Structured mindfulness training promotes independent home practice, practice quality, and improvements in functioning in Veterans with chronic pain: Results from a pilot study

Structured mindfulness training promotes independent home practice,  practice quality, and improvements in functioning in Veterans with chronic pain: Results from a pilot study

Background:

According to the CDC, US military veterans report higher rates of chronic pain, and greater pain severity, compared with the general population¹.  Chronic pain is associated with significant disruptions in quality of life, functioning, and mental health, and access to effective interventions for chronic pain management is imperative.  Mindfulness is an evidence-based treatment for pain² and has been associated with significant improvements in depression and mental health-related quality of life³.  Developing a formal home practice routine is associated with positive intervention outcomes^4,5 . Additionally, mindfulness practice quality (PQM), a self-reported assessment of the quality of one’s formal practice, improves with training⁶, and improvements in PQM predict positive changes in intervention outcomes (e.g., mindfulness, distress⁷).  However, patients often report difficulties with developing and/or sustaining a formal practice routine at home⁸.  Additionally, it is unclear whether formal practice is associated specifically with improved pain-related outcomes.

Purpose/Objectives:

The present study aimed to investigate the implementation of a mindfulness training program for veterans with chronic pain and assess changes in amount of formal home practice and PQM over time, along with outcomes of pain acceptance and health-related quality of life. 

Method:

Veterans with chronic pain served by 1 of 4 VA facilities in a region self-referred or were referred by a provider and participated in a mindfulness training program as part of routine clinical care.  This multi-phasal program included individual and group modalities, beginning with weekly individual sessions for the first 8 weeks (Foundation Phase), followed by biweekly-to-bimonthly individual sessions (Intermediate Phase and Continuing Care Phase, respectively). During the intermediate and continuing care phases, Veterans could opt into a weekly mindfulness practice group.  Both individual and weekly group sessions followed an established mindfulness protocol in terms of structure and approach.⁹   Measures of PQM, formal practice time, and a single item measure of pain interfering with enjoyment of life were administered weekly (at each individual and group session), and outcome measures of pain acceptance (Chronic Pain Acceptance Questionnaire 8) and health-related quality of life (WHO-5; WHOQOL-BREF, items 1 & 2) were administered in individual sessions at baseline, 1 month, 2 months, and 6 months.

Results:

The sample included 73 veterans (30% women, 70% men) who were, on average, 50 years old (SD = 13.39). 68.5% of the sample was White, 15% Black and/or African-American, 7% Asian, and 5.5% multiracial.  Outcomes of interest were increases in formal home practice time, practice quality (PQM), and self-reported pain acceptance, well-being, and health-related quality of life at baseline, 1 month, and 2 months (i.e., the end of the foundation phase). Results indicated that formal practice time increased over the course of treatment, from 4.20 minutes per day at intake to 14.61 minutes per day at 2 months (t = -3.247, p = .002). Results from mixed effects regression models showed that PQM improved throughout the foundation phase (b = 4.452e-4, p = .001) and that increases in PQM were associated with improvements in pain acceptance (b = 8.437e-5, p < .001) and pain interference (b = -0.097, p < .001). Subjective well-being (WHO-5) and quality of life (WHOQOL-BREF) improved from baseline to 2-month (t=-3.15, p=.00; t=-2.38, p=.023, respectively). Pain Interference with Enjoyment of Life did not improve.

Conclusions: Veterans who participated in a mindfulness training program for chronic pain evidenced increases in formal mindfulness practice time and mindfulness practice quality over the course of treatment. Additionally, self-reported pain acceptance, overall wellbeing, and quality of life all improved. Increases in mindfulness practice quality were associated with increased pain acceptance and decreased pain interference. In conclusion, this program appears to be beneficial to veterans with chronic pain, providing a structured approach to learning the mindfulness technique, developing/sustaining a routine practice, improving mindfulness practice quality, and utilizing mindfulness to cope more effectively with chronic pain.

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