MMT to controls were analysed. Outcomes of efficacy were pain, sleep, fatigue, depression and health-related quality of life (HRQOL). Effects were summarized using standardized mean differences (SMD [95% confidence interval]). Outcomes of safety were drop out because of adverse events and serious adverse events. A total of 7 out of 117 studies with 362 subjects and a median of 12 sessions (range 8–24) were included. MMT reduced sleep disturbances (−0.61 [−0.95, −0.27]; 0.0004), fatigue (−0.66 [−0.99, −0.34]; <0.0001), depression (−0.49 [−0.76, −0.22]; 0.0004) and limitations of HRQOL (−0.59 [−0.93, −0.24]; 0.0009), but not pain (−0.35 [−0.80, 0.11]; 0.14) compared to controls at final treatment. The significant effects on sleep disturbances (−0.52 [−0.97, −0.07]; 0.02) and HRQOL (−0.66 [−1.31, −0.01]; 0.05) could be maintained after a median of 4.5 (range 3–6) months. In subgroup analyses, only Yoga yielded significant effects on pain, fatigue, depression and HRQOL at final treatment. Drop out rate because of adverse events was 3.1%. No serious adverse events were reported. MMT are safe. Yoga had short-term beneficial effects on some key domains of FMS. There is a need for high-quality studies with larger sample sizes to confirm the results.
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Authors
Jost Langhorst
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Petra Klose
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Gustav J. Dobos
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Kathrin Bernardy
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Winfried Hauser
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Journal
Rheumatology International
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Author's primary institution
Department of Internal and Integrative Medicine, University of Duisburg-Essen, Kliniken Essen-Mitte, Essen, Germany
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Fibromyalgia
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