Pain and Mindfulness in Multiple Sclerosis

Chronic pain is one of the most crippling, and oftentimes intractable to treatment, symptoms of patients with Multiple Sclerosis, many of them young people in the prime of their lifetimes. Given that most pharmacological schedules eventually bring collateral effects that intoxicate or limit the wakefulness of patients with good jobs, paths in Alternative Medicine have been explored.

Almost two thirds of MS patients experience some kind of severe pain in their daily demeanor. Patients experience different types of pain, which can be grouped in the following categories:

1. Central neuropathic pain: dysesthetic extremity pain, tonic muscle spasm, trigeminal neuralgia.
2. Musculoskeletal pain: cervical or lumbar radiculopathies.
3. Mixed Neuropathies and nonneuropathic forms of pain: headaches.

Jon Kabat-Zinn initiated the practice of “mindfulness” in 1982 as a behavioral cure for pain. He wrote that it constitutes as “paying attention in a particular way; on purpose, in the present moment, and non-judgmentally.” It is as if the patient could detach himself/herself from the suffering condition and observe it in “an objective way” without expressing any judgements. It strives to let go of natural defensive mechanisms and to start the process of acceptance of pain. Various meditation practices like focused attention or open monitoring are being used, which activate some unique neural networks that modify the pain experience integrated in the CNS.

Angela Senders et al. designed a cross-sectional survey of MS patients followed in the outpatient clinic of the Oregon Health and Science University that completed several questionnaires during one study visit; patients that had a relapse or exacerbation in the previous 90 days were excluded. As a measurement device they use “pain interference”, which is “how much pain” limits the patient’s ability to perform the occupational and social tasks; they used the “Patient-reported Outcomes Measurement Information System (PROMIS) as the dependent variable in the study.

One hundred and fifty patients participated in the study, the majority were women (78%) and the mean age was 50.45 +/- 12.85 years; the majority of patients had the relapsing-remitting variant of the disease (74%) and two-thirds of them were taking MS DMT like interferon beta-1b. in the study model for every 18-point increase in the mindfulness score, the Pain-interference score was expected to decrease by 2.88 points. Six demographic features (age, sex, level of disability, type of MS, DMT and education) were studied for their interaction with mindfulness.

The study showed that the relationship between pain and mindfulness was very significant (t=-5.52, P less than .0001) For every 18-point increase in the mindfulness score, the pain interference score decreased by 3.96 points (Beta=-0.227, P less than .0001) In sum, there is a significant correlation between the practice of mindfulness and the amelioration of MS pain.

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