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Mindfulness meditation alleviates fibromyalgia symptoms in women: results of a randomized clinical t

Discussion in 'Other Health News and Research' started by Tom Kindlon, Jun 27, 2015.

  1. Tom Kindlon

    Tom Kindlon Senior Member

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    Somebody asked me for my thoughts on this trial. I thought I'd throw it out here.

    I'm particularly interested in hearing from people who have read the full paper.


     
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  2. voner

    voner Senior Member

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    tom,

    what are your thoughts?
     
  3. Graham

    Graham Senior Moment

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    Bits that caught my attention:

    The waffly justification bit on page 320 first column includes "However, stress reduction treatment interventions have shown promise in reducing or alleviating aberrant cortisol rhythms that can occur …" The cortisol profile didn't change, so why waffle on like this? The introduction is just there to implant false ideas.

    Very poor selection technique: volunteers from TV news and newspapers: 282 responded, but only 166 reported a diagnosis of FM??? Quite patchy completion, and only 42 patients, out of 51, actually completed at least half of the MBSR programme (bottom left page 323) - 8 two-and-a-half hour sessions. As usual, the more ill the patient, the more likely they were to give up.

    Again, like PACE, there was no control group. The group that did not get MBSR did not get any attention. The trial pitched attention against neglect, not MBSR against, say, relaxation.

    Lots of speculation on page 327, just padding and creating false positive ideas.

    I wonder why the "perceived" improvements were not graphed? Well, I can guess. The PSS scale (stress) is out of 40 and the scores dropped from 22 to 19.2. On a full graph running from 0 to 40 you would need a spirit level to spot the drop.

    The VAS scale (pain) is really impressive in its ability to be manipulated. Patients have to put a marker on a line running from no pain to ultimate pain (or whatever the choices are), and the position is measured from 0 to 100. It dropped from 68.1 to 60.4. It sounds like CBT all over again. Fill out your forms: then you are told "This technique is amazingly good at reducing pain and stress, if you do it properly and listen to us because we are the experts.": now fill out your forms again.

    In summary, from a quick look, it's the PACE trial all over again, but with a worse selection procedure. At least they didn't re-define FM at the end of the trial so that they could claim recovery.
     
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  4. Esther12

    Esther12 Senior Member

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    Control groups were better in PACE, but results were then spun more. This looks much more basic.

    I don't know enough about FMS to comment on a lot of the specifics so only skimmed through. Time consuming intervention leads to some minor improvements in self report compared to a wait-list control? Great stuff. Suspect that the mindfulness therapists got more out of this than the patients, but also, there are worse things to have inflicted on than some MBSR. (I think my standards for medicine may be too low).

    Title makes it sound better than it is.

    I don't really understand why studies like this are carried out. (Only obvious thoughts from me I'm afraid).
     
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  5. Bob

    Bob

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    I haven't read the paper, but I used to do quite a lot of meditation years ago (before I became ill with ME - my brainfog doesn't allow it any more)... And I've got a couple of things to say about having eight two-and-a-half hour sessions of mindfulness.

    Firstly, a two-and-a-half hour session of meditation for a beginner would be torture (by 'torture' I mean the sort of torture that school homework feels like when you'd rather be doing a million other things), and it would be impossible for most people to successfully focus on mindfulness for anything beyond a few consecutive 1 minute periods to begin with. After a week of daily practice perhaps a person could achieve 2, 5 or 10 minute sessions without it feeling like torture, or drifting off into a trail of thoughts and daydreams. By week eight, if practising every day, perhaps one could meditate, inconsistently, for ten, twenty or thirty minute sessions. I expect the patients were expected to meditate at home on a daily basis, but this level of commitment is difficult to achieve unless you have an instructor in front of you every day, or you are particularly motivated. This is esp the case for a beginner when any benefits or enjoyment of meditation may not be experienced to begin with. It really can feel torturous while learning the early stages. And the discipline for daily mediation is hard to achieve unless you have an instructor in front of you. So I doubt if many of these patients were achieving what they were expected to, in terms of how much time they were practising. And I doubt if many had become adept practitioners by the end of their course.

    From personal experience, I think that mindfulness can help some people cope with simple pain and other difficulties in life, but it's very personal and meditation doesn't suit everyone, and depends on personal circumstances. I can't mediate now that I have a neuro-immune illness and brain fog. It also took me a long time of practice before I was able to make use of mindfulness outside of formal practice sessions, and even then it was exceptionally limited in its practical applications. And I mean a long time - much longer than a few weeks. I was interested in it for years. So I doubt that 8 formal training sessions would make any real difference to a person's everyday life even if they begin to enjoy the practice. (And it can become very enjoyable for some people. Usually the ones who stick at it.) It's very difficult or impossible to implement mindfulness when doing everyday activities. And downright dangerous if doing something like driving or working with machinery. So any improvements in pain or coping with pain would be sporadic, possibly fleeting, and occasional, for a beginner in meditation. I suspect that any significant reported improvements in this study might be due to biases in the study design, such as patient expectations and a desire to please their instructor etc.

    I think mindfulness can allow some people to experience peace and serenity, and I think it can help with pain in some people at times (both coping with pain and reducing the subjective intensity pain), but I'm thinking of simple and mild pain without neurological complications etc. I don't have any insight into primary fibromyalgia, but I suspect that patients with many different types of underlying biomedical mechanisms end up being given a fibro diagnosis, so the cohort is probably highly heterogeneous. I'm not sure if all fibro patients would be able to meditate, esp if they have brain fog or neurological complications, or overwhelming pain and discomfort.

    The Tibetans describe meditation as 'mind training', and it's not a passive process. One has to actively engage with it. There are a myriad of different styles of meditation, and mindfulness is just one of them. Even with mindfulness there are many different approaches to it, and it's just the beginning of a potential journey into meditation. Mindfulness can be the preparation stage for more advanced levels of meditation. But an exceptionally useful and grounding preparation. One can find peace, joy, serenity and tranquillity in meditation. But it doesn't work for everyone, and it can take years to find one's way with it. I used to experience depression when I was younger and I never experienced the 'joy' or serenity or uplift in mood that one is supposed to experience from meditation. But I did experience a calmness of mind, and some interesting insights into my own psychology. It wasn't in any way transformational, but interesting nevertheless.

    Many people do not get on with meditation, and would just get immensely frustrated with it. And some even have negative psychological reactions to it. But I believe mindfulness may help some people cope with some types of pain, but it would be a very personal thing. It can be a very enjoyable and benign experience, for many people, but some people react negatively to it, psychologically.

    It's definitely not a cure for a complex neurological or immunological illness.
     
    Last edited: Jun 30, 2015
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  6. Effi

    Effi Senior Member

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    I didn't read the paper either, but I too have mindfulness meditation experience. I took an 8-week beginner's class before I got ill, and I must say I did benefit from it. I was more relaxed, had crystal clear concentration, needed less sleep and it really changed my thought patterns for good. I was very motivated, practicing every day, reading up on more mindfulness/meditation themes, engaging in mindful eating, etc. The class was very small, with a very engaging teacher that I personally knew and trusted. Even though I am now too ill to practice mindfulness, these newly acquired thought patterns still help me get through the extreme discomfort that is now my life.

    Although this was a very positive experience for me, I do have some reservations about mindfulness. Like @Bob says, it is not for everyone. Maybe for me, it was just the right thing at the right time. My mind just needed that little tiny push to get into a totally different mindset. This change doesn't come easily for everyone who does mindfulness. And that is the problem I have with it: it is marketed as the golden grail of happiness and health. That is not what it is. Just like so many other things, it can leave people feeling worse about themselves, because they were promised something that didn't happen. All they felt was the discomfort of being faced with a whirlwind of thoughts.

    Another thing that I find highly annoying is when mindfulness is used as a smokescreen to make people believe that just changing their thought pattern will heal them from physical illness. It could make you more aware of your body, which in turn could (could!) make you more able to deal with physical pain, by detaching emotion and negative thoughts from it. But it's not going to take the pain away. And learning a new skill while very sick is extra difficult.

    Meditation is a lifelong endeavour. It's not something that's ever finished. Claiming that 8 sessions of mindfulness meditation (which boils down to a clinical, westernized version of meditation) is going to make fibro patients less sick is beyond unrealistic. IF you are healthy enough to get through the course to begin with, mindfulness could help some carry the burden of their illness, but medical treatment is what is supposed to make you better. Over here there's a programme for cancer patients they can follow after their treatments, in order to cope better with how their lives have changed. Patients can follow mindfulness sessions, do physical therapy or movement therapy, talk to a psychologist. It is very similar to what we are offered, only with the minor detail that we don't get ANY treatment prior. Coping is the treatment. It's cruel reverse logic.
     
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  7. Snow Leopard

    Snow Leopard Hibernating

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    Conclusion: 'mindfulness therapy' altered questionnaire answering behaviour, but not much else.
     
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  8. A.B.

    A.B. Senior Member

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    Shame on whoever keeps funding this crap. I'm sure you could find a hundred things that resulted in slightly better questionnaire responses, but that doesn't mean they are an appropriate therapy. Psychology seems to attach the word therapy to anything that doesn't maim or kill the patient.
     
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  9. Bob

    Bob

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    I agree with everything @Effi said, and everyone else. This sort of thing is very similar to CBT for ME, and it brings with it the danger of patients being blamed for their symptoms because they're "interpreting their pain in the wrong way".
     
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  10. Sean

    Sean Senior Member

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    To ask the obvious once again of authority figures, how do they know what is the 'right' way?
     
  11. Bob

    Bob

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    When the patient stops complaining that they're ill, and so they're no longer a problem for the authorities? (If you can't treat them then at least get the patients to stop believing they're ill.)
     
    Last edited: Jul 1, 2015
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  12. A.B.

    A.B. Senior Member

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    The right way is when the patient agrees with the bizarre unprovable beliefs of the therapist.
     
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