Mindfulness-Based Interventions to Address Pain for Adults Living With and Beyond Cancer (2018–2022)

Abstract

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings related to pain for adults living with and beyond cancer, specifically those on mindfulness-based interventions.

Full Systematic Review Question

This systematic review addressed the question “What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve performance and participation for adults living with cancer?”

Current Theme Reported

The main theme of the studies included in this systematic review brief includes mindfulness-based interventions to address pain for adults living with and beyond cancer.

Clinical Scenario

There is a high prevalence of pain among adults living with and beyond cancer, with a pain prevalence rate of 39 to above 66% of pain in patients with cancer across various stages (van den Beuken-van Everdingen et al., 2016 as cited in Tien et al., 2022). Decreased participation in meaningful occupations, changes in psychological state, overall impact on daily functioning and effects on psychological outcomes including pain, have been reported (Dahlhamer et al., 2018 as cited in American Occupational Therapy Association, 2021; Fisher et al., 2007 as cited in American Occupational Therapy Association, 2021; American Occupational Therapy Association, 2021).

Being present, nonjudgmental, and intentional focus are key components to mindfulness (Baer et al., 2019 as cited in Zhang et al., 2021). Examples of mindfulness-based interventions (MBIs) include mindfulness-based stress reduction and mindfulness-based cognitive therapy, as well as other techniques that include mindfulness training within practice such as acceptance and commitment therapy (Hess, 2018). Occupational therapy practitioners are identified as providers who play a vital role in addressing pain and can uniquely use MBIs to highlight the importance of the mind–body–spirit relationship on engagement and participation in occupation and daily activities (American Occupational Therapy Association, 2021).

Summary of Key Findings

One systematic review was included related to interventions focusing on mindfulness to address pain for adults with and beyond cancer (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009). The strength-of-evidence designations are based on the guidelines of the U.S. Preventive Services Task Force (2018).

Table 1.

Evidence Table for Mindfulness-Based Interventions to Address Pain for Adults Living With and Beyond Cancer

Author, YearLevel of Evidence (types of study designs)Risk of Bias (RoB)Setting	Systematic Review Details	Findings From Reviews
One Level 1A review provided moderate strength of evidence to support the use of MBIs to improve pain outcomes for adults with varying types of cancer (majority breast) at all stages.
Feng et al. (2022) Level 1a—Systematic review with meta-analysis RoB Low Setting Remote or clinic-based	Participants N = 843 total (n = 422 MBIs); mixed types of cancer with 6/10 RCTs including participants with breast cancer; stages of cancer varied between 0 and IV; mean age: 50s, female: 90%, race/ethnicity: not reported Number of Articles (and Level) 10 RCTs Databases Searched Medline, PubMed, CINAHL, PsycINFO, Cochrane Central Registries of controlled trials, Clinical Trials.gov Outcome(s) Pain Intervention(s) MBSR adapted from standard MBSR program n = 4; ACT n = 2, mindfulness yoga n = 2, MBCT and commercial electronic mindfulness programs n = 2 Delivery Methods n = 4 remote interventions via online supervision and guidance (all were individual); others adopted standard clinic-based MBIs (all were group form) Dose Ranges (if available) n = 7 consisted of 8-wk program with 3 hr of practice weekly; Others not reported	MBIs were associated with a statistically significant improvement in pain intensity at short-term follow-up (6–12 wk) and long-term follow-up (3–6 mo). These findings were also consistent in contrast with passive control at both short- and long-term follow-up, except for pain interference postintervention. Clinic-based MBIs were found to have significant transient and lasting effects in reducing pain intensity at short- and long-term follow-up.

Note. ACT = acceptance and commitment therapy; MBCT = mindfulness-based cognitive therapy; MBI = mindfulness-based interventions; MBSR = mindfulness-based stress reduction; RCT = randomized clinical trial.

Bottom Line for Occupational Therapy Practice

Managing pain as a result of a cancer diagnosis and/or treatment is critical to supporting physical and psychosocial well-being for adults living with and beyond cancer. MBIs are a group of interventions that can be considered for improving pain at both short- and long-term follow-up, as supported by the findings of the systematic review. These interventions can take place at all stages along the continuum of cancer and for adults with varying cancer diagnoses. Although a majority of the participants in the review had a diagnosis of breast cancer, a range of other cancers were represented, including hematologic and solid tumors. Occupational therapy practitioners who incorporate MBIs into their practice may benefit from additional training. Specifically, standard clinic-based MBIs should be considered, if feasible, as a mode of delivery to address pain for adults with and beyond cancer as significant intervention effects were only seen in clinic-based MBIs compared with remote MBIs.