Background & Aims

Chronic pain patients are known to exhibit characteristic cognitive biases and behavioral patterns, such as pain catastrophizing and over-pacing(Leeuw, 2007). Physical pain and psychological status are known to affect each other(Fishbain, 1997). This association is thought to be mediated by interoceptive awareness, an ability to be aware of internal sensations in the body(Di Lernia, 2016). Recently, decreased interoceptive awareness in chronic pain patients was reported(Takaoka, 2023). Since cognitive behavioral therapy (CBT) is recommended well as psychological approach(Guzman., 2002, Gatchel, 2008), mindfulness-based cognitive therapy (MBCT), which combined CBT techniques with mindfulness to improve interoceptive awareness, has been drawing attention(Veehof, 2016). In this study, we conducted MBCT as an interdisciplinary treatment and investigated the recovery of interoceptive awareness in patients with chronic pain.

Methods

This is a retrospective cohort study for an 8-week standard MBCT program(Segal et al., 2001) performed for chronic pain patients (pain duration > 3 months) in the interdisciplinary pain center at Keio University Hospital from July 2018 to March 2022. Interoceptive awareness was evaluated by the Multidimensional Assessment of Interoceptive Awareness (MAIA) composed of 8 dimensions. We collected data including age, sex, pain-related factors assessed by the brief pain inventory, pain catastrophizing scale(PCS), pain self-efficacy questionnaire and pain disability assessment scale, psychological factors assessed by the hospital anxiety and depression scale, and sleep disorder using the Athens insomnia scale, and quality of life using the EuroQol 5 dimensions before and after the MBCT. Patients with missing data were excluded from the analysis. We examined improvement in each variable using the paired t-tests, and predictors for the improvement using the Pearson’s correlation analysis.

Results

A total of 65 patients were included in this study. The averaged age of the participants was 62.2, and 67% were female. The median number of visits to the MBCT program was 7 out of 8 sessions. Average pain intensity was 5.2 in the numerical rating scale. The paired t-test identified significant improvements in attention regulation, emotional awareness, self-regulation, body listening, and trusting which were dimensions in the MAIA (p < 0.005). In addition, there were improvements in the following pain-related factors; anxiety, daily activities, pain catastrophizing, self-efficacy, insomnia, and quality of life (p < 0.05), although pain intensity was not significantly improved. Correlation analysis showed self regulation and trusting in the MAIA were negatively correlated with PCS at baseline.

Conclusions

MBCT for chronic pain possibly improves interoceptive awareness and pain-related psychology in patients with chronic pain. The association between interoceptive awareness and pain catastrophizing suggests that cultivating interoceptive awareness may stop the vicious circle of chronic pain by reducing anxiety and avoidance behavior. Therefore, MBCT may be a valid alternative option for interdisciplinary treatment. Further studies are required to identify mechanisms and mediating factors regarding the MBCT.

References

Di Lernia D, Serino S, Riva G. Pain in the body. Altered interoception in chronic pain conditions: A systematic review. Neurosci Biobehav Rev 2016; 71: 328–341.

Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic Pain-Associated Depression: Antecedent or Consequence of Chronic Pain? A Review. Clin J Pain 1997; 13: 116–137.

Gatchel RJ, Rollings KH. Evidence-informed management of chronic low back pain with cognitive behavioral therapy. Spine J 2008; 8: 40–44.

Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2002; CD000963.

Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 2007; 30:77–94.

Segal, Zindel V. J. Mark G. Williams JDT. Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. Guilford Press. Guilford Pubn, 2001

Takaoka, S., Wakaizumi, K., Tanaka, C., Tanaka, S., Kawate, M., Hoshino, R., Matsudaira, K., Fujisawa, D., Morisaki, H., & Kosugi, S. (2023). Decreased Interoceptive Awareness as a Risk Factor for Moderate to Severe Pain in Japanese Full-Time Workers: A Longitudinal Cohort Study. Journal of Clinical Medicine, 12(8). https://doi.org/10.3390/jcm12082896

Veehof MM, Trompetter HR, Bohlmeijer ET, Schreurs KMG, Trompetter HR, Bohlmeijer ET et al. Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cogn Behav Ther 2016; 6073: 1–27.

Presenting Author

Chisato Tanaka

Poster Authors

Chisato Tanaka

MD, PhD

Department of Anesthesiology, Keio University School of Medicine

Lead Author

Yuta Shinohara

MA

Interdisciplinary Pain Center, Keio University Hospital

Lead Author

Morihiko Kawate

MD

Department of Anesthesiology, Keio University School of Medicine

Lead Author

Shizuko Kosugi M.D.

Ph.D.

Department of Anesthesiology, Keio University School of Medicine

Lead Author

Daisuke Fujisawa M.D.

Ph.D.

Department of Neuropsychiatry, Keio University School of Medicine,

Lead Author

Kenta Wakaizumi M.D.

Ph.D.

Department of Anesthesiology, Keio University School of Medicine

Lead Author

Topics

  • Treatment/Management: Pharmacology: Psychological and Rehabilitative Therapies