Journal Article Annotations
2017, 2nd Quarter

Chronic Pain

Annotations by Sean Heffernan, MD
July 2017

Prevalence and correlates of pain in fatigued patients with type 1 diabetes
Mindfulness meditation for chronic pain: systematic review and meta-analysis

PUBLICATION #1 — Chronic Pain

Prevalence and correlates of pain in fatigued patients with type 1 diabetes

Menting J, Tack CJ, Knoop H

J Psychosom Res 2017; 95:68-73

OBJECTIVE:
To investigate the prevalence, location and severity of pain, as well as its association with psychosocial and clinical variables and its impact on functional impairment in fatigued patients with type 1 diabetes.

METHODS:
120 severely fatigued patients with type 1 diabetes completed questionnaires on pain (McGill Pain Questionnaire, MPQ; Short Form Health Survey subscale bodily pain, SF-36), fatigue severity (Checklist Individual Strength subscale fatigue severity, CIS), depressive symptoms (Beck Depression Inventory Primary Care, BDI-PC) and functional impairment (Sickness Impact Profile-8, SIP-8). HbA1c and diabetes-related complications were assessed, and physical activity was measured using actigraphy.

RESULTS:
72% of patients reported pain. Muscle, joint and back pain, and headache were most common. Patients with pain were more often female (69 vs. 44%, p=0.013), reported more complications (mean number: 0.7 vs. 0.3, p=0.009) and scored higher on the BDI-PC measuring depressive symptoms (mean score: 3.8 vs. 2.3, p=0.002), compared to patients without pain. Pain was associated with diabetes duration, the number of complications, fatigue severity, depressive symptoms and functional impairment, but not with HbA1c or physical activity. Of patients with pain, 26% reported a high impact of pain. Both pain (β=-0.31, t(117)=-3.39, p=0.001) and fatigue severity (β=0.18, t(117)=2.04, p=0.044) contributed to functional impairment.

CONCLUSION:
Pain was highly prevalent in fatigued patients with type 1 diabetes, although pain impact and severity were relatively low, and the location of some pain symptoms was similar to the location of those in the general population. As pain is related to fatigue and contributes independently to functional impairment, fatigue interventions should address pain.

On PubMed: J Psychosom Res 2017; 95:68-73

Annotation

The finding: Nearly three quarters of fatigued patients with type I diabetes experience pain, specifically joint and muscle pain, headache, and low back pain. This figure includes both acute and chronic pain. Not all pain can be explained as a diabetes-related complication. Patients with diabetes, fatigue, and pain reported more depressive symptoms on BDI than those with diabetes and fatigue.

Strength and weaknesses: The major strength is that this study describes a large cohort of patients with similar comorbidities. Weaknesses include the lack of distinction between chronic and acute pain during survey, which was a self-report questionnaire done at a single time point. Also, the investigators did not clearly identify which pain complaints could be directly linked to diabetes. The subjects were not recruited for this study, but rather for a separate randomized control trial.

Relevance: This study highlights the importance of investigating pain complaints in subjects with type I diabetes, especially those with complaints of fatigue. Pain was associated with report of depressive symptoms, fatigue severity, and some functional impairment.

PUBLICATION #2 — Chronic Pain

Mindfulness meditation for chronic pain: systematic review and meta-analysis

Hilton L, Hempel S, Ewing BA, et al

Ann Behav Med 2017; 51(2):199-213

BACKGROUND:
Chronic pain patients increasingly seek treatment through mindfulness meditation.

PURPOSE:
This study aims to synthesize evidence on efficacy and safety of mindfulness meditation interventions for the treatment of chronic pain in adults.

METHOD:
We conducted a systematic review on randomized controlled trials (RCTs) with meta-analyses using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the GRADE approach. Outcomes included pain, depression, quality of life, and analgesic use.

RESULTS:
Thirty-eight RCTs met inclusion criteria; seven reported on safety. We found low-quality evidence that mindfulness meditation is associated with a small decrease in pain compared with all types of controls in 30 RCTs. Statistically significant effects were also found for depression symptoms and quality of life.

CONCLUSIONS:
While mindfulness meditation improves pain and depression symptoms and quality of life, additional well-designed, rigorous, and large-scale RCTs are needed to decisively provide estimates of the efficacy of mindfulness meditation for chronic pain.

On PubMed: Ann Behav Med 2017; 51(2):199-213

Annotation

The finding: A systematic review and meta-analysis of 30 randomized control trials concludes that mindfulness meditation is associated with mild improvement in chronic pain and depressive symptoms when compared with treatment as usual, passive controls, and education/support groups. The authors note inconsistent effects and weakness in the body of evidence and therefore support a conservative view of this intervention.

Strength and weaknesses: The authors took a balanced and comprehensive approach to the literature, focusing on validity of study as they collected data. The limitations of this manuscript lie primarily in the weakness of the studies it included, which were compromised by small samples, poor follow-up, and poor reporting of methods.

Relevance: More well-designed and rigorous RCTs are needed to develop an evidence base from which we could collectively draw stronger conclusions about the role and effect of mindfulness meditation as a treatment for chronic pain.