Feasibility of a Virtual Mindfulness-Based Stress Reduction Intervention for Individuals With Chronic Pain: Pilot Randomized Controlled Trial.

The short version

This pilot randomized trial with 61 adults living with chronic pain tested whether an 8-week mindfulness-based stress reduction (MBSR) course delivered over video could be run successfully, and looked at early signs of benefit. MBSR is a structured group program that teaches meditation, body awareness and gentle yoga so that people relate differently to pain and stress. Chronic pain limits physical function, emotional well-being and quality of life, and standard medical treatment often brings only limited relief, which is why the researchers explored this approach. Because it was a pilot, the main question was feasibility rather than effectiveness. Participants in Quebec, Canada, had non-cancer pain lasting at least three months, on most days of the week, rated 4 or higher out of 10. Thirty were assigned to MBSR and 31 to a no-intervention comparison group. The MBSR group met on Zoom for eight weekly two-hour sessions in groups of 15, with a 30-minute home practice goal six days a week, and everyone completed questionnaires before the program, at 8 weeks and at 3 months. The study did not meet its feasibility targets: 23.5% of people contacted joined (target 30%), 60.7% completed all assessments (target 80%) and 63.3% of the MBSR group attended at least four sessions and did enough home practice (target 80%). In exploratory analyses, pain-related disability dropped from 36.0 to 24.0 points by 3 months with MBSR versus 39.1 to 36.0 in the comparison group (interaction P = .03), and physical health, overall health and participation in social activities also improved more (P = .003, .02 and .02). No group-by-time differences appeared for pain catastrophizing, pain acceptance, pain self-efficacy or pain intensity. MBSR participants recorded 26 adverse events, mainly fatigue, pain and agitation during exercises. Questionnaires took about 36 minutes to complete, and 68.3% of expected practice-journal entries were returned. The authors describe all clinical results as hypothesis-generating because the trial was too small to test effectiveness, ran many comparisons without adjustment, and lost participants. Limitations they list include unplanned optional follow-up sessions and a peer-support group formed by participants that may have reinforced the 3-month results, adverse events recorded only through unstructured journals, and assessor blinding that was lost after baseline. They propose simpler consent, targeted recruitment and a waitlist control in a future, adequately powered trial.

Key findings

• In a pilot trial of 61 adults with chronic pain in Quebec, an 8-week virtual mindfulness-based stress reduction (MBSR) course missed all three feasibility targets: 23.5% of people contacted joined (target 30%), 60.7% completed all assessments (target 80%) and 63.3% of the MBSR group attended enough sessions and did enough home practice (target 80%).
• In exploratory analyses that were not adjusted for multiple comparisons, pain-related disability fell more with MBSR (36.0 to 24.0 on a 0-70 scale at 3 months vs 39.1 to 36.0 with no program; interaction P = .03), and physical health, global health and social participation also improved more (P = .003, .02, .02).
• There were no group-by-time differences in pain catastrophizing, pain acceptance, pain self-efficacy (apart from a self-rated global change favoring MBSR), pain intensity or most other quality-of-life scores.
• MBSR participants recorded 26 adverse events in journals, mainly fatigue, pain and agitation during exercises and mostly in the first session, and because the pilot was small and underpowered, its clinical findings are hypothesis-generating only.

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