Table 1.
Studies of Brief Mindfulness-Based Interventions for Pain Management (n = 20)
| Citation | Enrolled | Age (M) | % White | % Female | Completed | Design | Type of practice | Duration/delivery method | Control | Mindfulness measurement | Pain-related measurement | Results |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Evans et al.38 | 63 undergrads | 19 | 74 | 46 | Not found | 3-arm RCT (later collapsed into 2 arms) | Observe or observe, describe, and accept | About 3 min, instructions delivered through computer (text and audio) | Spontaneous coping | Use of observing, describing, and accepting on visual analog scales (0–100) | CPT: pain tolerance | Mindfulness group reported greater use of observing and describing relative to control (ps < 0.05). Mindfulness group exhibited less pain tolerance relative to control (p < 0.05). |
| Feuille and Pargament39 | 107 persons (mostly undergrads) reporting at least two migraines in past month | 20 | 72 | 80 | 74 | 3-arm RCT | (1) Mindfulness of breath (2) spiritualized mindfulness | 7-min group session (with script), instructed to practice 20 min/day for 2 weeks at home (given handout). Practiced 15 min just before CPT | Relaxing | Toronto mindfulness scale state | CPT: pain tolerance and self-reported pain intensity and stress (0–10 scales) | Mindfulness of breath outperformed relaxation on stress during CPT (d = 0.68, p = 0.03). State mindfulness was higher for spiritualized mindfulness relative to mindfulness of breath (d = 0.85, p = 0.02). |
| Forsyth and Hayes40 | 67 persons: 42 undergrads and 25 community members | 29 | not found | 72 | 58 | 3-arm RCT | (1) Mindful acceptance of thoughts (2) mindfulness of breath | About 4 min, delivered with audio-recording | Spontaneous coping | Not found | CPT: pain tolerance and pain threshold | Pain tolerance improvements for acceptance of thoughts (d = 2.83) and mindfulness of breath (d = 3.92) were significantly (ps < 0.05) greater than improvements for control. No between-group effects on pain threshold. |
| Garland et al.41 | 244 inpatients reporting “intolerable pain” or “inadequate pain control” | 51 | 94 | 57 | 240 | 3-arm RCT | Focused attention and open monitoring | Scripted, 15-min session delivered by a social worker | (1) Hypnosis, (2) psychoeducation | Not found | Self-reported pain intensity, unpleasantness, anxiety, and desire for opioids (0–10 scales) | Mindfulness group reported improvements in all four outcomes (ds ranged from 0.17 [desire for opioids] to 0.98 [anxiety], ps < 0.05). Mindfulness outperformed psychoeducation (but not hypnosis) on pain intensity and unpleasantness (ps < 0.01). |
| Howarth et al.42 | 14 chronic illness outpatients (6 with chronic pain) | 55 | Not found | 64 | 14 | Qualitative study (focus groups and interviews) | Body scan | 10-min audio-recording delivered in clinical setting, then instructed to practice at least thrice over 1 week at home | Not found | Focus groups and interviews | Focus groups and interviews | Reductions in pain and medication use identified as key benefits. One patient reported discomfort. Recommendation for 15 min practice (instead of 10 min) |
| Liu et al.43 | 86 undergrads | 20 | Not found | 100 | 60 | 3-arm RCT | Mindfulness of breath, feelings, body sensations, pain | 15-min audio-recording | (1) Imagining a happy or relaxing scene, (2) listening to light music | Not found | CPT: pain tolerance and self-reported pain intensity and distress (0–10 scales) | Mindfulness outperformed light music on pain tolerance and distress and outperformed imagery on distress (ps < 0.05). |
| Petter et al. (2013) 44 | 86 healthy children | 12 | 83 | 44 | 82 | 2-arm RCT | Nonjudgmental awareness of breath, thoughts, body sensations | 10-min audio-recording | Guided imagery | Childhood acceptance and mindfulness measure and direction of attention (1–5 scales) | CPT: pain tolerance and self-reported average and most severe pain (selected from a series of six faces) | Mindfulness group reported greater awareness of thoughts and body sensations during CPT relative to imagery group (ps < 0.01). No significant between-group differences on pain tolerance, average pain, or most severe pain. |
| Petter et al.45 | 198 adolescents | 16 | 87 | 67 | 198 | 2-arm RCT | Nonjudgmental awareness of breath, judgments, and body sensations | 10-min audio-recording | Reading | Mindful attention awareness scale state and awareness of thoughts (1–5 scale) | CPT: pain tolerance and self-reported pain intensity (0–10 scale) | Mindfulness group reported greater awareness of thoughts during CPT relative to reading group (p < 0.05). No significant between-group differences on pain tolerance or intensity. |
| Prins et al.46 | 51 undergraduates | 20 | Not found | 84 | 46 | 2-arm RCT | Open monitoring | 10-min audio-recording | Audio-recording of two fairy tales | Mindful attention awareness scale | Heat stimulation: self-reported pain intensity, affective pain, attention to the pain, and general anxiety (0–10 scales) | No overall group effect, but mindfulness group outperformed control on pain ratings among persons high in pain catastrophizing |
| Reiner et al.47 | 40 undergrads | 24 | Not found | 50 | 36 | 2-arm RCT | Mindfulness of breath, thoughts, feelings, and body sensations | 20-min session delivered by instructor and audio-recording, instructed to practice 25 min/day for 2 weeks at home (with audio and handout) | Relaxing | Mindful attention awareness scale | Heat stimulation: pain threshold and self-reported pain intensity (0–100 scale) | Relative to control, mindfulness group showed increased pain threshold (p < 0.001; more pronounced for those high in baseline mindfulness) and more rapid attenuation of pain intensity (p < 0.001). |
| Sharpe et al.48 | 140 undergrads | ∼20 | not found | 72 | 140 | 4-arm RCT | Body scan with (1) threat or (2) no threat | 12-min audio-recording | (1) PMR with threat, (2) PMR without threat | Toronto mindfulness scale state | CPT: pain tolerance and threshold and self-reported pain intensity (0–10 scale) | Under high threat, body scan yielded higher decentering and curiosity than PMR (ps < 0.03). No significant between-group effects on pain outcomes. |
| Swain and Trevena49 | 240 tertiary students | 21 | 76 | 50 | Not found | 4-arm RCT | Mindfulness (type not clear) delivered by (1) therapist or (2) DVD | 3-min script (with therapist or DVD) | (1) Hypnosis with therapist, (2) hypnosis with DVD | Not found | CPT: pain tolerance and self-reported pain intensity (visual analog scale) and anxiety (1–7 scale) | No differences between four conditions on pain tolerance. Hypnosis participants reported less pain intensity and anxiety than mindfulness participants (ps < 0.05). |
| Teixeira50 | 22 older adults with chronic diabetic peripheral neuropathy symptoms (pain and/or numbness) | 75 | 90 | 75 | 20 | 2-arm RCT | Mindfulness (type not clear) | 60-min in-person session, instructed to practice 5 days per week for 4 weeks at home (with audio-recording) | 60-min in-person session on nutrition and food diary for 4 weeks | Not found | Self-reported pain intensity, pain unpleasantness, and quality of life | No significant between-group effects on pain intensity, unpleasantness, or quality of life |
| Ussher et al.51 | 55 chronic pain outpatients (mostly back pain) | ∼60 | 71 | 78 | 55 (clinic)51 (home) | 2-arm RCT | Body scan | 10 min audio-recording, delivered once in clinic and once within 24 h when in pain at home | Audio-recording on natural history | Philadelphia mindfulness scale and measures of acceptance, present focus, decentering | Self-reported pain intensity, pain-related distress, pain social interference, and perceived ability for daily activities (0–10 scales) | No between-group effects on mindfulness outcomes, pain intensity, or perceived ability for daily activities in clinic or at home. In clinic only, body scan outperformed control on pain distress (p = 0.005) and pain social interference (p = 0.036). |
| Warth et al.52 | 84 hospitalized patients in palliative care | 63 | Not found | 71 | 78 | 2-arm RCT | Body scan | 20-min audio-recording | Music therapy | Not found | Self-reported pain intensity and mood with visual analog scales (0–10) | No between-group effects on pain intensity. Music therapy outperformed mindfulness on mood (d = 0.61, p = 0.01). |
| Zeidan et al.53 | 27 undergrads | 19 | 82 | 32 | 22 | Within-group | Focused attention and open monitoring | Three 20-min group trainings (2 delivered by provider, 1 by audio-recording) on 3 consecutive days | (1) Baseline (before and after training), (2) Reading (before training) | Freiburg Mindfulness Inventory | Electrical stimulation: self-reported pain intensity (0–6 scale) and state anxiety measure | Mindfulness increased and anxiety decreased from pre- to post-training (ps < .01). Relative to baseline and reading conditions, a mindfulness condition (after training) resulted in lowest pain intensity ratings (ps ≈ .01). |
| Zeidan et al.53 | 23 undergrads | 21 | 52 | 62 | 21 | Within-group | Focused attention and open monitoring | Three 20-min group trainings (two delivered by provider, one by audio-recording) on three consecutive days | (1) Baseline (before and after training), (2) relaxing (before training), (3) math distraction (before and after training) | Freiburg mindfulness inventory | Electrical stimulation: self-reported pain intensity (0–6 scale) and state anxiety measure | Mindfulness increased and anxiety decreased from pre- to post-training (ps < 0.01). Relative to baseline, relaxing, and math distraction conditions, a mindfulness condition (after training) resulted in lowest pain intensity ratings (ps < 0.05). |
| Zeidan et al.54 | 18 healthy young adults | 26 | 87 | 60 | 15 | Within-group | Focused attention and open monitoring | Four 20-min in-person trainings over 4 days | (1) Rest (before and after training), (2) attention to breath/placebo (before training) | Freiburg mindfulness inventory | Heat stimulation: self-reported pain intensity and unpleasantness with visual analog scales | Mindfulness increased from pre- to post-training (14% increase, p = 0.004). Relative to rest and attention to breath conditions, a mindfulness condition (after training) resulted in lowest pain intensity and unpleasantness ratings (reductions of 40%–57% in pain ratings). |
| Zeidan et al.55 | 80 healthy community members | 27 | 75 | 49 | 75 | 4-arm RCT | Focused attention and open monitoring | Four 20-min in-person trainings over 4 days | (1) Placebo conditioning, (2) sham mindfulness meditation, (3) audio-recording on natural history | Freiburg mindfulness inventory | Heat stimulation: self-reported pain intensity and unpleasantness with visual analog scales | Mindfulness condition increased mindfulness (16%) and reduced pain intensity (27%) and unpleasantness (44%) more than placebo, sham, and audio-recording (ps < 0.05). |
| Zeidan et al.56 | 95 healthy community members | 27 | 73 | 50 | 78 | 4-arm RCT | Focused attention and open monitoring with (1) naloxone or (2) saline | Four 20-min in-person trainings over 4 days | (1) Audio-recording on natural history + naloxone, (2) audio-recording on natural history + saline | Not found | Heat stimulation: self-reported pain intensity and unpleasantness with visual analog scales | Mindfulness conditions outperformed (ps < 0.001) controls on pain intensity and unpleasantness (reductions of 21% to 36%), with no significant differences between mindfulness conditions. |
CPT, cold-pressor task; PMR, progressive muscle relaxation; RCT, randomized controlled trial