Document Type

Critically Appraised Topic

Publication Date

2012

Clinical Scenario

Chronic pain is a common health problem affecting approximately 25-­‐35% of the adult population in the United States (Johannes, Le, Zhou, Johnston, & Dworkin, 2010). Primary conditions causing chronic pain include low back pain, osteoarthritis, and rheumatoid arthritis; prevalence is higher among women than men (34% vs. 24%), and reports of chronic pain increase with age. Johannes et al. (2010) did not find a consistent relationship between chronic pain and level of education in an internet-­‐based survey, but did find an increased likelihood of chronic pain at the lowest income levels.

Chronic pain has significant negative effects on the ability to work, basic activities of daily living, and overall quality of life (United States Department of Health and Human Services (HHS), 2012). Common treatment includes nonsteroidal anti-­‐inflammatory drugs and opioids, which unfortunately have intolerable side effects with long-­‐term use, especially for older adults (Kawada et al., 2012; Benyamin et al., 2008).

Mindfulness meditation was introduced to the Western medical community by Jon Kabat-­‐Zinn (1982) in the early 1980s; many forms of mindfulness-­‐based interventions are now used in medical settings for a variety of conditions. Because mindfulness-­‐based interventions do not require the use of medications, they may be a safer treatment option for individuals wishing to avoid medication side effects. If shown to be effective, these interventions may be useful to occupational therapists working with individuals with chronic pain.

Given an older client experiencing chronic pain (greater than 3 months duration) from osteoarthritis, treatment options should be carefully considered. Due to the dangerous gastrointestinal side effects of NSAIDs (Kawada et al., 2012) and the increased susceptibility to falls with the use of opioids (Benyamin et al., 2008), a mindfulness-­‐ based intervention may be worth consideration with this client. Research to be reviewed here suggests that mindfulness-­‐based interventions may positively affect not only chronic pain, but also overall physical functioning and psychological well-being.

Clinical Question

Do individuals with chronic pain who are treated with a mindfulness-­‐based intervention experience lower pain levels?

Clinical Bottom Line

Although the studies reviewed do not overwhelmingly demonstrate the efficacy of mindfulness-­‐based interventions in the reduction of chronic pain, they strongly suggest multiple beneficial effects with little to no risk. The lack of convincing research should not prevent occupational therapists from using this potentially therapeutic approach. Rather, occupational therapists are encouraged to consider learning ways in which they might effectively use mindfulness practices when working with individuals experiencing chronic pain. This could help generate evidence of the efficacy of occupation-­‐based interventions for people with chronic pain.

Mindfulness meditation treatments may be utilized to complement traditional therapeutic modalities by improving psychological distress in patients. Meditation supports the focus of occupational therapy by providing strategies that allow clients to increase participation in meaningful activities of daily living. In the practice of occupational therapy, mindfulness can be seamlessly incorporated into ongoing interventions as a stand-­‐alone preparatory method, or as an adjunct to performance of functional activities. Therapists are also encouraged to discuss the potential benefits of mindfulness with their clients and consider recommending formal training in mindfulness meditation for clients who have the time and resources available. Finally, because this is an area of growing research, therapists drawn to this approach should remain up-­‐to-­‐date with newly published findings so that they may efficiently incorporate new findings into their practice to best benefit their clients.

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