title: Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis.
abstract: BACKGROUND
  Chronic pain and its associated distress and disability are common reasons for seeking medical help. Patients with chronic pain use primary healthcare services five times more than the rest of the population. Mindfulness has become an increasingly popular self-management technique.
  
  
  OBJECTIVE
  To assess the effectiveness of mindfulness-based interventions for patients with chronic pain.
  
  
  METHODS
  Systematic review and meta-analysis including randomised controlled trials of mindfulness-based interventions for chronic pain. There was no restriction to study site or setting.
  
  
  METHODS
  The databases MEDLINE(®), Embase, AMED, CINAHL, PsycINFO, and Index to Theses were searched. Titles, abstracts, and full texts were screened iteratively against inclusion criteria of: randomised controlled trials of mindfulness-based intervention; patients with non-malignant chronic pain; and economic, clinical, or humanistic outcome reported. Included studies were assessed with the Yates Quality Rating Scale. Meta-analysis was conducted.
  
  
  RESULTS
  Eleven studies were included. Chronic pain conditions included: fibromyalgia, rheumatoid arthritis, chronic musculoskeletal pain, failed back surgery syndrome, and mixed aetiology. Papers were of mixed methodological quality. Main outcomes reported were pain intensity, depression, physical functioning, quality of life, pain acceptance, and mindfulness. Economic outcomes were rarely reported. Meta-analysis effect sizes for clinical outcomes ranged from 0.12 (95% confidence interval [CI] = -0.05 to 0.30) (depression) to 1.32 (95% CI = -1.19 to 3.82) (sleep quality), and for humanistic outcomes 0.03 (95% CI = -0.66 to 0.72) (mindfulness) to 1.58 (95% CI = -0.57 to 3.74) (pain acceptance). Studies with active, compared with inactive, control groups showed smaller effects.
  
  
  CONCLUSIONS
  There is limited evidence for effectiveness of mindfulness-based interventions for patients with chronic pain. Better-quality studies are required.
authors.affiliation: Centre of Academic Primary Care;
authors.forename: Fathima L Marikar
authors.initials: FL
authors.lastname: Bawa
authors.affiliation: General practice and primary care, Institute of Health and Wellbeing, University of Glasgow, Glasgow.
authors.forename: Stewart W
authors.initials: SW
authors.lastname: Mercer
authors.affiliation: Department of Psychological Services, NHS Highland, Inverness.
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Atherton
authors.affiliation: Adult Psychological Therapies Service, Murray Royal, Perth.
authors.forename: Fiona
authors.initials: F
authors.lastname: Clague
authors.affiliation: JJR Macleod Centre for Diabetes, Endocrinology and Metabolism, Department of Paediatric Psychology; University of Aberdeen, Aberdeen.
authors.forename: Andrew
authors.initials: A
authors.lastname: Keen
authors.affiliation: University of Aberdeen, Aberdeen.
authors.forename: Neil W
authors.initials: NW
authors.lastname: Scott
authors.affiliation: University of Aberdeen, Aberdeen.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Bond
mesh_terms: D059350:Chronic Pain / Q000523:psychology* / Q000628:therapy; D003863:Depression / Q000517:prevention & control / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D064866:Mindfulness / Q000379:methods; D011788:Quality of Life / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000523:psychology*
keywords: chronic pain; meta-analysis; mindfulness; primary health care; review