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Evid Based Ment Health. 2019 Feb;22(1):26-35. doi: 10.1136/ebmental-2018-300062.

Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: A systematic review and network meta-analysis.

Author information

1
Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
2
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
3
Faculty of Medicine, Memorial University of Newfoundland, Newfoundland and Labrador, Canada.
4
School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
5
Department of Psychology, McGill University, Montreal, Canada.
6
Independent Information Specialist Consultant, Ottawa, Ontario, Canada.
7
Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada.
8
Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada.
9
Department of Anesthesia and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Abstract

QUESTION:

This review compares mindfulness-based stress reduction (MBSR) to cognitive-behavioural therapy (CBT) in its ability to improve physical functioning and reduce pain intensity and distress in patients with chronic pain (CP), when evaluated against control conditions.

STUDY SELECTION AND ANALYSIS:

Ovid MEDLINE, EmbaseClassic+Embase, PsycINFO and the Cochrane Library were searched to identify randomised controlled trials. The primary outcome measure was physical functioning. Secondary outcomes were pain intensity and depression symptoms. We used random and fixed effects (RE and FE) network meta-analyses (NMA) to compare MBSR, CBT and control interventions on the standardised mean difference scale.

FINDINGS:

Twenty-one studies were included: 13 CBT vs control (n=1095), 7 MBSR vs control (n=545) and 1 MBSR vs CBT vs control (n=341). Of the 21 articles, 12 were determined to be of fair or good quality. Findings from RE NMA for change in physical functioning, pain intensity and depression revealed clinically important advantages relative to control for MBSR and CBT, but no evidence of an important difference between MBSR and CBT was found.

CONCLUSIONS:

This review suggests that MBSR offers another potentially helpful intervention for CP management. Additional research using consistent measures is required to guide decisions about providing CBT or MBSR.

KEYWORDS:

chronic pain; meta-analysis; cognitive-behavioral therapy; mindfulness-based stress reduction; randomized controlled trials

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