(312) The Effects of Mindfulness-Based Stress Reduction on Pain Catastrophizing in Episodic Migraine

Abstract

Pain catastrophizing plays a key role in shaping the experience of acute and chronic pain, adverse pain-related outcomes and amplified pain perception. Mindfulness-based stress reduction (MBSR) is an evidence-based program designed to focus attention on the present moment in order to decrease stress, and enhance overall wellbeing. MBSR is believed to benefit patients with chronic pain by increasing pain acceptance and potentially interrupting the link between cognitive and emotional experiences, such as catastrophizing, and the experience of pain. Recent findings in chronic low back pain indicate that the beneficial effects of both MBSR and cognitive-behavioral treatment may result from changes in common mechanisms, including pain catastrophizing. In a secondary analysis from a randomized controlled trial, 89 subjects with episodic migraine were randomized to MBSR (n=46) or Stress Management for Headaches control group (SMH, n=43). The effects of MBSR and SMH were measured at 8 weeks following a typical MBSR training class (mid-treatment) and again at 16 weeks following bi-weekly continuation of each intervention (end of treatment). Participants completed the Pain Catastrophizing Scale (PCS) at baseline (M=11.9, SD=9.6), mid-intervention (M=10.5, SD=8.2), and post-intervention (M=8.6, SD=7.2) as well as measures of headache impact and disability (HIT-6). Catastrophizing level was associated with headache impact/disability, as well as pain ratings, primarily at concurrent phases (r's=0.10-0.44). No treatment effect was observed at mid-treatment, but both MBSR and SMH were similarly effective in decreasing pain catastrophizing at the end of treatment compared to baseline (p=0.004). These findings suggest that, while MBSR appears to be effective in reducing pain catastrophizing, it may not be more effective than providing disease and stress management education (provided by an experienced nurse). Additional research is warranted to further explore the specific versus general effects of psychological treatment on pain catastrophizing, and to elucidate potential personalized factors that may enhance MBSR potency.