SP8.2.4 Mindfulness-based Cognitive Therapy (MBCT) reduces symptoms in patients with chronic visceral pain, and is associated with the alteration of pain-evoked neural activity and resting functional connectivity in the descending pain modulatory system
Sarah Waldman, Vishvarani Wanigasekera, Julia Henrich, Maryanne Martin, Bergljot Gjelsvik, Irene Tracey
British journal of surgery August 9, 2022 DOI: 10.1093/bjs/znac247.093 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Pre-post intervention study Peer reviewed |
|---|---|
| Sample size | 15 |
| Population | Women with irritable bowel syndrome |
| Duration | 6-week training course; assessments before and after |
| Measures | validated questionnaires on symptoms, functional MRI during thermal pain and at rest |
| Topics | Meditation |
| Key points | A six-week mindfulness-based cognitive intervention (MBCT-IBS) improved IBS symptoms and reduced pain sensitivity, with participants requiring a mean 1.21°C higher temperature to reach a 5/10 pain rating. Brain imaging showed altered activity and connectivity in pain-processing regions, which the authors argue suggests the intervention may work on the descending endogenous pain modulatory system. |
Abstract
Abstract:
Aims: Chronic visceral pain can cause repeated presentations to surgical services. Cognitive therapies show promise but are not often considered in the surgical setting. This study aims to assess the efficacy and mechanisms of MBCT-IBS, a mindfulness-based cognitive intervention for irritable bowel syndrome (IBS).
Methods: Fifteen women with IBS underwent a 6-week MBCT-IBS training course. Before and after this they completed validated questionnaires on symptoms, and functional MRI brain scans during thermal pain and at rest.
Results: MBCT-IBS led to improved symptoms (p<0.05). Increased temperatures were required to achieve 5/10 pain ratings (mean 1.21°C, p<0.001), indicating reduced pain sensitivity. Neuroimaging showed that MBCT-IBS led to altered pain responses in the anterior cingulate, the prefrontal cortex, the amygdala and the precuneus (Z>2.3, p<0.05). In the left dorsolateral prefrontal cortex (dlPFC) this correlated with reduced pain severity scores (rs(11)=-0.614, p=0.025). Altered functional connectivity was seen between the right dlPFC and multiple regions involved in emotional and sensory aspects of pain processing, including the amygdala. There was also altered connectivity between the amygdala and sensorimotor cortices (Z>2.3, p<0.05).
Conclusions: MBCT-IBS was an effective treatment for IBS. The fact that there was altered activity in and connectivity between key parts of the descending endogenous pain modulatory system suggests that MBCT-IBS may be an effective intervention for patients with dysfunctional pain pathways in whom the pathological cause for their pain is unclear. It is non-invasive and inexpensive, and has the potential to reduce the incidence of unnecessary surgical intervention in patients with chronic visceral pain.
Comparable studies
Other non-randomized and open-label trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Mindfulness-Based Stress Reduction in Relation to Quality of Life, Mood, Symptoms of Stress, and Immune Parameters in Breast and Prostate Cancer Outpatients Early-stage breast and prostate cancer patients | 2003 | Pre-post intervention study | n = 59 |
| Exploring self‐compassion and empathy in the context of mindfulness‐based stress reduction (MBSR) Community sample | 2010 | Pre-post intervention study | |
| Mindfulness-Based Stress Reduction Lowers Psychological Distress In Medical Students Second-year medical students | 2003 | Prospective nonrandomized cohort-controlled study | n = 302 |
| Intensive meditation training, immune cell telomerase activity, and psychological mediators. Retreat participants and matched controls | 2011 | Controlled trial with wait-list control group | n = 60 |
| The Effectiveness of Mindfulness Training for Children with ADHD and Mindful Parenting for their Parents Children aged 8-12 with ADHD and their parents | 2011 | Within-group waitlist controlled trial | n = 22 |