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Reducing Chronic Pain Using Mindfulness Meditation: an Exploration of the Role Of Reducing Chronic Pain Using Mindfulness Meditation: An Exploration of the Role of Spirituality By Al-Noor Mawani A Thesis submitted to the Faculty of Graduate Studies of The University of Manitoba In partial fulfillment of the requirements of the degree of Doctor of Philosophy Department of Psychology University of Manitoba Winnipeg Copyright © 2009 by Al-Noor Mawani Mindfulness meditation and pain 2 Table of Contents Abstract ............................................................................................................................... 4 List of Tables ...................................................................................................................... 5 Reducing Chronic Pain through Mindfulness Meditation: An Exploration of the Role of Spirituality........................................................................................................................... 6 Relevance of Spirituality to Canadian context ................................................................ 7 Relevance of Spirituality to Chronic Pain Management ................................................. 8 Established views of Chronic Pain .................................................................................. 9 Assessment of Pain ........................................................................................................ 14 Psychological treatment of Chronic Pain ...................................................................... 16 Holistic care and change ................................................................................................ 17 Western Views of Pain Management ............................................................................ 22 Spirituality......................................................................................................................... 23 Definitions of Spirituality .............................................................................................. 25 Spirituality and Religiosity ............................................................................................ 26 Mechanisms for Spirituality .......................................................................................... 31 Assessing Spirituality .................................................................................................... 33 Operational Definition of Spirituality ............................................................................ 36 Spirituality and meditation ............................................................................................ 40 Meditative practice ........................................................................................................ 41 Mindfulness meditation ................................................................................................. 42 Current issues in mindfulness meditation ...................................................................... 46 Mindfulness meditation and Chronic Pain ........................................................................ 48 Mindfulness meditation and pain 3 Mindfulness meditation and depression or anxiety .......................................................... 49 The role of Innerness ........................................................................................................ 50 The current study .............................................................................................................. 54 Method .............................................................................................................................. 57 Participants .................................................................................................................... 57 Materials ........................................................................................................................ 58 Measures ........................................................................................................................ 64 Procedure ....................................................................................................................... 71 Results ............................................................................................................................... 79 Hypothesis testing.......................................................................................................... 88 Supplemental Analyses.................................................................................................. 97 Discussion ....................................................................................................................... 101 Relationship between mindfulness and pain management .......................................... 102 Relationship between mindfulness and spirituality ..................................................... 104 Spirituality and Pain management ............................................................................... 105 Spirituality and psychological symptoms .................................................................... 107 Mindfulness and psychological symptoms .................................................................. 109 The role of Mindfulness .............................................................................................. 111 The role of Spirituality ................................................................................................ 112 Limitations ...................................................................................................................... 113 Future Research .............................................................................................................. 121 Implications of this study ................................................................................................ 122 References ....................................................................................................................... 125 Mindfulness meditation and pain 4 Abstract Chronic pain is estimated to affect approximately 29% of the Canadian population and causes far-reaching lifestyle changes and difficulties that have personal, social, and economic impact. Managing pain is a complex task that recently has been recognized as requiring a multidisciplinary approach. Significant amounts of research have been conducted to understand the biological and cognitive bases of pain; and yet, spiritual aspects of chronic pain have received less attention. Despite this, spirituality remains an important coping strategy as reported by individuals managing chronic health conditions. Some interventions in use today have spiritual roots; however, western medical treatments of pain often do not recognize or utilize spirituality on a regular basis. Utilizing one such intervention, namely mindfulness meditation (MM), this study attempted to understand the role that MM plays in the management of chronic pain and the development of spirituality. This study measured self-reported pain, anxiety, depression, and spirituality in individuals engaged in an 8-week group process in which individuals were provided chronic pain related psycho-education either with MM or without. A repeated measures model was utilized to measure changes that occurred in reported pain experiences (using the McGill Pain Questionnaire) and in spirituality (using the Spiritual Assessment Scale ) to determine if changes could be associated with the teaching of MM. Differences in Affective pain ratings were observed and correlations between pain ratings and spirituality discussed. Reasons for the lack of significant findings, including sample size, power, and measures are discussed. Mindfulness meditation and pain 5 List of Tables Table 1 Summary of treatment / intervention group content………………… ….75 Table 2 Demographic data summary for entire sample…………………………..82 Table 3 Pain location summary for entire sample………………………………..83 Table 4 Control group demographic data summary………………………………86 Table 5 Mindfulness group demographic data summary…………………………87 Table 6 Group demographic data comparison by group………………………….88 Table 7 Group differences on select MPQ scale means………………………….90 Table 8 Mean pre and post group scores for SAS subscales by group…………...92 Table 9 Pearson correlation matrix for SAS and MPQ scales change scores…….94 Table 10 Multiple regression values for SAS subscale and total change score predictors of MPQ Evaluative subscale change score…………………...95 Table 11 Regression values for SAS Transcendence and Total change score as predictors of MPQ Sensory change score………………………………..98 Table 12 Multiple regression values for SAS Innerness and Total change score predictors of HAD Depression change scores……………………..…….99 Table 13 Self reported Anxiety scores measured pre and post group…………….101 Mindfulness meditation and pain 6 Reducing Chronic Pain through Mindfulness Meditation: An Exploration of the Role of Spirituality Chronic pain is a debilitating disorder affecting millions of Canadians each year. Some have estimated that chronic pain affects approximately 29% of Canadians (Moulin, Clark, Speechley, and Morley-Foster, 2002). According to the Chronic Pain Association of Canada, the financial cost of chronic pain, excluding social cost, exceeds 10 billion dollars annually. Unlike some disorders that require relatively short term adjustments, chronic pain can have long term ramifications that necessitate broad ranging changes to lifestyle, career, and home life (Jamison, 1996). For example,
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