The power of the mind to help a patient with arthritis and chronic pain has been the subject of intense interest among physicians in both conventional as well as complementary medicine. A recent study reviewed the literature on eight mindbody interventions for older adults with chronic nonmalignant pain. (Morone NE, Greco CM. Mind-Body Interventions for Chronic Pain in Older Adults: A Structured Review. 2007; Pain Medicine 8 (4), 359375). The authors' objectives were to evaluate the feasibility, safety, and evidence for pain reduction in older adults with chronic nonmalignant pain in the following mindbody therapies: biofeedback, progressive muscle relaxation, meditation, guided imagery, hypnosis, tai chi, qi gong, and yoga. The researchers found 381 articles retrieved through a number of data bases. Of these, 20 trials that included older adults with chronic pain were reviewed. They found 14 articles that included participants aged 50 years and above, while only two of the articles focused specifically on persons aged ≥ 65 years. An additional six articles included persons aged ≥50 years. Fourteen articles were controlled trials. The authors found support for the efficacy of progressive muscle relaxation plus guided imagery for osteoarthritis pain. They found limited support for meditation and tai chi for improving function or coping in older adults with low back pain or osteoarthritis. In an uncontrolled biofeedback trial that stratified by age group, both older and younger adults had significant reductions in pain following the intervention. Several studies included older adults, but did not analyze benefits by age. Tai chi, yoga, hypnosis, and progressive muscle relaxation were significantly associated with pain reduction in these studies. The authors concluded that the eight mindbody interventions are safe. They commented that modifications were made to make them suitable for older adults. While they felt there was not yet sufficient evidence to conclude that these eight mindbody interventions convincingly reduce chronic nonmalignant pain in older adults, they did feel that there were signals indicative of beneficial effects. They recommended that further research should focus on larger, clinical trials of mindbody interventions. In another editorial, Dr. KY Loh discussed the role of meditation in the management of chronic pain. (Loh KY. Meditation for physical, mental and spiritual health Asia Pacific Family Medicine. 2003; 2 (4), 239239). He wrote, In chronic pain, the patient who practices meditation will try to observe the sensation of pain and be aware of the process and sensation as a changing phenomenon. Instead of reacting with anger, frustrations or hatred towards the pain as an obstacle, the patient can now face the situation with calm, composure, rational and harmonious state of mind and arrive at a solution for that problem." He remarked on the other health benefits including better sleep, reduced abuse of alcohol and drugs, reduction of blood pressure, decreased in mean total cholesterol syndrome, decreased incidence of headache, backache, fibromyalgia, and improvement in premenstrual syndrome. He also commented that meditation leads to less hospitalization and reduction of medical costs. Since these measures appear to contain very little potential for harm, I feel that they are worth trying in older adults with arthritis related pain that is not responding to conventional treatments alone. This is particularly true in older patients who take multiple medications already.
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