Mindfulness-based stress reduction for chronic pain and health-related quality of life after intensive care unit discharge

Vincenzo Damico; Luca Cossalter; Liana Murano; Roberto Latina

doi:10.23750/abm.v96i2.15953

Mindfulness-based stress reduction for chronic pain and health-related quality of life after intensive care unit discharge

Authors

Vincenzo Damico Department of Anesthesia and Critical Care, Azienda Socio-Sanitaria Territoriale of Lecco, Lecco, Italy
Luca Cossalter Department of Anesthesia and Critical Care, Azienda Socio-Sanitaria Territoriale of Lecco, Lecco, Italy
Liana Murano Residenza Sanitaria Assistenziale Madonna della Neve Onlus of Premana, Premana, Italy
Roberto Latina Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy

Keywords:

chronic pain, pain management, mindfulness-based stress reduction, intensive care units, survivors, quality of life, brief pain inventory, stress psychological, post-intensive care syndrome

Abstract

Aim: To test the efficacy of a mindfulness-based stress reduction (MBSR) program on pain management and on quality of life among chronic pain patients discharged from the intensive care unit (ICU).

Methods: A mindfulness-based stress reduction intervention, aimed at improving pain management was implemented in a sample of 43 survivors of critical illness who suffered from chronic pain at an ICU. In this observational study, data were collected before (T0= 12 months after ICU discharge) and after the adoption of a MBSR program (T1= 10 months after intervention). The Brief Pain Inventory-Short Form (BPI-SF) and EuroQol-5 Dimension (EQ-5D) were used.

Results: The Brief Pain Inventory showed a significant reduction in worst pain in the last 24 h (p< .001), least pain in the last 24 h (p= .011), pain on average (p< .001), and in terms of pain interference with mood (p= .002) and with sleep (p< .001). EQ-5D showed a significant reduction in the perception of moderate or extreme pain/discomfort (p= .009) and moderate to severe problems with anxiety/depression (p= .031).

Conclusion: MBSR program seems to improve chronic pain intensity and to reduce the negative interference of pain on quality of life. Although the results are statistically significant, they do not appear to be clinically relevant. However, further studies with larger sample sizes and control groups are needed.

References

1. Cuthbertson BH, Roughton S, Jenkinson D, et al. Quality of life in the five years after intensive care: a cohort study. Crit Care. 2010; 14(1):R6. doi: 10.1186/cc8848.

2. Battle CE, Lovett S, Hutchings H. Chronic pain in survivors of critical illness: a retrospective analysis of incidence and risk factors. Crit Care. 2013; 29;17(3):R101. doi: 10.1186/cc12746.

3. Treede RD, Rief W, Barke A, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019; 160(1):19-27. doi: 10.1097/j.pain.0000000000000160.

4. Baumbach P, Götz T, Günther A, et al. Prevalence and Characteristics of Chronic Intensive Care-Related Pain: The Role of Severe Sepsis and Septic Shock. Crit Care Med. 2016; 44(6):1129-37. doi: 10.1097/CCM.0000000000001635.

5. Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2012; 14;11(11):CD007407. doi: 10.1002/14651858.CD007407.pub3.

6. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol. 2014; 69(2):153-66. doi: 10.1037/a0035747.

7. Hofmann SG, Sawyer AT, Witt AA, et al. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010; 78:169–183. doi: 10.1037/a0018555.

8. Sharma M, Rush SE. Mindfulness-Based Stress Reduction as a Stress Management Intervention for Healthy Individuals: A Systematic Review.J Evid Based Complementary Altern Med. 2014; 19(4):271-286. doi: 10.1177/2156587214543143.

9. Wong SY, Chan FW, Wong RL, et al. Comparing the effectiveness of mindfulness-based stress reduction and multidisciplinary intervention programs for chronic pain: a randomized comparative trial. Clin J Pain. 2011;27(8):724-34. doi: 10.1097/AJP.0b013e3182183c6e.

10. Rosenzweig S, Greeson JM, Reibel DK, et al. Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. J Psychosom Res. 2010; 68(1):29-36. doi: 10.1016/j.jpsychores.2009.03.010.

11. Reibel DK, Greeson JM, Brainard GC, et al. Mindfulness-based stress reduction and health-related quality of life in a heterogeneous patient population. Gen Hosp Psychiatry. 2001; 23(4):183-92. doi: 10.1016/s0163-8343(01)00149-9.

12. Poletti S, Razzini G, Ferrari R, et al. Mindfulness-Based stress reduction in early palliative care for people with metastatic cancer: A mixed-method study. Complement Ther Med. 2019; 47:102218. doi: 10.1016/j.ctim.2019.102218.

13. Ludwig DS, Kabat-Zinn J. Mindfulness in medicine. JAMA. 2008; 17;300(11):1350-2. doi: 10.1001/jama.300.11.1350.

14. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap. 1994; 23(2):129-38. PMID: 8080219.

15. Kroenke K, Theobald D, Wu J, et al. Comparative responsiveness of pain measures in cancer patients. J Pain. 2012; 13(8):764-72. doi: 10.1016/j.jpain.2012.05.004.

16. Bonezzi C, Nava A, Barbieri M, et al. Validazione della versione italiana del Brief Pain Inventory nei pazienti con dolore cronico [Validazione della versione italiana del Brief Pain Inventory nei pazienti con dolore cronico]. Minerva Anestesiol. 2002; 68(7-8):607-11. Italian. PMID: 12244292.

17. EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199-208. doi: 10.1016/0168-8510(90)90421-9.

18. Balestroni G, Bertolotti G. L'EuroQol-5D (EQ-5D): uno strumento per la misura della qualità della vita [EuroQol-5D (EQ-5D): an instrument for measuring quality of life]. Monaldi Arch Chest Dis. 2012;78(3):155-9. Italian. doi: 10.4081/monaldi.2012.121.

19. Park S, Sato Y, Takita Y, et al. Mindfulness-Based Cognitive Therapy for Psychological Distress, Fear of Cancer Recurrence, Fatigue, Spiritual Well-Being, and Quality of Life in Patients With Breast Cancer-A Randomized Controlled Trial. J Pain Symptom Manage. 2020; 60(2):381-389. doi: 10.1093/jjco/hyx156.

20. Didonna F, Rossi R, Ferrari C, et al. Relations of mindfulness facets with psychological symptoms among individuals with a diagnosis of obsessive–compulsive disorder, major depressive disorder, or borderline personality disorder. Psychol Psychother. 2019; 92(1), 112–130. doi: 10.1111/papt.12180.

21. Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008; 31(1):23-33. doi: 10.1007/s10865-007-9130-7.

22. Demoro G, Damico V, Murano L, et al. Long-term consequences in survivors of critical illness. Analysis of incidence and risk factors. Ann Ist Super Sanita. 2020; 56(1):59-65. doi: 10.4415/ANN_20_01_09.

23. Damico V, Murano L, Margosio V, et al. Long-term effects of Coronavirus 2 infection after intensive care: a prospective study. Minerva Anestesiol. 2023; 89(3):175-187. doi: 10.23736/S0375-9393.22.16728-3.

24. Damico V, Murano L, Dal Molin A. Chronic pain in in survivors of critical illness: prevalence and associated psychological disorders. Prof Inferm. 2022; 75(2):106-114. PMID: 36964921.

25. Martinez V, Dziadzko M, Tamayo J, et al. Chronic pain characteristics in COVID-19 survivors after an ICU stay. A cross-sectional study. Anaesth Crit Care Pain Med. 2023; 24;42(6):101267. doi: 10.1016/j.accpm.2023.101267.

26. Gustafson OD, Rowland MJ, Watkinson PJ, et al. Shoulder Impairment Following Critical Illness: A Prospective Cohort Study. Crit Care Med. 2018; 46(11):1769-1774. doi: 10.1097/CCM.0000000000003347.

27. Hadi MA, McHugh GA, Closs SJ. Impact of Chronic Pain on Patients' Quality of Life: A Comparative Mixed-Methods Study. J Patient Exp. 2019; 6(2):133-141. doi: 10.1177/2374373518786013.

28. Kruis AL, Smidt N, Assendelft WJJ, et al. Integrated condition management interventions for patients with chronic obstructive pulmonary condition (review). Cochrane Database Syst Rev. 2013; 10;(10):CD009437. doi: 10.1002/14651858.CD009437.

29. Flanagan S, Damery S, Combes G. The effectiveness of integrated care interventions in improving patient quality of life (QoL) for patients with chronic conditions. An overview of the systematic review evidence. Health Qual Life Outcomes. 2017; 29;15(1):188. doi: 10.1186/s12955-017-0765-y.

30. Morone NE, Greco CM, Moore CG, et al. A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Intern Med. 2016; 176(3):329-37. doi: 10.1001/jamainternmed.2015.8033.

31. Carmen SG, José LM, Adriana RS, et al. A Pilot Randomized Controlled Trial of Effectiveness of a Psychoeducational Intervention on the Management of Musculoskeletal Chronic Noncancer Pain. Pain Manag Nurs. 2023; 24(4):427-435. doi: 10.1016/j.pmn.2023.01.007.

32. Garland EL, Brintz CE, Hanley AW, et al. Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis. JAMA Intern Med. 2020; 1;180(1):91-105. doi: 10.1001/jamainternmed.2019.4917.

33. Elsesser K, Cegla T. Long-term treatment in chronic noncancer pain: Results of an observational study comparing opioid and nonopioid therapy. Scand J Pain. 2017; 17:87-98. doi: 10.1016/j.sjpain.2017.07.005.

34. Chou R, Clark E, Helfand M. Comparative efficacy and safety of long-acting oral opioids for chronic non-cancer pain: a systematic review. J Pain Symptom Manage. 2003; 26(5):1026-48. doi: 10.1016/j.jpainsymman.2003.03.003.

35. Saïdi H, Pagé MG, Boulanger A, et al. Effectiveness of long-term opioid therapy among chronic non-cancer pain patients attending multidisciplinary pain treatment clinics: A Quebec Pain Registry study. Can J Pain. 2018; 19;2(1):113-124. doi: 10.1080/24740527.2018.1451252.

36. Pergolizzi JVJr, Raffa RB, Rosenblatt MH. Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: Current understanding and approaches to management. J Clin Pharm Ther. 2020; 45(5):892-903. doi: 10.1111/jcpt.13114.

37. Bicego A, Monseur J, Rousseaux F, et al. Drop-out from chronic pain treatment programmes: Is randomization justified in biopsychosocial approaches? J Rehabil Med. 2021; 28;53(4):jrm00185. doi: 10.2340/16501977-2824.

38. Damico V, Cazzaniga F, Murano L, et al. Impact of a Clinical Therapeutic Intervention on Pain Assessment, Management, and Nursing Practices in an Intensive Care Unit: A before-and-after Study. Pain Manag Nurs. 2018; 19(3):256-266. doi: 10.1016/j.pmn.2018.01.007.

39. Damico V, Macchi G, Murano L, et al. Incidence of pain at rest and during nursing procedures in ICU patients: a longitudinal observational study. Ann Ig. 2020 Jul-Aug; 32(4):407-418. doi: 10.7416/ai.2020.2364.

40. Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. 2021; 29;397(10289):2082-2097. doi: 10.1016/S0140-6736(21)00393-7.