1. PAIN & INTEROCEPTIVE BODY–AWARENESS
Understanding of pain-related questions differs between primary care pain patients and mind-body trained individuals
Mehling W, Bartmess E, Acree M, Price C, Daubenmier J, Gopisetty V, Stewart A
RESULTS
BACKGROUND
Table 2: Pain/Discomfort Questionnaire Items: Mean Values ± SD*
Interoceptive Body-Awareness is a construct with multiple dimensions:
● noticing body sensations incl. pain, discomfort
● behavioral reaction incl. ignoring, distraction
● emotional reaction incl. worry, upset
● attention regulation incl. mindfulness
● awareness of emotion-related sensations,
● behavioral and emotional self-regulation,
● and trust in meaningfulness of sensations.
Pain and Interoceptive Body-Awareness
● Ignoring pain (incl. distraction from pain) may be beneficial or maladaptive.
● Mind-body approaches, e.g. Yoga, Tai Chi, meditation, Feldenkrais, Alexander teach mindful body-awareness and not ignoring body sensations; preliminary studies of these approaches suggest benefits for pain.
Question: Do individuals trained in mind- body approaches respond differently to pain-related questions than pain patients in primary care?
Ignoring Pain or Discomfort
Pain
Mind-Body A
I do not notice physical tension or discomfort until they become more severe
2.8 ±1.4
1.6 ±1.1 B
I distract myself from sensations of discomfort
2.8 ±1.5
1.8 ±1.1 C
When feeling pain or discomfort, I try to power through it
3.6 ±1.3
1.9 ±1.2
Worry with Pain or Discomfort D
When I feel physical pain, I become upset
2.4 ±1.5
2.0 ±1.1 E
I start to worry that something is wrong if I feel any discomfort
2.1 ±1.5
1.5 ±1.1 F
I can notice an unpleasant body sensation without worrying about it (reversed)
1.8 ±1.4
1.6 ±1.0
Body and Pain Awareness with Mindfulness (selected items from subscale for attention regulation) G
I can be aware of pain or tension without actively trying to change it
3.4 ±1.3
3.6 ±0.9 H
I can maintain awareness of my whole body even when a part of me is in pain or discomfort
3.0 ±1.3
3.5 ±0.9
Awareness of Pain or Discomfort (selected items from subscale for noticing body sensations) I
When I am tense I notice where the tension is located in my body
3.4 ±1.6
4.0 ±0.7 J
I notice when I am uncomfortable in my body
4.0 ±1.3
4.3 ±0.7
Subscale Scores
Pain**
Mind-Body
Table 1: Demographics
Pain
Mind-Body
Gender (% female)* 53 79
Average age*
54 ±12
48 ±12
Ethnicity (%)*
Asian-American 11 3
African-American 8 2
Latino 6 4
White 68 83
Other 7
Education (%)*
High school 9
<1
Some college 26
College degree 37
Graduate school 28 N
436
307
*Group differences significant at p< .001
Scale Range: 0 (never) to 5 (always) for how often each statement applies to you in daily life.
* NOTE: All group differences in item and subscale means are significant at p<.001, except J p=0.12, controlled for age, gender, ethnicity, education **Bars: subscale means, 95% CI.
● Pain-Related Item and Sub-Scale Means (Table 2):
- Pain patients report more frequently ignoring pain or discomfort compared with mind-body trained individuals.
- Pain patients report being more often worried when feeling pain or discomfort than did mind-body trained individuals.
- Pain patients scored “worse” on all pain-related body-awareness items and subscales compared with mind-body trained individuals.
- Pain patients with current chronic pain did not differ from patients with past acute pain (2 years earlier) except for items E and H, where they scored “better” than patients with past acute pain (data not shown).
● Exploratory Factor Analysis: In an analysis with all MAIA subscales, items related to ignoring pain or discomfort factor-loaded together with items related to worry in mind-body trained individuals, but loaded separately in pain patients.
● MAIA Subscale Correlations were similar in both groups except “ignoring” and “worry”: in pain patients these did not correlate with each other (r = -.11) or with any other MAIA sub-scale (r <.20). However, in mind-body trained individuals, lower “ignoring” and “worry” scores correlated with higher scores on 3 other MAIA subscales for attention regulation, emotion & behavior self-regulation, and trust in meaningfulness of body sensations (r -.20 to -.35, p<.001).
METHODS
We compared:
● pain-related item and sub-scale means
● factor structure (EFAs)
● sub-scale correlations
using a new Self-Report measure:
Multidimensional Assessment of Interoceptive Awareness (MAIA)
Group1 (“Pain”): 436 pain patients seen in primary care 2 years after acute low back pain (19% of this group still in chronic pain), representative of the usual population seen in primary care
Group2 (“Mind-Body”): 307 healthy indivi- duals trained in mind-body therapies
CONCLUSIONS
● Data suggest that primary care patients with current or past pain endorse a common ignoring coping style in response to pain and discomfort, whereas mind-body trained individuals may have learned a new coping style.
● Data suggest that mind-body trained individuals use an alternate coping style of less ignoring and less worry about pain or discomfort than common pain patients; it goes along with greater self-reported skills in self-regulation of behavior and emotions.
● SUMMARY: Cross-sectional data suggest that mind-body trained individuals, different from primary care patients with past or current pain, may have learned a new style of coping with pain / discomfort. Whether this is true deserves further (longitudinal) study.
Research funding: NIH R21-AT004467
European Federation of IASP Chapters, Hamburg 9/2011