Mengting Zhu, Samuel Yeung-shan Wong, Claire Chenwen Zhong, et.al. Which type and dosage of mindfulness-based interventions are most effective for chronic pain? A systematic review and network meta-analysis, Journal of Psychosomatic Research, Volume 191, 2025, 112061, ISSN 0022-3999, https://doi.org/10.1016/j.jpsychores.2025.112061.
Chronic pain poses challenges due to the limitations and side effects of current therapeutic agents, leading to a focus on psychological treatments like mindfulness-based interventions (MBIs). Different types of MBIs exist, with Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) being common. MBSR combines mindfulness meditation, yoga, and stress-coping techniques, while MBCT merges MBSR with Cognitive Behavioral Therapy. Mindfulness-Oriented Recovery Enhancement (MORE) integrates mindfulness, CBT, and positive psychology to address reward dysregulation, specifically targets addiction and chronic pain.
MBIs emphasize being present in the moment and cultivating a non-judgmental attitude toward pain.
Despite positive findings in clinical trials, reviews, and meta-analyses on the benefits of MBIs in reducing pain intensity and improving overall well-being, there is a need for more research on optimal dosage and types. This study aims to compare the effectiveness of various MBIs on pain intensity, physical function, and depression while exploring factors like course length and session frequency. Results from this research can guide patient decision-making and the standardization of MBI delivery for maximum therapeutic impact.
The researchers conducted a random-effect pairwise meta-analysis and network meta-analysis on data from 68 studies with 5,339 participants.
This study excluded chronic cancer-related pain due to the substantial differences in causes, characteristics, diagnostics, and treatment strategies between chronic non-cancer pain and chronic cancer pain.
Both active and inactive control groups were included. Active controls included exercise, other behavioral and psychological interventions such as CBT, multidisciplinary pain interventions, psychoeducation with psychological or physical interventions or skills, and support group. Inactive controls included standard care or usual care, wait-list, placebo, sham control, no treatment, minimal treatment, and health education without psychological or physical interventions or skills.
Regarding study locations, the United States emerges as the predominant country, accounting for 25 studies (36.8 %). China follows with 14 studies (20.6 %), while Spain, Germany and Iran contribute the remaining studies. Three quarters of the studies concentrated on MBSR (39 studies, 57.4 %), followed by MBCT (12 studies, 17.6 %).
Overall effectiveness of MBIs versus active and inactive controls:
For the effectiveness of MBIs for chronic pain, for depression, and for physical functioning, results favored all MBIs versus inactive controls but found the results of MBIs not statistically different form active controls.
Comparative effectiveness of different MBIs:
For pain intensity: MBSR showed the strongest evidence for reducing pain intensity versus inactive controls, followed by MBCT . Other MBIs did not have statistically significant effects compared to inactive controls.
Physical function: MORE showed the strongest evidence for improving physical function compared with inactive controls,; followed by MBCT, followed by MBSR.
Depression: MBSR showed the strongest evidence for improving depressive symptoms versus inactive controls; followed by MBCT . Other MBIs did not have statistically significant effects compared with inactive controls.
This research paper indicates that mindfulness-based interventions (MBIs) are effective in improving physical function, depression, and pain intensity.
Similar to previous reviews, MBIs were more effective than inactive controls in improving physical function and depression. Mindfulness-Based Stress Reduction (MBSR) showed promise in reducing pain and depression, while Mindfulness-Oriented Recovery Enhancement (MORE) was effective in improving physical function.
Optimal Dose of MBIs:
The optimal dosage for MBIs was found to be an 8-week course, once per week, with sessions lasting between 90 and 120 minutes. – Larger dosages did not necessarily result in larger effect sizes, indicating a nuanced dose-effect relationship.
Conclusion:
The findings contribute to the evidence supporting the use of MBIs in chronic pain management and can inform the development of evidence-based guidelines and standardization of MBI course structures.