Psychological factors as mediators of the effectiveness of telehealth mindfulness-based interventions for pain and pain-related conditions.

Abstract

Importance: Mindfulness meditation is an evidence-based therapy for chronic pain for which some have explored possible mechanisms of action. However, these mechanisms can vary widely depending on the mindfulness-based intervention (MBI).

Objective: To study possible mechanisms of action of 2 similar MBIs for pain.

Design: We used data from our learning to apply mindfulness to pain (LAMP) pragmatic randomized controlled trial comparing usual care with virtual group or self-paced MBIs. The LAMP MBIs included education on adaptive pain behaviors and mindfulness and used shorter, less formal mindfulness practice than standard MBIs. We examined whether mindfulness, pain self-efficacy, pain catastrophizing, and stress mediated the treatment effects on 2 pain and 7 pain-related biopsychosocial outcomes at 10 weeks and 6 months using mediation models.

Results: The MBIs improved pain catastrophizing, pain self-efficacy, and mindfulness but did not affect perceived stress. Pain catastrophizing and pain self-efficacy had large mediating effects between the MBIs and pain interference, pain intensity, physical functioning, social functioning, anxiety, fatigue, sleep disturbance, depression, and post-traumatic stress disorder. mindfulness also mediated the above relationships with smaller effects between MBIs and all outcomes except for pain interference, pain intensity, physical functioning, and social functioning.

Conclusions: Reduced pain catastrophizing and increased pain self-efficacy were apparent mechanisms of action improving pain interference, pain intensity, and other biopsychosocial outcomes in our MBIs, whereas increased mindfulness was the apparent mechanism of action improving psychological and sleep-related outcomes. This study improves our understanding of mechanisms by which MBIs can affect pain and important pain-related outcomes.

Study registration and analytic plan registration: clinicaltrials.gov. Identifier: NCT04526158.