Jastrowski Mano Kristen E, Salamon Katherine S, Hainsworth Keri R, Anderson Khan Kimberly J, Ladwig Renee J, Davies W Hobart, Weisman Steven J
Altern Ther Health Med. 2013 Nov-Dec;19(6):8-14.
It is estimated that 1 in 5 children in the United States is affected by chronic pain. Increasing adaptive coping strategies and decreasing stress may be important in treatment. Research has suggested that mindfulness can help alleviate symptoms associated with medical illnesses and increase quality of life. Little is known about the effectiveness of mindfulness-based stress reduction (MBSR) in youth, partly due to insufficient methodological rigor in related studies.
The primary purpose of the present study was to examine the feasibility, acceptability, and effectiveness of MBSR for a treatment-seeking sample of youth with chronic pain.
The current study was the first randomized, controlled pilot study of MBSR for pediatric chronic pain. The research team had intended to use block randomization involving a total of five recruitment waves, with each wave consisting of one MBSR group and one psychoeducation group. Due to difficulties with recruitment and attrition before the start of either group, however, only MBSR was conducted at each wave after the first wave.
Participants were recruited from a multidisciplinary pain clinic in a large, Midwestern children's hospital.
The final sample included six adolescents between the ages of 12 and 17 y, four in the MBSR group and two in the psychoeducation group.
Weekly sessions for the MBSR group were 90 min in length and followed a structured protocol. Sessions included a review of homework, an introduction to and practice of meditation, discussion of the session, and a review of the home practice assignment. The psychoeducation group participated in six group sessions, which were based on a cognitive-behavioral model of pain, and discussion topics included the nature of chronic pain and stress management.
Health-related quality of life, pain catastrophizing, anxiety, functional disability, mindfulness, and treatment acceptability were all assessed pre- and postintervention as well as at follow-up.
Recruitment and retention difficulties were experienced. Qualitative examination of participants' scores suggested increased mindfulness but inconsistent patterns on other outcome measures.
The research team highlighted critical challenges faced by potential researchers aiming to investigate MBSR for pediatric chronic pain, and the study provides recommendations for research and implications for clinical practice.
据估计，美国每五名儿童中就有一名受慢性疼痛影响。增加适应性应对策略和减轻压力在治疗中可能很重要。研究表明，正念有助于缓解与疾病相关的症状并提高生活质量。关于基于正念的减压疗法（MBSR）对青少年的有效性知之甚少，部分原因是相关研究的方法严谨性不足。
本研究的主要目的是检验MBSR对寻求治疗的慢性疼痛青少年样本的可行性、可接受性和有效性。
本研究是第一项针对儿童慢性疼痛的MBSR随机对照试验研究。研究团队原计划采用区组随机化，共进行五轮招募，每轮包括一个MBSR组和一个心理教育组。然而，由于在任何一组开始之前招募和损耗方面存在困难，第一波之后的每一波只进行了MBSR。
参与者从一家位于中西部的大型儿童医院的多学科疼痛诊所招募。
最终样本包括6名年龄在12至17岁之间的青少年，4名在MBSR组，2名在心理教育组。
MBSR组每周课程时长为90分钟，并遵循结构化方案。课程包括作业回顾、冥想介绍与练习、课程讨论以及家庭练习任务回顾。心理教育组参加了六次小组课程，这些课程基于疼痛的认知行为模型，讨论主题包括慢性疼痛的本质和压力管理。
在干预前、干预后以及随访时评估与健康相关的生活质量、疼痛灾难化、焦虑、功能残疾、正念和治疗可接受性。
遇到了招募和保留方面的困难。对参与者分数的定性检查表明正念有所增加，但在其他结局指标上模式不一致。
研究团队强调了旨在研究MBSR治疗儿童慢性疼痛的潜在研究人员面临的关键挑战，该研究为研究提供了建议，并对临床实践具有启示意义。
