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Can mindfulness meditation reduce chronic pain?

If you have suffered from chronic pain, you have likely tried several strategies to relieve the pain. One strategy that has recently become popular for pain relief is mindfulness meditation. Mindfulness meditation refers to a process of developing the skill of bringing one’s attention to whatever is happening in the present moment.

In a recently published meta-analysis, Hilton and colleagues (2017) examined the effectiveness and safety of mindfulness meditation interventions for the treatment of chronic pain in adults. A meta-analysis is a research methodology in which the findings from several studies on the same topic are combined and analyzed together. It is considered the gold standard of evidence for understanding the robustness of an effect. In addition, this meta-analysis is particularly valuable because researchers only included randomized controlled trials, which means that participants were randomly assigned to a mindfulness meditation condition or a control condition. Because this meta-analysis included only randomized controlled trials, findings from this meta-analysis shed light on the extent to which mindfulness meditation treatments lead to decreases in chronic pain.

There were 38 studies included in the meta-analysis that had patients reporting chronic pain for at least 3 months. The patients were then randomized to either a formal mindfulness meditation treatment or a control treatment. Control treatments included no intervention, an education support group, or treatment as usual. Researchers coded for the effect of each intervention. In addition, researchers rated quality of evidence for each study as high, medium, low or very low. A study was rated lower quality if, for example, it did not report important pieces of the study methodology or did not include participants who dropped out of the study in analyses.

The results indicated that mindfulness meditation was more effective than control treatments in reducing chronic pain. However, the effect size was small and the quality of evidence was considered low due to publication bias (a bias where findings with significant results are more likely to get published) and inconsistency of results among the studies. In addition, 13 out of the 38 studies were rated as poor quality. Mindfulness meditation was also associated with improvement in depression, physical health-related quality of life (e.g., ability to engage in physically demanding activities), and mental-health related quality of life (e.g., having emotional problems that interfere with daily functioning).

Overall, findings suggest that mindfulness meditation results in improvements in chronic pain, depression, and quality of life. However, the weaknesses in the body of evidence (e.g., publication bias, inconsistencies among studies, large number of poor quality studies) prevent strong conclusions. Future researchers should conduct more rigorous randomized controlled trials examining the effect of mindfulness meditation on chronic pain. The trials should report all important pieces of study methodology, have longer follow-up, and include all participants who were randomized into the study when analyzing the results.

Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S., … Maglione, M. A. (2017). Mindfulness meditation for chronic Pain: Systematic review and meta-analysis. Annals of Behavioral Medicine, 51(2), 199–213. http://doi.org/10.1007/s12160-016-9844-2

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Do you think you are more or less physically active than others?: The influence on mortality

Inadequate physical activity levels are associated with a shorter lifespan because inadequate physical activity can increase an individual’s risk of developing chronic illnesses, like diabetes. Although the evidence is clear that increasing physical activity levels is important for preventing illness and premature mortality across the lifespan, do individual’s perceptions of their physical activity levels compared to others influence mortality? Prior work suggests that individual’s perceptions of their own health behaviors influences actual health behavior engagement leading to health outcomes.

A study recently published in Health Psychology examined whether adults’ perceptions of their physical activity levels predicted mortality. Data for this study came from the National Center for Health Statistics (NCHS), and included 61,141 participants across three nationally representative samples with follow-up time points up to 21 years later. One of the most important advantages of analyzing data from large-scale epidemiological studies is greater confidence in the accuracy of results by reducing the likelihood for error. Participants were asked to rate whether they perceived themselves as a lot more active, a little more active, as active, a little less active, and a lot less active than other people their same age. In addition, participants provided data on their actual physical activity levels via self-report or an accelerometer. Mortality was measured as death from any cause collected from the 2011 National Death Index. The authors chose to control for demographics variables, perceived health, number of illnesses, disability, mental health, smoking, body mass index, and actual physical activity levels in analyses to rule out alternative explanations for the effect.

This study found that, even after controlling for many variables influencing mortality, those who perceived themselves as a little more active or as active as others had an 8% increased likelihood of having died than those who perceived themselves as a lot more active than others. In addition, those who perceived themselves as a lot less active had an 18% increased likelihood of having died than those who perceived themselves as a lot more active. These results replicated in two additional samples, which provides evidence that these findings were not due to chance.

Taken together, this study supports a growing body of evidence that an individual’s perception of their own physical activity levels compared to others influences mortality. The authors suggest that perceptions predict mortality by influencing actual physical activity engagement. Future research will need to examine this mechanism. Given that physical activity interventions focus on increasing actual rates of physical activity, this study suggests that interventions may also want to target individual’s perceptions of their physical activity levels by informing people of their actual physical activity levels compared to others. Future research will need to assess the reasons why perceptions and social comparisons influence behavior.

Reference: Zahrt, O.H., & Crum, A.J. (2017). Perceived physical activity and mortality: Evidence from three nationally representative US samples. Health Psychology, 36, 1017-1025.