Advertisement

Effectiveness of Jyoti Meditation for Patients With Chronic Neck Pain and Psychological Distress—A Randomized Controlled Clinical Trial

  • Michael Jeitler
    Affiliations
    Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany

    Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
    Search for articles by this author
  • Stefan Brunnhuber
    Affiliations
    Department for Psychiatry and Psychotherapy, University Hospital Salzburg, Salzburg, Austria
    Search for articles by this author
  • Larissa Meier
    Affiliations
    Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany

    Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
    Search for articles by this author
  • Rainer Lüdtke
    Affiliations
    Karl and Veronica Carstens Foundation, Essen, Germany
    Search for articles by this author
  • Arndt Büssing
    Affiliations
    University Witten-Herdecke, Chair of Integrative Medicine, Witten, Germany
    Search for articles by this author
  • Christian Kessler
    Affiliations
    Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany

    Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
    Search for articles by this author
  • Andreas Michalsen
    Correspondence
    Address reprint requests to Andreas Michalsen, MD, Immanuel Krankenhaus Berlin, Klinik für Innere Medizin, Abteilung Naturheilkunde Charité–Universitätsmedizin Berlin, Hochschulambulanz für Naturheilkunde der Charité Berlin, Königstrasse 63, 14109 Berlin, Germany.
    Affiliations
    Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany

    Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
    Search for articles by this author
Published:November 03, 2014DOI:https://doi.org/10.1016/j.jpain.2014.10.009

      Highlights

      • We performed a randomized trial on the effects of meditation versus self-care exercise in chronic neck pain.
      • Meditation led to superior pain relief and decreased pain-related bothersomeness. Meditation had no effect on functional disability.
      • We conclude that meditation may support chronic pain patients in pain reduction and pain coping.

      Abstract

      Chronic neck pain is a common medical complaint partly mediated by psychosocial distress and having a high socioeconomic impact. There is preliminary evidence that stress reduction by meditation might be beneficial in chronic pain syndromes. We aimed to evaluate the effectiveness of an 8-week meditation program (jyoti meditation) in patients with chronic neck pain by means of a randomized clinical trial. Eighty-nine patients (aged 49.7 ± 10.5 years, 73 female) with chronic neck pain who scored >40 mm on a 100-mm visual analog scale and had concomitant increased perceived stress were randomized to an 8-week meditation program (jyoti meditation) with weekly 90-minute classes (n = 45) or to a home-based exercise program (n = 44) with a wait list offer for meditation. Both groups were instructed to practice at home. Outcomes were assessed at baseline and after 8 weeks. Primary outcome measure was change of mean pain at rest (visual analog scale score) from baseline to week 8. Secondary outcomes included pain at motion, functional disability, pain-related bothersomeness, perceived stress, quality of life, and psychological outcomes. Patients had neck pain for a mean of 11 years. Eighteen patients in the meditation group and 16 patients in the exercise group were lost to follow-up. Meditation training significantly reduced pain when compared to the exercise group after 8 weeks (reduction of 45.5 ± 23.3 mm to 21.6 ± 17.2 mm in the meditation group, and 43.8 ± 22.0 mm to 37.7 ± 21.5 mm in the exercise group; mean difference: 13.2 mm [95% confidence interval: 2.1, 24.4; P = .02]). Pain-related bothersomeness decreased more in the meditation group (group difference 11.0 mm [95% confidence interval: 1.0, 21.0; P = .03]). No significant treatment effects were found for pain at motion, psychological scores, and quality of life, although the meditation group showed nonsignificant greater improvements compared to the exercise group. In conclusion, meditation may support chronic pain patients in pain reduction and pain coping. Further well-designed studies including more active control comparisons and longer-term follow-up are warranted.

      Perspective

      This article presents the results of a randomized controlled trial on the clinical effects of an 8-week meditation program or self-care exercise in patients with chronic neck pain. Meditation reduced pain at rest but not disability and might be a useful treatment option for pain management of chronic neck pain.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bjornsdottir S.
        • Jonsson S.
        • Valdimarsdottir U.
        Mental health indicators and quality of life among individuals with musculoskeletal chronic pain: A nationwide study in Iceland.
        Scand J Rheumatol. 2014; 43: 419-423
        • Borghouts J.A.
        • Koes B.W.
        • Vondeling H.
        • Bouter L.M.
        Cost-of-illness of neck pain in the Netherlands in 1996.
        Pain. 1999; 80: 629-636
        • Bovim G.
        • Schrader H.
        • Sand T.
        Neck pain in the general population.
        Spine (Phila Pa 1976). 1994; 19: 1307-1309
        • Breivik H.
        • Collett B.
        • Ventafridda V.
        • Cohen R.
        • Gallacher D.
        Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment.
        Eur J Pain. 2006; 10: 287-333
        • Bullinger M.
        German translation and psychometric testing of the SF-36 Health Survey: Preliminary results from the IQOLA Project. International Quality of Life Assessment.
        Soc Sci Med. 1995; 41: 1359-1366
        • Carlson L.E.
        • Speca M.
        • Patel K.D.
        • Goodey E.
        Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients.
        Psychosom Med. 2003; 65: 571-581
        • Chiesa A.
        • Serretti A.
        Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis.
        J Altern Complement Med. 2009; 15: 593-600
        • Chiesa A.
        • Serretti A.
        Mindfulness-based interventions for chronic pain: A systematic review of the evidence.
        J Altern Complement Med. 2011; 17: 83-93
        • Cohen S.
        • Kamarck T.
        • Mermelstein R.
        A global measure of perceived stress.
        J Health Soc Behav. 1983; 24: 385-396
        • Cramer H.
        • Haller H.
        • Lauche R.
        • Dobos G.
        Mindfulness-based stress reduction for low back pain. A systematic review.
        BMC Complement Altern Med. 2012; 12: 162
        • Cramer H.
        • Lauche R.
        • Haller H.
        • Dobos G.
        A systematic review and meta-analysis of yoga for low back pain.
        Clin J Pain. 2013; 29: 450-460
        • Cramer H.
        • Lauche R.
        • Hohmann C.
        • Ludtke R.
        • Haller H.
        • Michalsen A.
        • Langhorst J.
        • Dobos G.
        Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain.
        Clin J Pain. 2013; 29: 216-223
        • Dworkin R.H.
        • Turk D.C.
        • Wyrwich K.W.
        • Beaton D.
        • Cleeland C.S.
        • Farrar J.T.
        • Haythornthwaite J.A.
        • Jensen M.P.
        • Kerns R.D.
        • Ader D.N.
        • Brandenburg N.
        • Burke L.B.
        • Cella D.
        • Chandler J.
        • Cowan P.
        • Dimitrova R.
        • Dionne R.
        • Hertz S.
        • Jadad A.R.
        • Katz N.P.
        • Kehlet H.
        • Kramer L.D.
        • Manning D.C.
        • McCormick C.
        • McDermott M.P.
        • McQuay H.J.
        • Patel S.
        • Porter L.
        • Quessy S.
        • Rappaport B.A.
        • Rauschkolb C.
        • Revicki D.A.
        • Rothman M.
        • Schmader K.E.
        • Stacey B.R.
        • Stauffer J.W.
        • von Stein T.
        • White R.E.
        • Witter J.
        • Zavisic S.
        Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations.
        J Pain. 2008; 9: 105-121
        • F.A.Z.-Institut für Management, Techniker Krankenkasse
        Erhebung zur Stressbelastung in der Deutschen Bevölkerung.
        F.A.Z.-Institut für Management-, Markt- und Medieninformationen GmbH, Techniker Krankenkasse, Frankfurt am Main, Hamburg2009
        • Fejer R.
        • Kyvik K.O.
        • Hartvigsen J.
        The prevalence of neck pain in the world population: A systematic critical review of the literature.
        Eur Spine J. 2006; 15: 834-848
        • Garratt A.
        • Schmidt L.
        • Mackintosh A.
        • Fitzpatrick R.
        Quality of life measurement: Bibliographic study of patient assessed health outcome measures.
        BMJ. 2002; 324: 1417
        • Goolkasian P.
        • Wheeler A.H.
        • Gretz S.S.
        The neck pain and disability scale: Test-retest reliability and construct validity.
        Clin J Pain. 2002; 18: 245-250
        • Goyal M.
        • Singh S.
        • Sibinga E.M.
        • Gould N.F.
        • Rowland-Seymour A.
        • Sharma R.
        • Berger Z.
        • Sleicher D.
        • Maron D.D.
        • Shihab H.M.
        • Ranasinghe P.D.
        • Linn S.
        • Saha S.
        • Bass E.B.
        • Haythornthwaite J.A.
        Meditation programs for psychological stress and well-being: A systematic review and meta-analysis.
        JAMA Intern Med. 2014; 174: 357-368
      1. Haase UF: Muskeln entspannen. Techniker Krankenkasse website. July 5th, 2009. Available at: http://www.tk.de/tk/gesunder-ruecken/entspannung-und-entlastung/trainingsposter-muskeln-entspannen/21574. Accessed February 1, 2013

      2. Hautzinger M, Bailer M: Allgemeine Depressionsskala (ADS). Die deutsche Version des CES-D, Beltz, Weinheim, 1991

        • Hoeger Bement M.
        • Weyer A.
        • Keller M.
        • Harkins A.L.
        • Hunter S.K.
        Anxiety and stress can predict pain perception following a cognitive stress.
        Physiol Behav. 2010; 101: 87-92
        • Hofmann S.G.
        • Sawyer A.T.
        • Witt A.A.
        • Oh D.
        The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review.
        J Consult Clin Psychol. 2010; 78: 169-183
        • Hogg-Johnson S.
        • van der Velde G.
        • Carroll L.J.
        • Holm L.W.
        • Cassidy J.D.
        • Guzman J.
        • Cote P.
        • Haldeman S.
        • Ammendolia C.
        • Carragee E.
        • Hurwitz E.
        • Nordin M.
        • Peloso P.
        The burden and determinants of neck pain in the general population: Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.
        J Manipulative Physiol Ther. 2009; 32: S46-S60
        • Jensen M.P.
        • Day M.A.
        • Miro J.
        Neuromodulatory treatments for chronic pain: Efficacy and mechanisms.
        Nat Rev Neurol. 2014; 10: 167-178
        • Kaaria S.
        • Laaksonen M.
        • Rahkonen O.
        • Lahelma E.
        • Leino-Arjas P.
        Risk factors of chronic neck pain: A prospective study among middle-aged employees.
        Eur J Pain. 2012; 16: 911-920
        • Kabat-Zinn J.
        • Lipworth L.
        • Burncy R.
        • Sellers W.
        Four-year follow-up of a meditation based program for the self-regulation of chronic pain: Treatment outcomes and compliance.
        Clin J Pain. 1987; 2: 159-173
        • Kabat-Zinn J.
        An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results.
        Gen Hosp Psychiatry. 1982; 4: 33-47
        • Kabat-Zinn J.
        • Lipworth L.
        • Burney R.
        The clinical use of mindfulness meditation for the self-regulation of chronic pain.
        J Behav Med. 1985; 8: 163-190
        • Lauche R.
        • Cramer H.
        • Dobos G.
        • Langhorst J.
        • Schmidt S.
        A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome.
        J Psychosom Res. 2013; 75: 500-510
        • Laux L.
        • Glanzmann P.
        • Schaffner P.
        • Spielberger D.
        Das State-Trait-Angstinventar.
        Theoretische Grundlagen und Handanweisung, 1981
        • Lee E.H.
        Review of the psychometric evidence of the perceived stress scale.
        Asian Nurs Res. 2012; 6: 121-127
        • Lesage F.X.
        • Berjot S.
        • Deschamps F.
        Clinical stress assessment using a visual analogue scale.
        Occup Med. 2012; 62: 600-605
        • Michalsen A.
        • Traitteur H.
        • Ludtke R.
        • Brunnhuber S.
        • Meier L.
        • Jeitler M.
        • Bussing A.
        • Kessler C.
        Yoga for chronic neck pain: A pilot randomized controlled clinical trial.
        J Pain. 2012; 13: 1122-1130
        • Morone N.E.
        • Greco C.M.
        • Weiner D.K.
        Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study.
        Pain. 2008; 134: 310-319
        • Morone N.E.
        • Rollman B.L.
        • Moore C.G.
        • Li Q.
        • Weiner D.K.
        A mind-body program for older adults with chronic low back pain: Results of a pilot study.
        Pain Med. 2009; 10: 1395-1407
        • Piet J.
        • Hougaard E.
        The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysis.
        Clin Psychol Rev. 2011; 31: 1032-1040
        • Radloff L.S.
        The CES-D scale: a self-report depression scale for research in the general population.
        Appl Psychol Measure. 1977; 1: 385-401
        • Reiner K.
        • Tibi L.
        • Lipsitz J.D.
        Do mindfulness-based interventions reduce pain intensity? A critical review of the literature.
        Pain Med. 2013; 14: 230-242
        • Rendant D.
        • Pach D.
        • Ludtke R.
        • Reisshauer A.
        • Mietzner A.
        • Willich S.N.
        • Witt C.M.
        Qigong versus exercise versus no therapy for patients with chronic neck pain: A randomized controlled trial.
        Spine (Phila Pa 1976). 2011; 36: 419-427
        • Salo P.
        • Ylonen-Kayra N.
        • Hakkinen A.
        • Kautiainen H.
        • Malkia E.
        • Ylinen J.
        Effects of long-term home-based exercise on health-related quality of life in patients with chronic neck pain: A randomized study with a 1-year follow-up.
        Disabil Rehabil. 2012; 34: 1971-1977
        • Scherer M.
        • Blozik E.
        • Himmel W.
        • Laptinskaya D.
        • Kochen M.M.
        • Herrmann-Lingen C.
        Psychometric properties of a German version of the neck pain and disability scale.
        Eur Spine J. 2008; 17: 922-929
        • Schmidt S.
        • Grossman P.
        • Schwarzer B.
        • Jena S.
        • Naumann J.
        • Walach H.
        Treating fibromyalgia with mindfulness-based stress reduction: Results from a 3-armed randomized controlled trial.
        Pain. 2011; 152: 361-369
        • Sedlmeier P.
        • Eberth J.
        • Schwarz M.
        • Zimmermann D.
        • Haarig F.
        • Jaeger S.
        • Kunze S.
        The psychological effects of meditation: A meta-analysis.
        Psychol Bull. 2012; 138: 1139-1171
        • Sherman K.J.
        • Cherkin D.C.
        • Erro J.
        • Miglioretti D.L.
        • Deyo R.A.
        Comparing yoga, exercise, and a self-care book for chronic low back pain: A randomized, controlled trial.
        Ann Intern Med. 2005; 143: 849-856
        • Sherman K.J.
        • Cherkin D.C.
        • Wellman R.D.
        • Cook A.J.
        • Hawkes R.J.
        • Delaney K.
        • Deyo R.A.
        A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain.
        Arch Intern Med. 2011; 171: 2019-2026
        • Sherman K.J.
        • Cook A.J.
        • Wellman R.D.
        • Hawkes R.J.
        • Kahn J.R.
        • Deyo R.A.
        • Cherkin D.C.
        Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain.
        Ann Family Med. 2014; 12: 112-120
        • Sibille K.T.
        • Langaee T.
        • Burkley B.
        • Gong Y.
        • Glover T.L.
        • King C.
        • Riley 3rd, J.L.
        • Leeuwenburgh C.
        • Staud R.
        • Bradley L.A.
        • Fillingim R.B.
        Chronic pain, perceived stress, and cellular aging: An exploratory study.
        Mol Pain. 2012; 8: 12
        • Singh R.
        Inner and Outer Peace Through Meditation.
        Radiance, Chicago1997
        • Spielberger C.D.
        State Trait Anxiety Inventory: Bibliography.
        2nd Ed. Consulting Psychologists Press, Palo Alto, CA1989
        • Spielberger C.D.
        • Gorsuch R.L.
        • Lushene R.
        • Vagg P.R.
        • Jacobs G.A.
        Manual for the State-Trait Anxiety Inventory.
        Consulting Psychologists Press, Palo, CA1983
        • Veehof M.M.
        • Oskam M.J.
        • Schreurs K.M.
        • Bohlmeijer E.T.
        Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis.
        Pain. 2011; 152: 533-542
        • Vernon H.
        • Humphreys B.K.
        • Hagino C.
        The outcome of control groups in clinical trials of conservative treatments for chronic mechanical neck pain: A systematic review.
        BMC Musculoskelet Disord. 2006; 7: 58
        • Wong S.Y.
        • Chan F.W.
        • Wong R.L.
        • Chu M.C.
        • Kitty Lam Y.Y.
        • Mercer S.W.
        • Ma S.H.
        Comparing the effectiveness of mindfulness-based stress reduction and multidisciplinary intervention programs for chronic pain: A randomized comparative trial.
        Clin J Pain. 2011; 27: 724-734