Feasibility of Mindfulness Meditation Training and Home Practice in Persons with Spinal Cord Injury: A Pilot Study

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Project Summary: The prevalence of debilitating chronic pain in people with spinal cord injury (SCI) ranges from 65-85%. Chronic pain after SCI contributes to anxiety, depression and diminishes the health-related quality of life (QOL). Pharmacological agents such as opioids are the primary therapeutic options to manage chronic pain after SCI, but are ineffective in relieving pain and associated with significant side effects. Mindfulness meditation training (MM) has been shown to improve mental and physical symptoms, including pain-related interference, in many studies of people without SCI who have chronic pain. However, these interventions are typically lengthy, expensive, and require in-person visits with a therapist, making them inaccessible to many people with SCI. Mounting evidence suggests that mobile apps may provide an effective and low-cost way to provide MM. Indeed, one recent study found that internet-based MM training led to reduced pain interference and improved mental health in people with SCI and chronic pain, suggesting app-based MM interventions may have promise in this population. However, this study used an intervention created by the researchers which is not currently available to the public for free, limiting large-scale dissemination. Additionally, the feasibility found in that study may not necessarily translate to that of an existing, publicly available app-based MM intervention among persons with SCI. Similarly, the feasibility of other app-based MM interventions for non-SCI populations may not translate to persons with SCI due to the specific physiological limitations experienced by person with SCI. Our multidisciplinary, interinstitutional team of investigators proposes to randomize 60 SCI patients experiencing chronic pain to practice audio-guided MM for ≥ 10 minutes daily for 6 weeks using the free app “Mindfulness Coach” developed by the Department of Veteran Affairs, or to view TED talks for ≥ 10 minutes daily for 6 weeks on the free TED app (active control). Primary outcomes are the feasibility and acceptability of proposed interventions in people with SCI and chronic pain. Secondary outcomes include the feasibility of collecting patient-reported outcomes of pain, anxiety, depression, mindfulness, and quality of life. Given the great need for remotely delivered, low-cost chronic pain management and unique physiological limitations among person with SCI, it is essential to determine the feasibility and acceptability of a free, publicly available app-based MM intervention prior to conducting a larger efficacy study. With the emerging use of telemedicine in this COVID-19 era, therapy-focused apps and remote data collection are becoming increasingly popular making this line of inquiry both timely and innovative. Furthermore, the app-guided MM intervention has the potential to facilitate self-management of pain by persons with SCI, as the MM exercises can be practiced at the individual’s preferred time and place. The long-term goal of this study is to improve pain management and QOL of people with SCI living with chronic pain by identifying affordable and accessible app- guided interventions which can be used as an adjuvant tool after SCI in conjunction with other treatments.