Does Mindfulness Based Stress Reduction Help Fibromyalgia?

Last week our systematic review and meta analysis was published! You can read the full paper here: https://onlinelibrary.wiley.com/doi/10.1002/ejp.70239 Below is a summary of some key points 👇 What did the paper ask? We wanted to know if Mindfulness Based Stress Reduction (MBSR) helped with pain severity, quality of life, pain catastrophising and depression symptoms in people living with fibromyalgia (FM). What is Mindfulness Based Stress Reduction? Jon Kabbat Zinn introduced mindfulness meditation to the scientific paradigm in the 1980's when he developed Mindfulness-Based Stress Reduction (MBSR) (Braun, 2017). He recognised that to bring mindfulness health benefits into the mainstream, he needed to create a standardised programme that could be researched.

Kabat-Zinn teaching an MBSR class in the hospital at UMass Medical Center, 1992. - Source

His early research on mindfulness based interventions showed increased physical activity levels and reduced need for pain medication when taught to people with persistent pain (Kabat-Zinn et al., 1985). MBSR entails an intensive eight week programme with at least 2 hour long weekly sessions and an intensive retreat, typically for a day (Carmody & Baer, 2009; Hofmann & Gómez, 2017). The MBSR programme includes an array of mindfulness practices including sitting meditation, walking meditation and yoga (Kabat-Zinn and Hanh, 2009). The sessions aim to cultivate awareness of one’s sensation, emotions and thoughts as they are experienced in the present with no additional judgement (Day et al., 2014). What is Pain Catastrophising? Pain catastrophising (unhelpful name) is when the mind interprets pain as more threatening than it is (Sullivan et al., 2001). It is driven by three patterns: magnification (“this is really bad”), rumination (“I can’t stop thinking about it”) and helplessness (“there’s nothing I can do about this”). When pain catastrophising is high, the exaggerated threat perception can unfortunately become a self fulfilling prophecy. High pain catstrophising predicts pain severity in people living with FM (Angst et al., 2022) 💡 It appears the helplessness component of pain catastrophising is the main predictor for how much pain people with persistent pain experience (Pinto et al., 2023). How did we try to answer the question?

We conducted a systematic review and meta-analysis. We gathered all relevant clinical trials on MBSR for fibromyalgia, assessed their quality and combined the data to estimate overall effects.

This allows us to move beyond individual studies and ask: what does the totality of the evidence suggest?

What were the findings in a nutshell? Pain severity

MBSR did have a small effect on reducing pain, but only when compared with people on a waiting list, and only in the first few weeks after the participants finished the programme. There was no effect on pain when compared with people receiving other treatments, and no effect over the long term (around 6 months later) even compared with those on the waiting list. Overall, the data available doesn't suggest MBSR is helpful for reducing pain severity in people living with FM.

Quality of life MBSR had a medium effect improving quality of life compared with people on a waiting list and people receiving other treatments in the first few weeks after the participants finished the programme. Impressively, a small beneficial effect on quality of life was still present around the 6 month mark after the programme, even compared with people who received other treatments. Overall, the data available suggests MBSR is helpful for improving quality of life in people living with FM. Pain Catastrophising MBSR had a large effect improving pain catastrophising compared with people on a waiting list and a medium effect compared with people receiving other treatments in the first few weeks after the participants finished the programme. Impressively, a medium beneficial effect on quality of life was still present around the 6 month mark, even compared with people who received other treatments. Overall, the data available suggests MBSR is helpful for improving pain catastrophising in people living with FM. Depression

Like pain severity, MBSR did have a small effect on reducing depression symptoms, but only when compared with people on a waiting list, and only in the first few weeks after the participants finished the programme. There was no effect on depression symptoms when compared with people receiving other treatments, and no effect over the long term (around 6 months later) even compared with those on the waiting list. Overall, the data available doesn't suggest MBSR is helpful for reducing depression in people living with FM.

Do these findings apply to me? If you're a lady in her 40's or 50's living with FM, yes! The vast majority of participants in the research were ladies in their 40's or 50's. If you are a man or a woman in a different age bracket living with FM, unfortunately the findings may not apply to you.

This is particularly problematic for blokes, who make up about 40% of people living with FM (Wolfe et al., 2018), tend to endure pain for longer before seeking treatment (Conversano et al., 2021) and more commonly live with depression in addition to FM (Henao-Pérez et al., 2022). Summary The current evidence suggests MBSR has limited impact on pain severity and depression symptoms in people living with fibromyalgia, particularly beyond the short term. In contrast, it demonstrates sustained benefits for quality of life and pain catastrophising. References Angst, F., Lehmann, S., Sandor, P. S., & Benz, T. (2022). Catastrophizing as a prognostic factor for pain and physical function in the multidisciplinary rehabilitation of fibromyalgia and low back pain. European journal of pain, 26(7), 1569–1580. https://doi.org/10.1002/ejp.1983

Braun, E. (2017). Mindful but Not Religious: Meditation and Enchantment in the Work of Jon Kabat-Zinn. In D. McMahan & E. Braun (Eds.), Meditation, Buddhism, and Science. Oxford University Press. https://doi.org/10.1093/oso/9780190495794.003.0009 Carmody, J., & Baer, R. A. (2009). How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. Journal of Clinical Psychology, 65(6), 627–638. https://doi.org/10.1002/jclp.20555 Conversano, C., Ciacchini, R., Orrù, G., Bazzichi, M. L., Gemignani, A., & Miniati, M. (2021). Gender differences on psychological factors in fibromyalgia: a systematic review on the male experience. Clinical and experimental rheumatology, 39 Suppl 130(3), 174–185. https://doi.org/10.55563/clinexprheumatol/73g6np Day, M. A., Jensen, M. P., Ehde, D. M., & Thorn, B. E. (2014). Toward a Theoretical Model for Mindfulness-Based Pain Management. The Journal of Pain, 15(7), 691–703. https://doi.org/10.1016/j.jpain.2014.03.003 Henao-Pérez, M., López-Medina, D. C., Arboleda, A., Bedoya Monsalve, S., & Zea, J. A. (2022). Patients With Fibromyalgia, Depression, and/or Anxiety and Sex Differences. American journal of men's health, 16(4), 15579883221110351. https://doi.org/10.1177/15579883221110351 Hofmann, S. G., & Gómez, A. F. (2017). Mindfulness-Based Interventions for Anxiety and Depression. The Psychiatric Clinics of North America, 40(4), 739–749. https://doi.org/10.1016/j.psc.2017.08.008 Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163–190. https://doi.org/10.1007/BF00845519 Kabat-Zinn, J., & Hanh, T. N. (2009). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY: Random House Publishing Group. Sullivan, M. J., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., & Lefebvre, J. C. (2001). Theoretical perspectives on the relation between catastrophizing and pain. The Clinical journal of pain, 17(1), 52–64. https://doi.org/10.1097/00002508-200103000-00008

Walsh E, Hart K, Forster B. (2026) A Systematic Review and Meta-Analysis Examining the Effect of Mindfulness Based Stress Reduction on Pain Severity and Quality of Life in People Living With Fibromyalgia. European Journal Pain, 30(4), e70239. doi: 10.1002/ejp.70239 Wolfe, F., Walitt, B., Perrot, S., Rasker, J. J., & Häuser, W. (2018). Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias. PloS one, 13(9), e0203755. https://doi.org/10.1371/journal.pone.0203755