Systematic scoping review of interactions between analgesic drug therapy and mindfulness-based interventions for chronic pain in adults: current evidence and future directions

Rex Park; Mohammed Mohiuddin; Patricia A Poulin; Tim Salomons; Robert Edwards; Howard Nathan; Chris Haley; Ian Gilron

doi:10.1097/PR9.0000000000000868

Systematic scoping review of interactions between analgesic drug therapy and mindfulness-based interventions for chronic pain in adults: current evidence and future directions

Pain Rep. 2020 Nov 25;5(6):e868. doi: 10.1097/PR9.0000000000000868. eCollection 2020 Nov-Dec.

Authors

Rex Park¹, Mohammed Mohiuddin¹, Patricia A Poulin^{2

3

4}, Tim Salomons^{5

6}, Robert Edwards⁷, Howard Nathan⁴, Chris Haley¹, Ian Gilron^{1

8

6

9}

Affiliations

¹ Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
² Department of Psychology, The Ottawa Hospital, Ottawa, ON, Canada.
³ Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁴ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
⁵ Department of Psychology, Queen's University, Kingston, ON, Canada.
⁶ Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
⁷ Department of Anesthesiology, Harvard University, Cambridge, MA, USA.
⁸ Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
⁹ School of Policy Studies, Queen's University, Kingston, ON, Canada.

Abstract

Most patients with chronic pain do not find adequate pain relief with a single treatment, and accumulating evidence points to the added benefits of rational combinations of different treatments. Given that psychological therapies, such as mindfulness-based interventions (MBIs), are often delivered in conjunction with concomitant analgesic drug therapies (CADTs), this systematic scoping review examines the evidence for any interactions between MBIs and CADTs. The protocol for this review has been published and registered. MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and PsycINFO databases were searched until July 2019. We included randomized controlled trials that evaluated the efficacy of MBIs for the treatment of chronic pain. A total of 40 randomized controlled trials (2978 participants) were included. Thirty-nine of 40 (97.5%) included mindfulness-based clinical trials allowed the use of CADTs. However, only 6 of these 39 (15.4%) trials provided adequate details of what these CADTs were, and only 4 (10.3%) trials controlled for CADTs. Of great relevance to this review, none of the included trials analyzed the interactions between MBIs and the CADTs to determine whether they have an additive, synergistic, or antagonistic effect on chronic pain. Adverse events were inconsistently reported, and no judgment could be made about safety. Future trials assessing the interactions between MBIs and CADTs, with better harms reporting, are needed to better define the role of MBIs in the management of chronic pain.

Keywords: Analgesic therapy; Chronic pain; Clinical trials; Meditation; Mindfulness; Systematic review.

Publication types

Review