relaxation and mindfulness in pain: a review

8/3/2019 Relaxation and Mindfulness in Pain: A Review

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Relaxation and Mindfulness in Pain: A Review

Dunford, E. & Thompson, M. (2010). Relaxation and mindfulnessin pain: a review. Reviews in Pain. 4, 18-23.

NB: The e-mail address for the authors are not printed inside this document.Miles Thompson can be contacted via this web site: www.mvdct.org.uk
http://www.mvdct.org.uk/http://www.mvdct.org.uk/


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Outline

Ts ate podes a seete naate eew of te exstng,

pee-eewed edene fo te use of eaxaton and mndfunesswt ndduas sueng fom pan. Hang dened bot tems,

te pape w outne te sope of ts eew befoe pesentng ts

ndngs. It onudes by dsussng boade aeas eeant to ts

eew as we as potenta esea detons.

Terms

An obsee watng ete a eaxaton o a mndfuness ass

toug te gass of a doo mgt stugge to te tem apat. Bot

woud pobaby noe a goup of patpants sttng o yng st

wt te eyes sut. Howee te deng dentons assoated

wt tese tenques nt at te sgnant aatons n wat tey

am to aee.

Reaxaton as been dened as tose pates wose pmay stated

goa s etaton of a psyopysooga state of eaxaton o ypo

aousa (p.3). A ommon denton of mndfuness s payng

attenton n a patua way: on pupose, n te pesent moment,

and non-judgmentay. Fo te pupose of ts ate we suggest

te foowng paae dentons of eaxaton and mndfuness,

debeatey - and possby oe-smpstay - set up to ontast one

anote: Reaxaton ams to aow ndduas to edue te feengs

of stess o tenson, we mndfuness ams to aow ndduas to

obsee te feengs of stess o tenson.

Reaxaton as a na tenque omes n many deent foms

nudng: pogesse muse/musua eaxaton, autogen

tanng, bofeedbak and guded magey. Deent aetes of

mndfuness aso exst su as Mndfuness-Based Stess Reduton(MBSR), Mndfuness Based Cognte Teapy (MBC) as we as

exstng wtn deent teapeut modes su as Aeptane and

Commtment Teapy (AC) and Daeta Beaou Teapy

(DB)3.

It s ea fom te paagaps aboe tat deenes exst between

eaxaton and mndfuness. Of ouse peope wo ae eanng

mndfuness mgt nd te exeses eaxng and tose wo ae

eaxed mgt nd t ease to e mndfuy. Howee t appeas tat

te tenques ae deent agendas.

Review Method

Ts ate does not am to pode a quanttate o meta-anayt

eew of te edene base fo eaxaton and mndfuness. Instead

t opes to ge a moe genea oeew of te uent state of te

teatue. Seaes usng Web of Sene and PsyINFO databases

wee onduted on 7t August 8. Tey wee mted between te

yeas 958 and 8 and used te tems eaxaton and pan, and

mndfuness and pan. Te eew tageted peous systemat

eews and goup-based esea studes pubsed n pee-eewed

jounas usng ete eaxaton o mndfuness n pan popuatons

(ete aute o on). Ate abstats wee ead by one auto

and exuded f tey: a) used eaxaton o mndfuness as ony onepat of a wde teapeut nteenton; b) dd not nude a sepaate

Reaxaton and Mndfuness n Pan: A ReewEmma Dunfod BSBath Centre for Pain Services.

Mes Tompson DCnPsyBath Centre for Pain Services.

S r i :

Ts ate eews te exstng, pee-eewed edene fo te use of eaxaton and mndfuness nbot aute and on pan.

Tee s some edene tat eaxaton an edue pan outomes n bot aute and on pan,owee tee s edene tat tese mpoements ae not mantaned oe tme.

Moe mted esea suggests tat mndfuness an ead to mpoements n psyooga measuesand pysa funtonng and tese mpoements appea to be mantaned at foow-up.

Fute esea s needed. Bot eseaes and pattones need to be eae on te outomes tatte tenques best fatate and te poesses w ae ate wtn tem.


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sensaton n on ow bak pan, atts and pegnany-eated

pan. Autogen tanng, jaw eaxaton and systemat eaxaton

wee found to edue postopeate pan. Rytm beatng and

ote eaxaton nteentons wee not found to be eete. In te

studes wee foow-up data wee nuded, mpoements wee not

mantaned at 3 and 6 monts5,6.

Evidence for Mindfulness and Pain

Of te nta esuts fom te seaes ony 3 studes met

te nuson tea of ts eew. A numbe of tese studes

andomsed patpants and/o used onto goups to some extent,

owee many wee pot studes. en ates wee teatment

outome studes nestgatng te eeteness of mndfuness wtn

adut on pan popuatons. Te emande nuded ete

mxed sampes o nestgated aute pan toeane wtn eaty

patpants. A summay of te 3 studes eewed ae pesented nTable 1. Te foowng text dsusses te studes by pan pesentaton

(on pan, bomyaga, atts, mxed and ommunty sampes

and eaty patpants).

Kabat-Znn and s team onduted some of te st esea studes

nto te eeteness of mndfuness7,8. Inteestngy, tese utsed

on pan popuatons. Ts esea found mpoements n

pysa and psyooga measues and tese mpoements wee

mantaned up to 5 monts ate. Moe eenty a study ompaed

mndfuness to massage teapy and standad ae ontos n a

andomsed onto ta. Patpants n te mndfuness ondton

epoted no deene n ete pysa o psyooga symptomsdety foowng te nteenton, but at week foow-up

epoted sgnant mpoements on psyooga measues. In

ontast, patpants n te massage ondton epoted a sgnant

pan eduton mmedatey foowng te nteenton but ts was

not mantaned at foow-up. Mndfuness nteentons ae aso

been found to ead to sgnant edutons n depesson, anxety

and pan-eated gef and sgnant ong tem mpoements n

pan aeptane and pysa funtonng wen ompaed to ontos

n a andomsed onto ta (RC). Futemoe, edene fom

fae to fae and dstane mndfuness nteentons eeas sgnant

mpoements n psyooga dstess, emotona and soa

funtonng and pan atastopsng wen ompaed to a onto

ondton.

A sma numbe of studes ae been onduted wt bomyaga

suees. In RCs, mndfuness nteentons ae been found to

sgnanty edue symptoms of depesson3 and nease sense of

oeene. Futemoe, eent esea epots tat mndfuness

nteentons ead to sgnant edutons n anxety and depesson

and neases n epoted quaty of fe wen ompaed to eaxaton,

exese and soa suppot5. Tese mpoements wee mantaned at

a 3 yea foow-up. Wt eumatod atts suees, no deene

was found at te end of teatment o ndeed at te mont foow-

up. Howee at te 6 mont foow-up, tose n te mndfuness

ondton epoted sgnant mpoements n psyooga dstessand we-beng n ompason to watng st ontos6.

measue of pan n te outomes; ) wee dssetatons o ase studes;

d) ontaned no abstat; o e) wee not wtten n Engs. In ases

of unetanty suoundng wete an ate met te nuson

tea, aaton was sougt toug dsusson wt te ote

auto.

Te esea ommunty as ad substantay onge to estabs

an edene base fo eaxaton tenques and te tem eaxaton

eates to many ote tngs, fo exampe te pysooga eaxaton

of a muse n sugey. Aodngy t was unsupsng tat te

seaes ntay podued 55 esuts fo eaxaton and pan, and

fo mndfuness and pan.

Evidence for Relaxation and Pain

Te eaxaton esea edene oes a wde span of tme and a

wde aety of pan expeenes. Fotunatey, gen ts beadt anddept, 3 systemat eews,5,6 pubsed n 8 and 6 pode

oeews, but not meta-anayses, of te edene base fo eaxaton

between 5 and 5 fo bot aute and on pan n adut

popuatons. Tese eews w fom te bass of te eaxaton

ndngs fo ts ate.

Sees and Caos (8) systemat eew of eaxaton n aute

pan dented seen andomsed onto tas w met te

spe nuson tea. A nestgated te use of eaxaton,

ete dung o foowng a suga poedue. In tems of pan

outomes (e.g. pan sensatons and pan dstess), ony 3 of 7 studes

epoted sgnant edutons7,8,

. Fe studes nuded measues ofwde psyooga outomes (e.g. anxety, mood, opng), of w

ony study epoted a sgnant eduton8. Seea metodooga

weaknesses wee ggted, su as unea dentons of

eaxaton, sma sampe szes and eaxaton nteentons ombnng

deent tenques. Sees and Cao onuded tat based on te

exstng edene t s not possbe to daw onusons about te

eeteness of eaxaton nteentons n aute pan.

Wtn on pan, Cao and Sees (8) dented

andomsed onto ta studes (7 studyng non magnant pan,

studyng ane pan) meetng te nuson tea5. Ony

out of 7 studes fousng on non-magnant pan (e.g. eumatod

atts and bomyaga) epoted sgnant pan edutons at

post-teatment,. Tee of tese studes onduted foow-ups,,3

at tme nteas angng fom weeks to monts but none found

tat sgnant mpoements wee mantaned. Wtn onoogy,

studes wee dented and epoted sgnant deenes n

pan outomes wen eaxaton was ompaed to ontos. Wen

ompaed to ote nteentons, te eew found eaxaton to be

ess eete tan ydoteapy, bofeedbak and oa spnt dees.

Kwekkeboom and Getasdott (6) onduted a moe eent

systemat eew of te eay of eaxaton tenques n bot

aute and on pan6. Oea eaxaton was found to ae a

sgnant eet on pan outomes n 8 of 5 andomsed ontostudes. Pogesse muse eaxaton was found to edue pan


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moment to moment awaeness so tat peope an bette note

te tendenes to at n fe as t unfods. Subte but mpotant

deenes ke ts may be pat of te eason fo te esuts

pesented aboe.

As ee, moe goous metodooges wt bette ontos, moe

aefu seeton of outome measues and onge foow-up

peods ae equed. Studes w dety ompae eaxaton

and mndfuness woud aso be usefu. At pesent, esea tends to

measue deent outomes w makes nte-study ompason

dut. Reseaes aso need to onsde w outomes ae most

appopate. Measung pan s ntute; assessng te mpat of

ote psyooga aabes su as anxety and depesson s aso

usefu. Howee, futue esea soud aso onsde measung

ees of nddua funtonng. Ts w aow eseaes to assess

f eaxaton and mndfuness aow subjets to do moe n te

eeyday es een f pan o psyooga dstess do not deease.

Fute esea aso needs to nestgate te poesses noed n

eaxaton and mndfuness so tat te usefuness an be eauated

and te teang mpoed. Despte te eatey sot tme t as

been a subjet of westen sent study, mndfuness as aeady

stated to expoe tese questons3. Some of ts wok as een been

done wt on pan patents3. Resea suggests tat unde

te umbea tem mndfuness oexst a numbe of nteeated

psyooga poesses w osey mo mpotant fatos n

ontempoay ontextua psyooga esea and teapy3.

Payng moe attenton to poesses su as ognte fuson (wee

entangement wt tougts and feengs domnate oe ote

possbe nuenes on an ndduas beaou), aeptane/wngness and ontat wt te pesent moment, may aow us to

mpoe ou abty to tea mndfuness n te futue (see Hayes,

6, fo moe nfomaton and expanaton of tese tems3).

As yet, many questons st eman about te makeup of te

ate ngedents nsde eaxaton. It s possbe tat onto o

dstaton ae an mpotant oe to pay. If so, te expementa

teatue may aeady aow us to make some ompasons between

aspets of eaxaton and mndfuness. Fo exampe, eaty subjets

ae demonstated neased pan toeane n a od pesso

task wen appyng aeptane (mndfuness) ate tan onto

(eaxaton)33. Equay, eaty subjets wo eeed eet soks

found aeptane to be moe usefu tan dstaton (eaxaton)3.

Of ouse dstaton as been found to be nay eete n te

eduton of paedat pan dung mmunzatons35, but tese ae

sot ed poedues and te utty fo on ondtons s ess

etan. Indeed tee s an extense teatue w suggests tat

foms of tougt suppesson an atuay be ountepodute36.

Dsussons of ts natue ggt ow mpotant t s fo

pattones and eseaes to be ea about wat tey want to

aee and wat te tenques atuay do. Due to te uent

state of te teatue t s ony possbe to daw tentate onusons

about te eay of bot of tese nteentons. Howee, based

on te exstng edene t woud appea tat wst eaxatonnteentons an be benea n te sot tem, mndfuness may be

One study used a mxed sampe onsstng of a aety of meda

ondtons, nudng 37 on pan patents and 6 bomyaga

suees. Foowng te mndfuness nteenton sgnant

mpoements n pysa and psyooga dstess, and eat-

eated quaty of fe wee epoted7. Howee, t s dut to

genease fom tese esuts as pan patpants made up sma

peentages of te sampe (6% and 5% espetey) and no onto

o foow-up data was nuded. Mndfuness as aso been ompaed

to a ognte beaoua stess eduton (CBSR) nteenton n

a ommunty sampe teated fo stess eduton wee pan was

measued8. Te mndfuness nteenton was found to demonstate

bette outomes wen ompaed to te CBSR ondton owee

t s mpotant to note te eatey ow aeage pe-teatment

ees of pan and g aatons of pan soes wtn and between

te sampes n ts study. Fnay, te eet of mndfuness and

guded magey on pan toeane wtn eaty subjets as been

nestgated n an RC9. Patpants n te mndfuness ondton

demonstated neased pan toeane dung an expementayndued aute pan task; owee, te autos onuded tat ts

was not eated to te aquston of mndfuness sks.

Discussion

Despte te fat tat eaxaton tenques ae a onsdeabe

tme adantage n estabsng te empa edene base, t s

nteestng tat te teatue n pan s not moe ompeng n

outome. Geneay speakng, tee s some edene tat eaxaton

tenques an edue pan outomes n aute pan but te

esea s not oewemng. In on pan, agan tee s somesuppotng edene but foow-up data suggests tat te usefuness

of eaxaton edues oe tme. Mndfuness esea as tended

to fous on on pan ondtons and nteestngy te uent

edene s geneay bette tan eaxaton at foow-up een f esuts

mmedatey afte te nteenton ae not aways so stong.

Wen ntepetng te ndngs fom ts eew t s mpotant to

note te deenes between te sepaate edene bases. Te eew

of te eaxaton teatue was based on 3 exstng systemat eews

weeas te eew of te mndfuness teatue was based on atua

studes. Te systemat eews of te eaxaton teatue apped

moe goous seeton tea tan tose n te eew of te

mndfuness teatue. Teefoe auton s needed wen ntepetng

te ndngs fom ts eew as some of te mndfuness studes

wee, fo exampe, unontoed and/o ontaned eatey sma

sampe szes. Indeed t s possbe tat studes wt bette onto and

age numbes mgt not ontnue to suppot te uent ndngs

and unt moe esea as been aed out no m onusons an

be made.

If esea metodoogy and onto s not te eason fo te aboe

esuts t s possbe to ypotesze ote easons. One possbty s

tat t s dut to genease and mantan eaxaton sks outsde

of te assoom/teapy enonment. Indeed t may be patuay

ad to engage n su beaou dung tmes of g stess wtneeyday fe. Mndfuness, on te ote and, expty teaes


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3. Saw L, E A. Reaxaton tanng as a teatment fo on

pan aused by ueate ots. Pan 987; 9(3): 87-93.

. Soman R, Bown P, Adana E, Cee E. Te use of eaxaton

fo te pomoton of omfot and pan eef n pesons wt

adaned ane. Contemp Nuse 99; 3(): 6-.

5. Gay MC, Pppot P, Lumnet O. Deenta eeteness of

psyobooga nteentons fo edung osteoatts pan: a

ompason of Ekson ypnoss and Jaobsen eaxaton. Eu J

Pan ; 3(3): 69-77.

6. Hasson D, Anetz B, Jeeus L. A andomzed na ta of

te teatment eets of massage ompaed to eaxaton tape

eodngs on duse ong-tem pan. Psyote Psyosom

; 73(): 7-.

7. Kabat-Znn J. An outpatent pogam n beaoa mednefo on pan patents based on te pate of mndfuness

medtaton: teoeta onsdeatons and pemnay esuts.

Gen Hosp Psy 98; (): 33-7.

8. Kabat-Znn J, Lpwot L, Buney R. Te na use of

mndfuness medtaton fo te sef-eguaton of on pan. J

Bea Med 985; 8(): 63-9.

9. Pews-Ogan M, Owens JE, Goodman M, Wofe P, Song J.

A pot study eauatng mndfuness-based stess eduton and

massage fo te management of on pan. J Gen Inten Med

5; (): 36-8.

. Sagua D, Re KG. Te eeteness of mndfuness tanng on

te geng poess and emotona we-beng of on pan

patents. J Cn Psyo Med Settngs ; (): 333-.

. Moone NE, Geo CM, Wene DK. Mndfuness medtaton

fo te teatment of on ow bak pan n ode aduts: a

andomzed ontoed pot study. Pan 8; 3(3): 3-9.

. Gadne-Nx J, Bakmant S, Babat J, Gummtt J. Eauatng

dstane eduaton of a mndfuness-based medtaton

pogamme fo on pan management. J eemed eeae

8; (): 88-9.

3. Septon SE, Samon P, Wessbeke I, Ume C, Foyd A,

Hooe K, et a. Mndfuness medtaton aeates depesse

symptoms n women wt bomyaga: esuts of a andomzed

na ta. Atts Reum-Atts Cae Res 7; 57():

77-85.

. Wessbeke I, Samon P, Studts JL, Foyd AR, Dedet EA,

Septon SE. Mndfuness-based stess eduton and sense of

oeene among women wt bomyaga. J Cn Psyo Med

Settngs ; 9(): 97-37.

moe usefu n te ong tem f te desed esut s te aquston of

sks w ae usefu outsde of te teapy oom.

Re f e R e n c e s

. Astn JA, Sapo SL, Esenbeg DM, Foys KL. Mnd-body

medne: state of te sene, mpatons fo pate. J Am

Boad Fam Pat 3; 6(): 3-7.

. Kabat-Znn J. Weee you go, tee you ae: mndfuness

medtaton n eeyday fe. New Yok: Hypeon; 99.

3. Bae RA. Mndfuness tanng as a na nteenton: a

oneptua and empa eew. Cn Psyo S Pat 3;

(): 5-3.

. Sees K, Cao D. Reaxaton tenques fo aute panmanagement: a systemat eew. J Ad Nus 998; 7(3): 66-

75.

5. Cao D, Sees K. Reaxaton fo te eef of on pan: a

systemat eew. J Ad Nus 998; 7(3): 76-87.

6. Kwekkeboom KL, Getasdott E. Systemat Reew of

Reaxaton Inteentons fo Pan. J Nus Soas 6; 38(3):

69-77.

7. Ceo CM. Postopeate pan eef toug eaxaton n

edey patents wt fatued ps. Otop Nus 98; 3(3):-9.

8. Mande CL, Doma AD, Hangton DP, Leseman J, Bozadjan

E, Fedman R, Benson H. Reaxaton esponse n femoa

angogapy. Radoogy 99; 7(3): 737-9.

9. Wson JF. Beaou pepaaton fo sugey: benet o am. J

Bea Med 98; (): 79-.

. Dusk P, Newman AM. Te eeteness of eaxaton n

eeng pan of women wt eumatod atts. In Funk SG

et a. (edtos). Key aspets of omfot. Management of pan,

fatgue and nausea. Spnge, New Yok: Spnge; 989, p. 5-

.

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ommunty: teang eaxaton as a opng sk. Depatment

of Heat Post-Dotoa Nusng Resea Feowsp. London:

Depatment of Heat; 993.

. Okeson JP, Moody PM, Kempe J, Haey JV. Eauaton of

ousa spnt teapy and eaxaton poedues n patents wt

tempoomandbua dsodes. J Am Dent Asso 983; 7(3):

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5. Gossman P, efentae-Gme U, Raysz A, Kespe U.

Mndfuness tanng as an nteenton fo bomyaga:

edene of postnteenton and 3-yea foow-up benets n

we-beng. Psyote Psyosom 7; 76(): 6-33.

6. Padan EK, Baumgaten M, Langenbeg P, Handwege B,

Gpn AK, Magya , et a. Eet of mndfuness-based stess

eduton n eumatod atts patents. Atts Reum-

Atts Cae Res 7; 57(7): 3-.

7. Rebe DK, Geeson JM, Banad GC, Rosenzweg S.

Mndfuness-based stess eduton and eat-eated quaty of

fe n a eteogeneous patent popuaton. Gen Hosp Psyat

; 3(): 83-9.

8. Smt BW, Seey BM, Daen J, Wggns K, ooey E, Benad

J. A pot study ompang te eets of mndfuness-based and

ognte-beaoua stess eduton. J Atenate Comp Med8; (3): 5-8.

9. Kngston J, Cadwk P, Meon D, Sknne . A pot

andomzed onto ta nestgatng te eet of mndfuness

pate on pan toeane, psyooga we-beng, and

pysooga atty. J Psyosom Res 7; 6(3): 97-3.

3. Bae RA, Smt G, Hopkns J, Ketemeye J, oney L. Usng

sef-epot assessment metods to expoe faets of mndfuness.

Assessment. 6; 3(): 7-5.

3. MCaken L, Tompson M. Components of mndfuness npatents wt on pan. J Psyopato Bea Assess 9;

3(): 75-8.

3. Hayes SC, Luoma JB, Bond FW, Masuda A, Ls J. Aeptane

and ommtment teapy: Mode, poesses and outomes.

Bea Res Te. 6; (): -5.

33. Hayes SC, Bssett R, Kon Z, Zette RD, Rosenfab IS, Coope

LD, et a. Te mpat of aeptane esus onto atonaes on

pan toeane. Psyo Re 999; 9(): 33-7.

3. MMuen J, Banes-Homes D, Banes-Homes Y, Stewat I,

Luano C, Coane A. Aeptane esus dstaton: bef

nstutons, metapos and exeses n neasng toeane fo

sef-deeed eet soks. Bea Res Te 8; 6(): -

9.

35. DeMoe M, Coen LL. Dstaton fo pedat mmunzaton

pan: a ta eew. J Cn Psyo Med Settngs 5; ():

8-9.

36. Wenza RM, Wegne DM. Tougt suppesson. Annu Re

Psyo ; 5: 59-9.


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Table 1. Summary of Mindfulness Studies Involving Pain

Author Total N

(control[s])

Random

allocation

Mindfulness

treatment

Main outcome for mindfulness group Fol low-up: Result

Gardener-Nix

et al. (2008)

278 (99 face to

face, 57 videoconferencing,

59 waiting list)

No 10 weeks, 10

hours per week.

Signicant improvements in pain level,

catastrophising, and mental health scorescompared to controls.

None.

Grossman et

al. (2007)

58

(13 active social

support)

Quasi

random

allocation

8 weeks, 2.5

hours per week.

Signicant improvements in quality of

life, coping with pain, anxiety, depression,

somatic complaints and pain ratings,

compared to pre-intervention and control

conditions.

3 years: Improvements maintained.

Kabat-Zinn et

al. (1982)

51 (0) No 10 weeks, 2 hours

per week.

Signicant reductions in pain ratings,

mood disturbance and psychiatric

symptomatology.

2.5, 7 months: Improvements

remained relatively stable.

Kabat-Zinn et

al. (1985)

142

(21 standardcare, 21 waiting

list)

No 10 weeks, 2 hours

per week.

Signicant improvements in present

moment pain, physical functioning, mood,psychological measures such as anxiety

and depression. Improvements not

observed in the control conditions.

2.5, 4.5, 7, 12 and 15 months:

Improvements sustained except forpresent moment pain.

Kingston et

al. (2007)

42

(21 guided

imagery control)

Yes 6 x 1 hour

sessions.

Signicant improvement in pain tolerance

in healthy subjects compared to controls.

Authors conclude this was not due to

mindfulness skills.

None.

Morone et al.

(2008)

37

(18 waiting list)

Yes 8 weeks, 1.5

hours per week.

Signicant improvements in acceptance,

activity engagement and physical

functioning compared to the control

condition.

3 months: Improvements

maintained.

Plews-Ogan

et al. (2005)

30

(10 massage

condition, 10

standard care

control)

Yes 8 weeks, 2.5

hours per week.

No signicant differences in pain or mental

health ratings compared to controls.

12 weeks: Signicant

improvements in mental health

ratings compared to controls.

Pradhan et al.

(2007)

63

(32 waiting list)

Yes 8 weeks, 2.5

hours per week.

No signicant difference compared to

controls.

6 months: Signicant

improvements in psychological

distress, well-being, depressive

symptoms and mindfulness.

Reibel et al.

(2001)

136 (0) No 8 weeks, 2.5

hours per week &

1 x 7 hour day.

Signicant improvements in health-related

quality of life, physical and psychological

distress in a mixed diagnosis sample.

1 year: Improvements maintained.

Sagula et al.

(2004)

57

(18 waiting list)

No 8 weeks, 1.5

hours per week.

Signicant reductions in depression and

state anxiety. Moved more quickly through

the stages of pain-related grief compared

to the control group.

None.

Sephton et al.

(2007)

91

(40 waiting list)

Yes 8 weeks, 2.5

hours per week.

Signicant improvement in depressive

symptoms compared to controls.

2 months: Improvements

maintained.

Smith et al.

(2008)

50

(14 cognitive

behavioural

stress reduction

condition)

No 8 weeks, 3 hours

per week.

Signicant reductions in pain, perceived

stress, depression, psychological well-

being, neuroticism, energy, binge eating

and mindfulness.

None.

Weissbeckeret al. (2002)

61(24 waiting list)

Yes 8 weeks, 2.5hours per week.

Signicant increase in sense of coherencecompared to controls.

None.

relaxation and mindfulness in pain: a review

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