Chronic Neck Pain – Rheumatoid Arthritis Treatment Using Mindfulness Training
Coping with chronic neck pain may be made easier with mindfulness training if we generalize the results of a recent pilot study into the use of the therapy for patients with Rheumatoid Arthritis. The randomized study found that group-therapy using mindfulness techniques helped patients manage daily symptoms of chronic joint pain more effectively and reduced feelings of stress in comparison to the control group. What does ‘mindfulness’ mean though, and how can you incorporate it into your neck painmanagement regime?
Staying in the Moment
The researchers carrying out this study looked at sixty-seven patients with inflammatory Rheumatoid Arthritis and chronic joint pain, including those with ankylosing spondylitis, and psoriatic arthritis, with the former a common cause of neck pain and back pain. Published in the Annals of the Rheumatic Diseases in December, the study details the use of mindfulness, whereby the patients try to maintain an attentive awareness to the moment. This attention to the present reality is one of the factors in Buddhist enlightenment and the researchers considered it a potential aid to patients when accepting and coping with chronic pain conditions.
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The patients in the mindfulness group were expected to have less psychological distress, better emotional processing, and less fatigue, pain, and other symptoms after completing the course. Unfortunately, the lack of a genuine control group makes assessment difficult as the patients who did not attend the group therapy were given instead a CD of mindfulness exercises to practice at home. There were thirty-six patients in the therapeutic group and thirty-five in the control group, with sixty-seven completing all of the questionnaires included in the study. The mindfulness training involved ten group sessions over fifteen weeks, with a booster session at six months after completion of the initial training. The sessions concentrated on training patients to experience the present moment, no matter how hard that was. Patients in the control group had usual care, plus the take-home CD with which to practice mindfulness should they wish.
Feeling the Pain
Exercises in mindfulness also focused on recognizing limitations, coping with strong emotions, regarding chronic pain or other issue, and the programme aimed to teach the patients to become aware of their feelings, thoughts, and physical sensations, including chronic pain, without judging the experiences or trying to avoid acknowledging the sensations.
How Viable is Mindfulness Training for Chronic Pain?
The study used practitioners trained in mindfulness therapy to deliver the programme, with the cost-effectiveness and accessibility of the scheme questionable in light of the specific training needed. The importance of the experience of the trainers in guiding patients to carry out creative exercises involving music, drawing, and sharing of stories amongst the group means that such treatment is unlikely to be available for all those suffering with chronic pain from a joint condition including cervicalgia (neck pain).
Positive Effects of Mindfulness Training in RA
The results of the mindfulness training for Rheumatoid Arthritis patients did show that there were improvements in coping abilities, stress, fatigue, and symptom control, with assessments made after the initial training was complete and after twelve months. Stress scores over twenty-three were present in thirteen of the intervention group, dropping to just two after twelve months. In the control group this went from ten to eight. The control group saw no change from baseline fatigue in the twelve month period whereas those receiving mindfulness training for chronic pain did have improvements in levels of fatigue.
Long-Lasting Results from Mindfulness Training
The lead author of the study, Heidi A. Zangi, RN, MNSc, noted that similar psychoeducational interventions, including Cognitive Behavioral Therapy, tend to have a diminishing effect with time after the end of the programmes. With tailored interventions this decline is often avoided, with the benefits for depression, anxiety, and fatigue lasting longer. A previous study also noted benefits for mindfulness training in patients with Rheumatoid Arthritis (Arthritis Rheum. 2007;57:1134-1142), and it may be that nurses and physicians working with patients with chronic neck pain could undergo additional training to deliver some of this kind of training.
Group Therapy for Chronic Joint Pain
Group therapy sessions incorporating mindfulness training for existing chronic pain support groups could help reach more patients than a new initiative based solely on such techniques. Many physicians already try to include such therapy in their practice but without the benefit of having had proper training themselves. With the evidence building to support the use of mindfulness for Rheumatoid Arthritis and chronic neck pain it may be that these techniques become more commonplace in pain management clinics.
Reference
Zangi, H.A., Mowinckel, P., Finset, A., Eriksson, L.R., Hoystad, T.O., Lunde, A.K., Hagen, K.B., (2012). A mindfulness-based group intervention to reduce psychological distress and fatigue in patients with inflammatory rheumatic joint diseases: a randomised controlled trial, Ann Rheum Dis. Published online December 20, 2011.
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