Mindfulness therapy no help in fibromyalgia trial

A program aimed at easing stress with meditation and yoga may not be much help for people with the chronic-pain condition fibromyalgia, a recent study suggests.

The study, published in the journal Pain, looked at the effects of so-called mindfulness-based stress reduction — a technique developed by researchers at the University of Massachusetts in 1979 that combines mindfulness meditation and gentle yoga postures.

The technique is now available throughout the world — in the form of an eight-week program of classes — to help people manage general stress or health problems, including chronic pain.

For the new study, researchers led by Dr. Stefan Schmidt, of the University Medical Center in Freiburg, Germany, tested the program’s effects among 177 women with fibromyalgia.

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They found that women assigned to the mindfulness program showed no greater gains in health-related quality of life than those assigned to a waiting list for treatment.

That meant no significant improvements in either physical symptoms or emotional well-being.

“I’m surprised it didn’t work better than it did,” Dr. Alex Zautra, a professor in psychology at Arizona State University in Tempe, told Reuters Health. Zautra, who was not involved in the study, said he would have expected better results since people with fibromyalgia would seem to be good candidates for the mind-body therapy.

Fibromyalgia is a syndrome marked by widespread pain — including discomfort at specific “tender points” in the body — along with symptoms like fatigue, irritable bowel and sleep problems. It is estimated to affect up to 5 million U.S. adults, most commonly middle-aged women.

The precise cause of fibromyalgia is unknown. There are no physical markers, like inflammation or tissue damage in the painful areas — but some researchers believe the disorder involves problems in how the brain processes pain signals.

Standard treatments include painkillers, antidepressants, cognitive-behavioral therapy and exercise therapy. However, many people with fibromyalgia find that their symptoms persist despite treatment.

One reason, some researchers suspect, may be because standard treatments do not specifically address the role psychological stress and emotions can play in triggering pain.

Studies have found that people with fibromyalgia have higher-than-average rates of stressful life events, like childhood abuse and marital problems. There’s also evidence suggesting they are less aware of their own emotions and have more difficulty holding on to positive feelings compared to people without fibromyalgia.

The idea behind mindfulness practices, Zautra said, is that people become more aware of how they are feeling, emotionally and physically, from moment to moment. Then they can start to see how their emotions affect their perceptions of their physical symptoms.

But maybe the problem, Zautra said, is that “awareness by itself is not enough for patients with fibromyalgia.”

That is, people with the disorder may need extra help in learning how to manage the emotions that come up when they meditate or practice mindfulness-based yoga.

Another recent study of the “mind-body” approach to fibromyalgia suggested that patients can benefit from addressing their emotions. In that study of 45 women with fibromyalgia, about half of those who underwent a therapy called “affective self-awareness” reported a significant improvement in their pain over six months.

Affective self-awareness — a newer therapy that is not widely available — tries to get people to “directly engage” their emotions with the help of various techniques. Mindfulness meditation and “expressive” writing are two of them.

Zautra and his colleagues are in the middle of a clinical trial testing their own mindfulness-based program against standard cognitive-behavioral therapy and general health education for people with fibromyalgia.

So the “jury is still out,” Zautra said, as to whether some fibromyalgia patients can benefit from mindfulness practices.

In the meantime, if someone with the disorder wants to try a mindfulness meditation class, “this study doesn’t tell them not to,” Zautra said.

“But don’t expect it to cure your pain,” he added. “This study raises questions about when and for whom (mindfulness techniques) may be helpful.”

The current findings are based on 177 women with fibromyalgia who were randomly assigned to one of three groups: one that went through the eight-week mindfulness-based stress reduction program; an “active” control group that received relaxation training and learned gentle stretching exercises; and a second control group where patients were put on a waiting list for treatment.

All of the women completed a standard questionnaire to rate their health-related quality of life at the beginning of the study, directly after the therapy program ended, and again two months later.

Overall, Schmidt’s team found, the entire study group showed a small improvement in quality of life over time. But there were no significant differences between the three groups.

According to Zautra, one possibility is that only certain subsets of fibromyalgia patients stand to benefit from this or other mindfulness-based therapies.

In one of his own studies, Zautra said, people with rheumatoid arthritis who also had a history of depression benefited more from mindfulness meditation than arthritis patients who had never battled depression.

It’s possible — though not proven — that the same pattern could hold true for fibromyalgia patients, he noted.

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Yoga by prescription: Doctors treat back pain with yoga

After months of agonizing back pain, Suellen Rinker was at a loss.

A surgeon suggested a range of options: painkillers, medication injected into the spine, back surgery. An MRI scan revealed a herniated spinal disk, and the pain, like a stabbing ice pick, filled her days with misery and robbed her nights of sleep.

“I was taking massive amounts of ibuprofen,” the 51-year-old Portland woman says. “I did have one of the spinal shots. It wasn’t particularly effective.”

Suspicious of surgery, Rinker decided to try a therapy her surgeon hadn’t offered but her primary care physician enthusiastically endorsed: yoga. Working one-on-one with a physical therapist yoga instructor, Rinker learned to practice three simple stretching positions along with breathing exercises and meditation. After about a month of daily practice, Rinker no longer felt crippled by back pain.

“Now I’m back to hiking. I went snowshoeing this winter,” she says.

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Her back pain isn’t gone, but she’s gained the upper hand. “I still feel it. I can usually go home, do one of these stretches and I don’t seem to have a problem.”

With clinical trials now backing up many uses of yoga as therapy, physicians and other mainstream health professionals are giving serious consideration to the 5,000-year-old practice. In the latest national survey by the magazine Yoga Journal, 6.1 percent of U.S. adults said a doctor or therapist had recommended yoga to them. It’s part of a broader acceptance of non-Western healing traditions by U.S. medical schools and health systems. Oregon Health & Science University and Providence Health & Services offer yoga in addition to standard medical care for cancer and other diseases, and both health systems employ physicians who are also yoga teachers.

“I’ve started recommending it to patients pretty regularly for a large number of issues,” says Dr. Meg Hayes, an avid yoga practitioner and an associate professor of family medicine at Oregon Health & Science University. Hayes recently co-authored a journal article reviewing results of clinical trials with yoga and offering advice to physicians interested in prescribing it.

Time, cost pose problems

In Hayes’ experience, most patients are happy to try yoga. The biggest barrier she’s found is the cost and time commitment needed to learn and practice yoga. Group classes range from $10 to $25 a session, less for a package of classes. Private instruction ranges from $50 to hundreds of dollars an hour. And health insurance generally won’t pay for yoga classes.

During office visits, Hayes routinely teaches yoga moves to patients who aren’t familiar with the ancient practice. “If they have low back pain, I might show them a half-pigeon pose,” she says. “Often if we do a little bit of that stretching they start to see right away that they feel better, that there is a move or posture that is available to them and will give them some pain relief right away.”

Unlike medical therapies aimed at fixing one problem, yoga works on many levels at the same time. “You get stronger muscles, you get more flexible joints, you get joints that are better lubricated, the spine lengthens, you breath more deeply,” Hayes says. “All of those benefits combined really help you to be strong, function better and have a sense of emotional well-being.”

In recent clinical trials, yoga improved symptoms of asthma and obstructive pulmonary disease when added to conventional care. Yoga breathing can help lower blood pressure. There’s some evidence that yoga practice during pregnancy can reduce the risk of pre-term labor and low birth weight.

Helping people cope with chronic pain that defies conventional treatment may be yoga’s most significant medical benefit.

Fibromyalgia trial

Bobbie Wethern, who’s lived with fibromyalgia for 20 years, reached a low in 2008. Physical activity became so exhausting she couldn’t climb stairs, clean house or carry laundry. “There were days I couldn’t get dressed,” says the 57-year-old. Wethern, who grew up in South Dakota, never considered yoga a good fit.

“I thought it was for really pretzel-like people,” she says. “I thought it was kind of weird.”

But a trusted therapist suggested she enroll in a clinical trial offering a yoga program tailored for people with fibromyalgia. Wethern volunteered.

Kimberly Carson and her husband James Carson, a clinical health psychologist at OHSU, eliminated some potentially stressful yoga movements and adapted standing poses so they could be performed sitting or lying down. Weekly sessions also included extensive instruction on applying yoga principles to cope with illness. The Carsons and their research colleagues published the clinical trial results earlier this year in the journal Pain.

After eight weeks, women in the yoga group showed significant improvement in measures of pain, fatigue, stiffness, sleep quality, depression, memory, anxiety and balance, while the control group showed none. Wethern cut her pain medicine doses by half. Pain interfered less with sleep. She regained enough stamina to walk five miles and to resume gardening.

“The poses are very, very important and have helped me become more flexible and have more strength, but it’s much more than that,” she says. Yoga breathing techniques help her relax rather than tense up during bouts of pain. While her pain, fatigue and other symptoms are far from cured, meditation has changed her response.

“Yoga teaches you to work through it or allow it to take place rather than resist it,” she says. “That experience was very foreign to me. It felt like years of pressure being removed from my body.

“It’s taken the power of pain away.”

-– Joe Rojas-Burke

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Study: Yoga helps with fibromyalgia pain

Yoga that includes gentle stretching exercises combined with meditation can lessen the symptoms of fibromyalgia, a U.S. study found.

Twenty-five women diagnosed with fibromyalgia, a chronic pain syndrome, took part in a 2-hour weekly yoga class for eight weeks.

At the end of the study, the group reported improvements in both physical and psychological aspects of fibromyalgia, including decreased pain, fatigue, tenderness, anxiety and better sleep and mood, HealthDay reported Thursday.

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Researcher finds link between meditative breathing and pain relief

We’ve all been told to “just breathe.” But a few psychology researchers at ASU and the Barrow Neurological Institute in Phoenix took that a step further in a study that took a closer look at the actual value of breathing.

The study, more specifically, looked at how meditative breathing affects the way women with fibromyalgia respond to pain in the form of heat pulses.

College Times met with Alex Zautra, the lead author of the study and a foundation professor of psychology at ASU, to talk about what this study means to the public, the idea of pain and pain treatments and the value of meditation.

College Times: From what I gather, this study was about the mind-body relationship. Can you talk a little about that?

Zautra: One of the methods by which a person can regain a kind of physiological balance and homeostatic state is through a relaxation method, and some are more valuable than others. One of the methods people have been doing since ancient times in the Eastern world is meditation, whether it’s local or mindfulness meditation, and breathing is a big part of that; slowing down your breathing rate. And that’s what we tried to put into the laboratory.

Does meditative breathing really have a physiological effect on people?

We did measure that; that’s not reported in the study yet. We’ll report it in later studies … The premise of the study is that slower breathing does activate the parasympathetic nervous system, slows the heart, reduces blood pressure and leads to greater, what is called, heart-rate variability, which is a greater sense of capacity to be both alert and relaxed.

That’s kind of a paradox though; awareness while trying to forget one’s pain.

It seems paradoxical doesn’t it? Well, what we teach with chronic pain patients is, ‘Yes, you’re in pain, but that’s not all you feel. What else are you feeling at the time?’ It expands their horizons to allow themselves to do more than be embattled with the pain they have and to see many other emotions; some they can appreciate more if they can allow themselves a greater latitude to understand their own feelings.

Why did you decide to make half of the study’s population fibromyalgia patients?

First of all, it’s a population in pain that’s troubled by their condition. So we think that this group could benefit greatly from meditation interventions. When that study started we didn’t have that, but we do now have a five-year study to examine whether meditative practices could benefit somebody with fibromyalgia. We don’t have the results yet, because we’re in the middle of it.

Do you worry about the way the pharmaceutical industry might respond to research like this being successful?

I don’t worry about that. I think the pharmaceutical companies have their own business, but they’re also interested in methods that can accent, elaborate on or facilitate benefits to patients that are on the medications they have. So, when we talk to rheumatologists, who are prescribing meds for people with fibromyalgia or some other chronic pain condition, they’re eager to support [and] participate by helping us learn [and] they find ways for their patients to learn about our studies because they see it as meds-plus as being what’s going to be most beneficial for their patients.

[via College News]
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Slow breathing may soothe pain

Fox News: The simple practice of slow breathing may help people deal with the physical and emotional reactions to moderate pain, a small study suggests.

Researchers say the findings, published in the journal Pain, offer support for the idea that yoga-style breathing exercises and meditation can help ease chronic pain.

The study gauged pain responses among 27 women with the chronic pain condition fibromyalgia and 25 healthy women the same age.

Researchers found that when they had the women perform slow breathing, it dampened their reactions to a moderately painful stimulus — brief pulses of heat from a probe placed on the palm. Overall, the women rated the pain intensity as lower and reported less emotional discomfort when they slowed their normal breathing rate down by half.

The benefit was greater and more consistent among the healthy study participants than those with fibromyalgia.

However, the findings suggest that breathing techniques could offer an additional way to deal with fibromyalgia or other types of chronic pain, according to lead researcher Dr. Alex J. Zautra, a psychology professor at Arizona State University in Tempe.

“What’s really valuable is that we were able…

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to put this yoga-like, meditation approach under the microscope,” he told Reuters Health in an interview.

The study did not assess any formal yoga or meditation technique, but did look at the effects of becoming more aware of your breathing, which is at the foundation of those practices. The findings, according to Zautra, appear to be the first to show that “how we breathe” does alter perceptions of and responses to pain.

He and his colleagues are currently studying the effects of mindfulness meditation as part of fibromyalgia treatment.

Fibromyalgia is a syndrome marked by widespread aches and pains — on both sides of the body and above and below the waist — along with other symptoms such as fatigue, sleep problems and depression. Its cause is unclear — there are no physical signs, such as inflammation — but researchers believe that fibromyalgia involves problems in how the brain processes pain signals.

“It is not ‘all in your head,'” Zautra noted, “but it may be in your brain.”

Slow breathing, he explained, may help by bringing a better balance to the activities of the sympathetic and parasympathetic nervous systems.

The sympathetic nervous system activates what is often dubbed the “fight-or-flight” response during times of stress — increasing heart rate, blood pressure and perspiration, for example. If the sympathetic nervous system is seen as an accelerator, then the parasympathetic nervous system is akin to a brake.

Learning breathing techniques might be particularly useful for painful conditions like fibromyalgia, but Zautra said there is also potential for helping people deal with other types of chronic pain, like osteoarthritis and lower back pain.

People are “remarkably resilient” in their capacity to recover from pain, Zautra explained. “Sometimes they just need a little help.”

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Beyond standard pain relievers (Newswise)

oga, massage or plain old exercise? It could be just what the doctor ordered to minimize pain from chronic conditions such as rheumatoid arthritis, osteoarthritis, neck pain, low back pain or fibromyalgia, according to the September issue of Mayo Clinic Women’s HealthSource.

Given recent news about the risk of some pain relieving medications, many people are considering other ways to manage chronic pain. While not a quick fix, therapies such as massage, ice, heat and even acupuncture can be very effective if you give them time to work and use them consistently.

The September issue of Mayo Clinic Women’s HealthSource explores alternative ways to manage chronic pain.

Exercise: Most people with chronic pain feel better if they are physically active every day. But don’t overdo. Exercising too much or too intensely can make pain worse.

Ice and heat: Applying ice or heat provides short-term pain relief. Ice reduces pain and swelling. Heat is useful for reducing joint stiffness and for muscle spasm, back pain and arthritis.

Acupuncture: Extremely thin needles inserted at one or more of about 350 strategic points on your body may relieve low back pain and pain from fibromyalgia and osteoarthritis.

Electrical stimulation: Electrically stimulating the nerves that control muscles is a safe, easy and effective way to control many types of pain. One example is transcutaneous electrical stimulation, where a small device directs mild electric pulses to nerve endings beneath the skin. A physical therapist can teach you how to do this therapy at home.

Relaxation: Meditation, deep breathing, guided visualization, biofeedback and self-hypnosis can reduce stress, pain, anxiety and depression.

Manual therapy and massage: Osteopathic doctors, physical therapists, chiropractors and massage therapists use various techniques to improve movement and function and relieve pain in muscles and joints.

Before you try alternative therapies, learn all you can about the safety and effectiveness. If nothing seems to work, talk to your doctor, who may refer you to a pain management program to suggest other ways to cope with long-term pain.

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