Immediate and Lasting Chronic Pain Reduction Following a Brief Self-Implemented Mindfulness-Based Interoceptive Exposure Task: a Pilot Study
Immediate and Lasting Chronic Pain Reduction Following a Brief Self-Implemented Mindfulness-Based Interoceptive Exposure Task: a Pilot Study
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DOI：
10.1007/s12671-017-0823-x
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发表时间：
2020-01-01
期刊：
影响因子：
3.6
通讯作者：
Shires, Alice
中科院分区：
文献类型：
--
作者：
Cayoun, Bruno;Simmons, Akeesha;Shires, Alice
最近的成像研究表明，大约80%从急性疼痛过渡到慢性疼痛的人产生神经可塑性，将疼痛通路与大脑的学习区域联系起来，从而显示慢性疼痛在很大程度上是学习的生理证据。正念冥想计划已经成功地用于教导人们减少与疼痛相关的痛苦的方法，并消除他们与疼痛的无益关系。然而，并不是所有的慢性疼痛患者都愿意接受完整的正念计划，然后保持日常练习。因此，我们进行了一项试点研究，从第二代MBI中提取的任务，正念整合认知行为疗法，其中包括一个自我引导的30秒正念为基础的内感受性暴露任务（MIET）的疼痛感觉在15个医学诊断的慢性疼痛患者。在15天内反复使用MIET的参与者学会了不认同疼痛，并专注于内感受的四个子成分（质量，运动，温度和凝聚力），同时保持镇定。这导致疼痛焦虑（p = 0.001; d = 0.96）、疼痛持续时间（p = 0.01; d = 0.86）和每次30秒暴露后的疼痛强度（p <0.001; d = 1.37）显著降低。在2个月随访时，这些效果得以维持，有些进一步改善。还观察到抑郁、焦虑和压力明显减少（p <0.001; d = 0.81）。虽然参与者对这项任务的评价是高度可接受的，有些人减少了止痛药的使用，但不需要其他的医疗或心理治疗。这些早期的结果显示了MIET作为慢性疼痛传统治疗的辅助手段的潜力，尽管还需要对照研究来确定我们结果的有效性。大脑成像研究也需要评估MIET对皮质边缘区域可能的遗忘效应，这一过程可以被称为“中枢脱敏”。"
Recent imaging research shows that approximately 80% of people who transit from acute to chronic pain produce neuroplasticity linking pain pathways to learning areas of the brain, thus showing physiological evidence that chronic pain is largely learned. Mindfulness meditation programs have been used successfully to teach people a way of decreasing pain-related distress and unlearning their unhelpful relationship to pain. However, not all chronic pain patients are amenable to undergo a full mindfulness program and then maintain daily practice. Accordingly, we conducted a pilot study of a task extracted from a second-generation MBI, Mindfulness-integrated Cognitive Behavior Therapy, which consisted of a self-guided 30-s mindfulness-based interoceptive exposure task (MIET) to pain sensations in 15 medically diagnosed chronic pain patients. Participants using the MIET repeatedly over 15 days learned not to identify with pain and focused on four subcomponents of interoception (mass, motion, temperature, and cohesiveness) while remaining equanimous. This led to significant reduction in pain anxiety (p = .001; d = 0.96), pain duration (p = .01; d = 0.86), and pain intensity after each 30-s exposure (p < .001; d = 1.37). These effects were maintained, and some further improved, at 2-month follow-up. Marked decrease in depression, anxiety and stress were also observed (p < .001; d = 0.81). While participants rated the task as highly acceptable and some reduced their use of analgesic medication; no other change in medical or psychological treatment was required. These early results show the potential for the MIET to be use as an adjunct to traditional treatments of chronic pain, although controlled studies are needed to establish the validity of our results. Brain-imaging studies are also needed to assess the possible unlearning effect of the MIET on corticolimbic regions, a process that may be termed "central desensitization."