MBSR Not Particularly Effective for Fibromyalgia

Cort

Phoenix Rising Founder
Messages
7,361
Likes
2,058
Location
Arizona in winter & W. North America otherwise
This is really interesting study because Fibromyalgia is the type of disorder one would think would helped by mindfulness based stress reduction because it was developed to treat pain disorders. MBSR did help quality of life but it had limited effects on FM measures. An earlier less rigorous study had found better effects.

Its a little help but it's not really a treatment.

Pain. 2010 Dec 10. [Epub ahead of print]
Treating fibromyalgia with mindfulness-based stress reduction: Results from a 3-armed randomized controlled trial.

Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H.
Department of Environmental Health Sciences, University Medical Center, Freiburg, Germany; Institute for Transcultural Health Studies, European University Viadrina, Frankfurt (Oder), Germany; Samueli Institute, European Office, Brain, Mind and Healing Programme, Germany; Heymans Chair of Exceptional Human Experiences, University for the Humanistics, Utrecht, The Netherlands.
Abstract

Mindfulness-based stress reduction (MBSR) is a structured 8-week group program teaching mindfulness meditation and mindful yoga exercises. MBSR aims to help participants develop nonjudgmental awareness of moment-to-moment experience. Fibromyalgia is a clinical syndrome with chronic pain, fatigue, and insomnia as major symptoms.

Efficacy of MBSR for enhanced well-being of fibromyalgia patients was investigated in a 3-armed trial, which was a follow-up to an earlier quasi-randomized investigation. A total of 177 female patients were randomized to one of the following: (1) MBSR, (2) an active control procedure controlling for nonspecific effects of MBSR, or (3) a wait list.

The major outcome was health-related quality of life (HRQoL) 2months post-treatment. Secondary outcomes were disorder-specific quality of life, depression, pain, anxiety, somatic complaints, and a proposed index of mindfulness. Of the patients, 82% completed the study.

There were no significant differences between groups on primary outcome, but patients overall improved in HRQoL at short-term follow-up (P=0.004). Post hoc analyses showed that only MBSR manifested a significant pre-to-post-intervention improvement in HRQoL (P=0.02).

Furthermore, multivariate analysis of secondary measures indicated modest benefits for MBSR patients. MBSR yielded significant pre-to-post-intervention improvements in 6 of 8 secondary outcome variables, the active control in 3, and the wait list in 2.

In conclusion, primary outcome analyses did not support the efficacy of MBSR in fibromyalgia, although patients in the MBSR arm appeared to benefit most. Effect sizes were small compared to the earlier, quasi-randomized investigation. Several methodological aspects are discussed, e.g., patient burden, treatment preference and motivation, that may provide explanations for differences. In a 3-armed randomized controlled trial in female patients suffering from fibromyalgia, patients benefited modestly from a mindfulness-based stress reduction intervention.


Copyright 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserv
 

Esther12

Senior Member
Messages
13,774
Likes
28,350
I don't know that much about it, but from what I've seen, MBSR seems like a really sensible approach for dealing with anxiety. To me, it seems that the approach to understanding our minds which it promotes is just a useful tool for life. Something that should be taught to children.

Apparently not that handy for FM pain though.

I have to admit, I'd have guessed that it would have reduced disability levels even without having any impact upon the underlying cause. Maybe MBSR is less good than I thought?
 

Cort

Phoenix Rising Founder
Messages
7,361
Likes
2,058
Location
Arizona in winter & W. North America otherwise
I would thought it would have been a bit more effective as well. It did provide benefits - QOL did go up but not between groups - so I guess it went up in both groups? Interesting that it helped quality of life but not anxiety or depression ---so they were still as anxious as before but felt better about it? Actually I can see that happening with this type of technology - altho I would have thought that in itself would have reduced anxiety. (unless, the anxiety is not being produced by the mind...???)

No significant reduction in pain - is kind of shocking since that was what it was developed for....so maybe the pain in FM is different from the kind of pain that it works for???

In any case - yes benefits - but modest for sure.......Not considered a very effective treatment for FM.
 

Sasha

Fine, thank you
Messages
17,863
Likes
34,206
Location
UK
I've just started reading Kabat-Zinn's book with a view to doing that 8-week course at home and my understanding from the intro is that it is designed to reduce stress and anxiety but not to impact disease or symptoms (rather one's attitude towards them), although sometimes symptoms such as pain do reduce.
 

Cort

Phoenix Rising Founder
Messages
7,361
Likes
2,058
Location
Arizona in winter & W. North America otherwise
That would make sense and that would be very Buddhist wouldn't it....you would still have pain but you wouldn't be as bothered by it.....AND your quality of life would improve...:thumbsup::thumbsup:

It would be interesting to look at the individual data- I imagine there were some people in there who's pain did get reduced substantially. FM is now believed to be a disease of subsets just like CFS is (just not as many) - if they treat FM like one disorder - they are going to have problems.

Good luck with book! Its great stuff for anyone really.
 

Sasha

Fine, thank you
Messages
17,863
Likes
34,206
Location
UK
That would make sense and that would be very Buddhist wouldn't it....you would still have pain but you wouldn't be as bothered by it.....AND your quality of life would improve...:thumbsup::thumbsup:
I think that's about the size of it!

Having said that, some of the recent research work indicates improved wound healing & immune function in people who have been meditating for short periods (8 weeks or so), so I would hope for long-term effects for PWC maybe; but learning better ways of coping would be a huge thing anyway.

I saw somewhere on the boards you mentioning you're about to start on "Buddha's Brain" - it's fascinating. Good to see science tackling this stuff. It will mean that people who wouldn't previously have considered meditation (me, for a start) will be willing to try it out.
 

Cort

Phoenix Rising Founder
Messages
7,361
Likes
2,058
Location
Arizona in winter & W. North America otherwise
Great! I'm looking forward to learning about the intersection between meditation/mindfulness and the autonomic nervous system...One thing all the mind'body techniques for CFS (LP, Amygdala) focus on is the sympathetic/parasympathetic nervous problems - which are pretty well documented for CFS.
 
Messages
5
Likes
0
MBSR was recommended to me. I couldn't afford the official course, so I borrowed the Kabat-Zinn book and CDs from the library. Read the book and have started the 8 week "course". The one hour a day/six days a week is hard for me, but I'm trying. So far, I find that the body-scan meditation just heightens my awareness of my pain and fatigue (I have CFS and migraines, not FM), which doesn't seem very helpful. I'm only on week 3 in the program, but I also have a number of problems with some of the theory. There seem to be some contradictory messages about mind and body and what "wholeness" might mean (and whether it is separate from the body), especially for folks with disabilities. Maybe once (if) I make it through all 8 weeks I'll try to write up my responses.

If anyone knows of other threads exploring MBSR & CFS, please point me to them (I'm new to the forum and a bit overwhelmed by all the threads.).
 

Esther12

Senior Member
Messages
13,774
Likes
28,350
Hi Dewluca.

I find that when I'm reading about new ideas, I'm always drawn towards focussing upon the parts I disagree with. This can be a problem with stuff written from a different cultural tradition, like Buddhist, meditative stuff, as they'll often be uing language in a slightly different way to what I'm used to, and I can be unfairly dismissive or confused by what they mean.

Some of it I do just disagree with, but I think that a lot of it is more helpful and sensible than one would initially realise.

You can do 'retreats' from your home on the phone, which includes the ability to ask questions particular to your circumstances... this could be helpful for you? This is not MSBR, but is related... there could be something else more appropriate out there too? http://basicmindfulness.org You're certain to be getting some things wrong (everyone does) and being able to talk it through with someone who is well informed about this stuff could help you move on.

Or it could be it's just not for you? I don't think it should be seen as a treatment for CFS, but as an interesting way to approach life than many find useful and can be a helpful way of managing ones emotions and suffering.
 
Messages
5
Likes
0
Thanks for the link Esther. I'll look into it.
I'm not really new to "mindfulness" (I've done yoga for 30 years), just to the Kabat-Zinn MBSR approach. The instructions are to just "follow the instructions" and that there is no "right or wrong way" . . . We'll see how it goes. You're probably right about it not being for me (my long-time political activism seems incompatible with "just accept things as they are" :) ), but my doctors already consider me "non-compliant" because I have had such negative reactions to so many drugs they've tried to prescribe for me, so when they suggest a non-drug treatment I try to do my best to follow it.
Thanks again.
 

Esther12

Senior Member
Messages
13,774
Likes
28,350
re: there is no "right or wrong way"

Yeah - they always say that to try to stop you from putting pressure on yourself and doing things in a self-critical way. They'd probably phrase it in a very positive, non-judgemental way: "Well, you could continue with your current approach, but some people find it more helpful to try..."

re: Political activism being incompatible with "Just accept things as they are" - I know exactly what you mean, and I initially thought the same, but I think this is a misunderstanding. They want you to accept things as they are in this moment... accept that you cannot magically make the universe a better place, but need to start with the way things are. It doesn't mean that you shouldn't expect yourself to work to improve things - not at all. At least that is now how I've come to understand it.

It sounds like you have more experience with this stuff than I, so I could be misleading you here. It's been a while since I've read any Kabat-Zinn stuff, and I've never been especially dedicated with any of it, seeing it more as ideas to be understood than a practice to be followed - more like one would read western philosophy than as a part of a serious attempt to change my life - but also as with western philosophy I've found interesting ideas that have been useful and developed my own approach to life.

Best of luck with it all.
 

Marco

Grrrrrrr!
Messages
2,386
Likes
3,211
Location
Near Cognac, France
I read Kabat-Zinn's 'Full Catastrophe Living' and found it an enjoyable and interesting read. If you accept all the claims made it the book, a mindfulness based approach can achieve many things. I'm not in a postion to refute these claims.

Its also undeniable that we folks have problems dealing with stressors of any type. Whether that abnormal response in due to XMRV replication, a disorder of the HPA axis, immune dysfunction is undetermined.

I am certain that a mindfulness based approach can help us identify 'stressors' and our reaction to them and might help prevent frequent crashes/relapses. However regardless how zen-like we live our lives the truth is there are many stressors, physical, cognitive or emotional that we just can't avoid and the underlying disease process will always manifest itself.

I also don't recall that the book claims that anyone found that their pain was reduced (a difficult concept, but assume reduced as in the effect of an anaesthetic), rather their acceptance or tolerance of it increased with a consequent improvement in quality of life.

I believe there is great merit in developing a mindfulness approach to life in general, not just for those currently ill. As one of his other books says, something like, wherever you are that's where you are. A guide to living regardless of your circumstances.

As long as you are OK with the concept of non-striving - I've always been more of a self-improvement type.

Potentially helpful but no cure.
 

Recovery Soon

Senior Member
Messages
380
Likes
38
You're probably right about it not being for me (my long-time political activism seems incompatible with "just accept things as they are" :)
This is a common misinterpretation. Mindfulness meditation, insight meditation specifically, which is the basis of MBSR, does not ask people to turn a blind eye to injustice, nor to not take appropriate action to effect positive change.

Rather, it challenges you to look directly at a situation, and accept that it is already occurring, or has already occurred, and then move forward in an appropriate manner.

Resignation is the opposite of Mindfulness. There are many paradoxes in meditation- that's one of 'em.
 

Recovery Soon

Senior Member
Messages
380
Likes
38
It's been a while since I've read any Kabat-Zinn stuff, and I've never been especially dedicated with any of it, seeing it more as ideas to be understood than a practice to be followed - more like one would read western philosophy than as a part of a serious attempt to change my life.
Mindfulness/Insight Meditation is the most Practical Path for Transformation, and far more than a philosophy to debate or discuss with logic and opinions. It's only merit is found in practice. And the only way to know if it works is to commit yourself to doing it. Philosophizing or Psychologizing about it will not give one ounce of liberation.