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Assessing the Effectiveness of Mindfulness in the Treatment of Chronic Back Pain: Use of Quantitative Sensory Pain Assessment

  • Keren Reiner
  • Pesach Shvartzman
  • Zahira Ziva Cohen
  • Joshua D. Lipsitz


Findings from clinical trials of mindfulness-based interventions (MBI) support significant effects on chronic pain, yet the mechanisms underlying these effects are not well understood. A limitation of current research is reliance on global measures of functioning or narrow, self-report ratings of chronic pain severity. The present research aims to explore potential mechanisms that may explain the effects of MBIs on chronic pain by focusing on acute pain ratings, using quantitative sensory pain testing (QST) rather than chronic pain ratings. Thirty-six patients (10 men, 26 women, mean age = 58.03, ± 14.9) with chronic low back pain (CLBP) were randomly assigned to an 8-week MBI or wait-list control. QST measures of thermal and pain thresholds, as well as pain ratings to fixed stimuli, self-report measures of chronic pain severity, and interference with daily activities were assessed at baseline and after 8 weeks. We found a significant group X time interactions in self-report ratings of chronic pain severity (p = .04, ηp2 = .12) and interference (p = .04, ηp2 = .11): The MBI group showed a decrease in ratings while the control group showed an increase. Also, while patients in the control group exhibited an increase in suprathreshold pain ratings over time (p = .03, ηp2 = .15), indicating an apparent sensitization effect to painful stimuli, participants in the MBI group maintained their original ratings. The results suggest that mindfulness practice may have a “buffering effect” for CLBP patients, by attenuating their tendency to facilitate pain experience.


Chronic pain Mindfulness-based intervention Quantitative sensory pain testing QST Randomized clinical trial RCT 



Special thanks are given to Dr. Yamima Osher for her professional and generous help. This paper is dedicated to professor Joshua D. Lipsitz, our beloved mentor, who inspired and encouraged the making of this work.

Authors Contributions

KRN designed and executed the study, analyzed the data, and wrote the manuscript. PS collaborated with the design and writing of the study. ZZC collaborated in the writing, re-analyzed the data and edited the final manuscript. JDL designed the study and wrote the manuscript.

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study before their inclusion in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. Al-Obaidi, S., Nelson, R., Al-Awadhi, S., & Spine, N. A.-S. (2000). The role of anticipation and fear of pain in the persistence of avoidance behavior in patients with chronic low back pain. Spine, 25(9), 1126–1131.CrossRefGoogle Scholar
  2. Arendt-Nielsen, L., & Yarnitsky, D. (2009). Experimental and clinical applications of quantitative sensory testing applied to skin, muscles and viscera. The Journal of Pain, 10(6), 556–572.CrossRefGoogle Scholar
  3. Ballantyne, J. C., & LaForge, K. S. (2007). Opioid dependence and addiction during opioid treatment of chronic pain. Pain, 129(3), 235–255. Scholar
  4. Bawa, F. L. M., Mercer, S. W., Atherton, R. J., Clague, F., Keen, A., Scott, N. W., & Bond, C. M. (2015). Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis. British Journal of General Practice, 65(635), e387–e400. Scholar
  5. Bohlmeijer, E., Prenger, R., Taal, E., & Cuijpers, P. (2010). The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. Journal of Psychosomatic Research, 68(6), 539–544. Scholar
  6. Brown, C. A., & Jones, A. K. P. (2013). Psychobiological correlates of improved mental health in patients with musculoskeletal pain after a mindfulness-based pain management program. The Clinical Journal of Pain, 29(3), 233–244. Scholar
  7. Cleeland, C. S., & Ryan, K. M. (1994). Pain assessment: global use of the brief pain inventory. Annals of the Academy of Medicine, Singapore, 23(2), 129–138.PubMedGoogle Scholar
  8. Crombez, G., Vlaeyen, J., Heuts, P., & Pain, R. L. (1999). Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain, 80(1–2), 329–339.CrossRefGoogle Scholar
  9. Dworkin, R., Turk, D., Farrar, J., & Haythornthwaite, J. (2005). Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain, 113(1–2), 9–19.CrossRefGoogle Scholar
  10. Edwards, R. R., & Fillingim, R. B. (2007). Self-reported pain sensitivity: lack of correlation with pain threshold and tolerance. European Journal of Pain, 11(5), 594–598. Scholar
  11. Elzahaf, R. A., Tashani, O. A., Unsworth, B. A., & Johnson, M. I. (2012). The prevalence of chronic pain with an analysis of countries with a human development index less than 0.9: a systematic review without meta-analysis. Current Medical Research and Opinion, 28(7), 1221–1229. Scholar
  12. Esmer, G., Blum, J., Rulf, J., & Pier, J. (2010). Mindfulness-based stress reduction for failed back surgery syndrome: a randomized controlled trial. Journal of the American Osteopathic Association, 110(11), 646–652.PubMedGoogle Scholar
  13. Gourlay, D. L., Heit, H. A., & Almahrezi, A. (2005). Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Medicine, 6(2), 107–112. Scholar
  14. Granot, M., Granovsky, Y., Sprecher, E., Nir, R.-R., & Yarnitsky, D. (2006). Contact heat-evoked temporal summation: tonic versus repetitive-phasic stimulation. Pain, 122(3), 295–305. Scholar
  15. Grant, J. a., & Rainville, P. (2009). Pain sensitivity and analgesic effects of mindful states in Zen meditators: a cross-sectional study. Psychosomatic Medicine, 71(1), 106–114. Scholar
  16. Grant, J. A., Courtemanche, J., Duerden, E. G., Duncan, G. H., & Rainville, P. (2010). Cortical thickness and pain sensitivity in zen meditators. Emotion, 10(1), 43–53. Scholar
  17. Greenberg, J., Reiner, K., Meiran, N., Buchner, A., & Goolkasian, P. (2012). “Mind the trap”: mindfulness practice reduces cognitive rigidity. PLoS One, 7(5), e36206. Scholar
  18. Grosen, K., Fischer, I., & Olesen, A. (2013). Can quantitative sensory testing predict responses to analgesic treatment? European Journal of Pain, 17(9), 1267–1280.CrossRefGoogle Scholar
  19. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: model, processes and outcomes. Behaviour Research and Therapy. Scholar
  20. Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary. General Hospital Psychiatry, 4(1), 33–47.CrossRefGoogle Scholar
  21. Kabat-Zinn, J., Massion, A., Hebert, J., & Rosenbaum, E. (1998). Meditation. In J. C. Holland (Ed.), Textbook on Psychooncology. Oxford: Oxford University Press.Google Scholar
  22. Lutz, A., McFarlin, D., Perlman, D., Salomons, T., & Davidson, R. (2013). Altered anterior insula activation during anticipation and experience of painful stimuli in expert meditators. Neuroimage, 64, 538–546.CrossRefGoogle Scholar
  23. Martell, B. A., O’Connor, P. G., Kerns, R. D., Becker, W. C., Morales, K. H., Kosten, T. R., & Fiellin, D. A. (2007). Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Annals of Internal Medicine. American College of Physicians. Scholar
  24. Morone, N. E., Greco, C. M., & Weiner, D. K. (2008). Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study. Pain, 134(3), 310–319. Scholar
  25. Neville, A., Peleg, R., Singer, Y., & Sherf, M. (2008). Chronic pain: a population-based study. The Israel Medical Association Journal, 10(10), 676–680.PubMedGoogle Scholar
  26. Perlman, D. M., Salomons, T. V., Davidson, R. J., & Lutz, A. (2010). Differential effects on pain intensity and unpleasantness of two meditation practices. Emotion, 10(1), 65–71. Scholar
  27. Pfau, D. B., Geber, C., Birklein, F., & Treede, R.-D. (2012). Quantitative sensory testing of neuropathic pain patients: potential mechanistic and therapeutic implications. Current Pain and Headache Reports, 16(3), 199–206. Scholar
  28. Pfingsten, M., Leibing, E., Harter, W., Kröner-Herwig, B., Hempel, D., Kronshage, U., & Hildebrandt, J. (2001). Fear-avoidance behavior and anticipation of pain in patients with chronic low back pain: a randomized controlled study. Pain Medicine, 2(4), 259–266. Scholar
  29. Phillips, K., & Clauw, D. J. (2011). Central pain mechanisms in chronic pain states--maybe it is all in their head. Best Practice & Research. Clinical Rheumatology, 25(2), 141–154. Scholar
  30. Ploghaus, A., Tracey, I., Gati, J., Clare, S., Menon, R., Matthews, P., & Rawlins, J. (1999). Dissociating pain from its anticipation in the human brain. Science, 284(5422), 1979–1981.CrossRefGoogle Scholar
  31. Reiner, K., Tibi, L., & Lipsitz, J. D. (2013). Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Medicine, 14(2), 230–242. Scholar
  32. Rosier, E. M., Iadarola, M. J., & Coghill, R. C. (2002). Reproducibility of pain measurement and pain perception. Pain, 98(1–2), 205–216. Scholar
  33. Segal, Z., Williams, J., & Teasdale, J. (2002). Mindfulness-based cognitive therapy for depression: a new approach to relapse prevention. New York: Guilford.Google Scholar
  34. Shvartzman, P., Friger, M., Shani, A., & Barak, F. (2003). Pain control in ambulatory cancer patients—Can we do better? Journal of Pain and Symptom Management, 26(2), 716–722.CrossRefGoogle Scholar
  35. Staud, R. (2009). Abnormal pain modulation in patients with spatially distributed chronic pain: fibromyalgia. Rheumatic Disease Clinics of North America. Scholar
  36. Staud, R. (2012). Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions. Expert Review of Neurotherapeutics, 12(5), 577–585. Scholar
  37. Toblin, R. L., Mack, K. A., Perveen, G., & Paulozzi, L. J. (2011). A population-based survey of chronic pain and its treatment with prescription drugs. Pain, 152(6), 1249–1255. Scholar
  38. Valencia, C., Fillingim, R. B., & George, S. Z. (2011). Suprathreshold heat pain response is associated with clinical pain intensity for patients with shoulder pain. The Journal of Pain, 12(1), 133–140. Scholar
  39. Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. G. (2016). Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cognitive Behaviour Therapy, 45(1), 5–31. Scholar
  40. Yarnitsky, D., Sprecher, E., Zaslansky, R., & Hemli, J. A. (1995). Heat pain thresholds: normative data and repeatability. Pain, 60(3), 329–332. Scholar
  41. Yarnitsky, D., Sprecher, E., Zaslansky, R., & Hemli, J. A. (1996). Multiple session experimental pain measurement. Pain, 67(2–3), 327–333. Scholar
  42. Zeidan, F., Martucci, K. T., Kraft, R. A., Gordon, N. S., McHaffie, J. G., & Coghill, R. C. (2011). Brain mechanisms supporting the modulation of pain by mindfulness meditation. The Journal of Neuroscience, 31(14), 5540–5548. Scholar
  43. Zgierska, A., Burzinski, C., Cox, J., & Kloke, J. (2016). Mindfulness meditation and cognitive behavioral therapy intervention reduces pain severity and sensitivity in opioid-treated chronic low back pain: pilot findings from a randomized controlled trial. Pain Medicine, 17(10), 1865–1881.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Keren Reiner
    • 1
  • Pesach Shvartzman
    • 2
    • 3
  • Zahira Ziva Cohen
    • 1
  • Joshua D. Lipsitz
    • 1
  1. 1.Department of PsychologyBen-Gurion University of the NegevBeer ShevaIsrael
  2. 2.Division of Community Health, Pain and Palliative Medicine UnitBen-Gurion University of the NegevBeer ShevaIsrael
  3. 3.Clalit Health Services–Southern DistrictBeer ShevaIsrael

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