Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal.
Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135 Porto, Portugal.
Medicina (Kaunas). 2024 Apr 23;60(5):686. doi: 10.3390/medicina60050686.
: There has been an increasing interest in the use of non-pharmacological approaches for the multidimensional treatment of chronic pain. The aim of this systematic review was to assess the effectiveness of mindfulness-based therapies and Guided Imagery (GI) interventions in managing chronic non-cancer pain and related outcomes. : Searching three electronic databases (Web of Science, PubMed, and Scopus) and following the PRISMA guidelines, a systematic review was performed on Randomized Controlled Trials (RCTs) and pilot RCTs investigating mindfulness or GI interventions in adult patients with chronic non-cancer pain. The Cochrane Risk of Bias Tool was utilized to assess the quality of the evidence, with outcomes encompassing pain intensity, opioid consumption, and non-sensorial dimensions of pain. : Twenty-six trials met the inclusion criteria, with most of them exhibiting a moderate to high risk of bias. A wide diversity of chronic pain types were under analysis. Amongst the mindfulness interventions, and besides the classical programs, Mindfulness-Oriented Recovery Enhancement (MORE) emerges as an approach that improves interoception. Six trials demonstrated that mindfulness techniques resulted in a significant reduction in pain intensity, and three trials also reported significant outcomes with GI. Evidence supports a significant improvement in non-sensory dimensions of pain in ten trials using mindfulness and in two trials involving GI. Significant effects on opioid consumption were reported in four mindfulness-based trials, whereas one study involving GI found a small effect with that variable. : This study supports the evidence of benefits of both mindfulness techniques and GI interventions in the management of chronic non-cancer pain. Regarding the various mindfulness interventions, a specific emphasis on the positive results of MORE should be highlighted. Future studies should focus on specific pain types, explore different durations of the mindfulness and GI interventions, and evaluate emotion-related outcomes.
人们越来越关注使用非药物方法来多维治疗慢性疼痛。本系统综述旨在评估基于正念的疗法和引导想象（GI）干预在管理慢性非癌症疼痛及相关结果方面的有效性。
通过检索三个电子数据库（Web of Science、PubMed 和 Scopus）并遵循 PRISMA 指南，对正念或 GI 干预成年慢性非癌症疼痛患者的随机对照试验（RCT）和试验性 RCT 进行了系统综述。使用 Cochrane 偏倚风险工具评估证据质量，结果包括疼痛强度、阿片类药物消耗和疼痛的非感觉维度。
有 26 项试验符合纳入标准，其中大多数试验的偏倚风险为中度至高度。分析了各种慢性疼痛类型。在正念干预中，除了经典方案外，正念导向恢复增强（MORE）作为一种改善内脏感知的方法也脱颖而出。六项试验表明，正念技术可显著降低疼痛强度，三项试验还报告了 GI 的显著结果。有十项使用正念的试验和两项涉及 GI 的试验支持在疼痛的非感觉维度上有显著改善的证据。四项基于正念的试验报告了阿片类药物消耗的显著效果，而一项涉及 GI 的研究发现该变量存在较小的效果。
本研究支持正念技术和 GI 干预在慢性非癌症疼痛管理中的益处的证据。关于各种正念干预，应特别强调 MORE 的积极结果。未来的研究应侧重于特定的疼痛类型，探索正念和 GI 干预的不同持续时间，并评估与情绪相关的结果。
