Physical functioning and mindfulness skills training in chronic pain: a systematic review

William Jackson,1 Emily L Zale,2 Stanley J Berman,3 Alberto Malacarne,1 Amy Lapidow,4 Michael E Schatman,5,6 Ronald Kulich,1,7,* Ana-Maria Vranceanu2,* 1Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 2Department of Psychiatry, Massachusetts General Hospital, Harvard School of Medicine, MA, USA; 3Department of Clinical Health Psychology, William James College, MA, USA; 4Department of Health Sciences Library, Tufts University School of Dental Medicine, Boston, MA, USA; 5Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 6Research and Network Development, Boston PainCare, Waltham, MA, USA; 7Department of Anesthesia, Massachusetts General Hospital, Harvard School of Medicine, MA, USA *These authors contributed equally to this work Purpose: The importance of improved physical function as a primary outcome in the treatment of chronic pain is widely accepted. There have been limited attempts to assess the effects mindfulness skills training (MST) has on objective outcomes in chronic pain care. Methods: This systematic review evaluated published reports of original randomized controlled trials that described physical function outcomes after MST in the chronic pain population and met methodological quality according to a list of predefined criteria. PRISMA criteria were used to identify and select studies, and assess their eligibility for inclusion. The established guidelines for best practice of systematic reviews were followed to report the results. Results: Of the 2,818 articles identified from the original search of four electronic databases, inclusionary criteria were met by 15 studies published as of August 10, 2015, totaling 1,199 patients. All included studies used self-report measures of physical function, and only two studies also employed performance-based measures of function. There were wide variations in how physical function was conceptualized and measured. Although the quality of the studies was rated as high, there was inconclusive evidence for improvement in physical function assessed by self-report due to contradiction in individual study findings and the measures used to assess function. Strong evidence for lack of improvement in physical function assessed via performance-based measures was found. Conclusion: This review draws attention to the importance of having a unified approach to how physical function is conceptualized and assessed, as well as the importance of using quality performance-based measures in addition to subjective self-reports that appropriately assess the physical function construct within MSTs for chronic pain. Keywords: mindfulness, chronic pain, physical functioning, systematic review, outcome measures, activity tracker