A Randomized Pilot Study on the Effects of an Adapted Mindfulness-Based Intervention for Adolescents with Chronic Pain
Purpose: Chronic pain in children and adolescents is a common condition that results in significant impairments in quality of life. Mindfulness is an approach that takes roots in ancient Buddhist meditative practices. It has been used with promising results in various adult and adolescent populations to address such conditions as depression, anxiety and chronic pain. The primary objective of this study was to determine the feasibility, validity and acceptability of a randomized pilot trial measuring the impact of an adapted mindfulness-based intervention in adolescents with chronic pain. This study also aimed to gather pilot data exploring changes in health-related quality of life, perceived pain intensity, mood and anxiety symptoms, psychological distress, as well as salivary cortisol levels among participants.
Methods: This study was a prospective, experimental, longitudinal trial of 20 adolescent participants (n= 20) recruited from outpatient pediatrics, psychiatry and adolescent medicine clinics at a tertiary hospital center. All participants had a reported history of organic or psychosomatic pain of more than three months. Participants were randomized into an intervention group and a wait-list control group. Both groups successively followed an adapted 8-week mindfulness curriculum designed specifically for adolescents with chronic pain. Participants were required to keep a personal log book, provide saliva samples and fill-in series of questionnaire packages during the 4-month study period for measurement of quality of life, pain perception, anxiety, depression, psychological distress and cortisol levels. Six pre-determined criteria were established by a panel of experts to assess the feasibility, validity and acceptability of the study model. These criteria were: enrollment, exclusion and attrition rates, compliance to study protocol, adequate monitoring of outcomes and quality control of the intervention.
Results: Recruitment of study participants took place between October and December 2014. Participants were referred from seven different outpatient clinics within the same tertiary care center. Mean (SD) participant age was 15.3 (1.13) years. Exclusion and attrition rates were low (16.7 and 15% respectively). Attendance to mindfulness sessions and compliance to study protocol were excellent, allowing for optimal monitoring of outcomes. Quality control by an external expert reviewer showed near-perfect observance of curriculum objectives. All participants reported high levels of appreciation of mindfulness sessions and formal or informal mindfulness practice between sessions. Pilot data showed non-significant differences in quality of life scores and pain perception in the intervention vs. wait-list control group.
Conclusion: Mindfulness is an innovative therapeutic intervention for which very limited data exists in adolescents with chronic pain. This pilot study showed high levels of acceptability, validity and feasibility and was highly appreciated by all teenagers involved. More research in the form of a large-scale randomized control trial is needed to demonstrate the efficacy of mindfulness interventions in teenagers with chronic pain.