Evaluation of Mindfulness-based Interventions for Pain, Anxiety, and Depression in Spinal Cord Injury Patients: A Systematic Review and Meta-Analysis

Introduction: Current rehabilitative measures utilized in patients with spinal cord injuries (SCI) typically fail to mitigate the precipitated symptoms of psychological distress that further heighten pain levels. Mindfulness-based interventions (MBI) have been proposed to address such concerns. This study seeks to review existing literature on the application of MBI throughout rehabilitation in patients with SCI and to analyze the impact on pain and psychological outcomes.

Methods: A systematic literature search for prior studies using MBI as treatment for patients suffering from pain and adverse psychological symptoms following SCI was conducted. Primary outcomes examined were average pain, assessed by Numeric Pain Rating Scale (NPR) and Brief Pain Inventory (BPI), and anxiety and depression, assessed by the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes of interest included stress and quality of life, as measured by the Perceived Stress Scale (PSS) and World Health Organization Quality of Life (WHO-QOL). Only comparative studies were included.

Results: Seven studies (n=419) were included with yoga, mental imagery, biofeedback, and mindfulness meditation as the administered MBI. Five studies (n=260) reported pain using NPR. The mean post-treatment difference comparing the control and MBI groups was -1.26 (95%CI:[-2.44; -0.07]), with MBI showing significant pain reduction (p=0.04). The intergroup difference was not statistically significant, but trended favoring the treatment group. Three studies included HADS (n=282) and BPI (n=203), with neither reaching statistical significance in post-treatment comparisons, but showing improvements favoring MBI for both. Further, intergroup changes for MBI groups revealed marginal mood benefits. Secondary outcomes were not statistically analyzed.

Conclusion : A significant difference was observed regarding NPR post-treatment scores. The results of this study trend positively towards the treatment groups, showing possible benefits in utilizing MBI for patients with SCI suffering from pain and psychological concerns.