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A Randomized, Controlled Pilot Study of Mindfulness-based Stress Reduction for Pediatric Chronic Pain
Kristen E. Jastrowski Mano, PhD; Katherine S. Salamon, PhD; Keri R. Hainsworth, PhD; Kimberly J. Anderson Khan, PsyD; Renee J. Ladwig, MSN, CNS, LMFT; W. Hobart Davies, PhD; Steven J. Weisman, MD
ABSTRACT Context • It is estimated that 1 in 5 children in the United States is affected by chronic pain. Increasing adaptive coping strategies and decreasing stress may be important in treatment. Research has suggested that mindfulness can help alleviate symptoms associated with medical illnesses and increase quality of life. Little is known about the effectiveness of mindfulness-based stress reduction (MBSR) in youth, partly due to insufficient methodological rigor in related studies. Objective • The primary purpose of the present study was to examine the feasibility, acceptability, and effectiveness of MBSR for a treatment-seeking sample of youth with chronic pain. Design • The current study was the first randomized, controlled pilot study of MBSR for pediatric chronic pain. The research team had intended to use block randomization involving a total of five recruitment waves, with each wave consisting of one MBSR group and one psychoeducation group. Due to difficulties with recruitment and attrition before the start of either group, however, only MBSR was conducted at each wave after the first wave. Setting • Participants were recruited from a multidisciplinary pain clinic in a large, Midwestern children’s hospital. Participants • The final sample included six adolescents
between the ages of 12 and 17 y, four in the MBSR group and two in the psychoeducation group. Intervention • Weekly sessions for the MBSR group were 90 min in length and followed a structured protocol. Sessions included a review of homework, an introduction to and practice of meditation, discussion of the session, and a review of the home practice assignment. The psychoeducation group participated in six group sessions, which were based on a cognitive-behavioral model of pain, and discussion topics included the nature of chronic pain and stress management. Primary Outcome Measures • Health-related quality of life, pain catastrophizing, anxiety, functional disability, mindfulness, and treatment acceptability were all assessed pre- and postintervention as well as at follow-up. Results • Recruitment and retention difficulties were experienced. Qualitative examination of participants’ scores suggested increased mindfulness but inconsistent patterns on other outcome measures. Conclusions • The research team highlighted critical challenges faced by potential researchers aiming to investigate MBSR for pediatric chronic pain, and the study provides recommendations for research and implications for clinical practice. (Altern Ther Health Med. 2013;19(6):8-14.)
Kristen E. Jastrowski Mano, PhD, is an assistant professor at Alliant International University in San Diego, California. Katherine S. Salamon, PhD, is a pediatric pain psychologist at Children’s National Medical Center in Washington, DC. Keri R. Hainsworth, PhD, is an associate professor at the Medical College of Wisconsin in Milwaukee, Wisconsin. Kimberly J. Anderson Khan, PsyD, is an assistant professor at the Medical College of Wisconsin. Renee J. Ladwig, MSN, CNS, LMFT, is an advanced practice nurse at Children’s Hospital of Wisconsin in Milwaukee, Wisconsin. Hobart
8 ALTERNATIVE THERAPIES, NOV/DEC 2013, VOL. 19, 6
Davies, PhD, is a professor at the University of WisconsinMilwaukee in Milwaukee, Wisconsin. Steven J. Weisman, MD, is a professor of anesthesiology and pediatrics at the Medical College of Wisconsin and is the Jane B. Pettit Chair in Pain Management at Children’s Hospital of Wisconsin. Corresponding author: Kristen E. Jastrowski Mano, PhD E-mail address: email@example.com
Jastrowski—Pediatric Chronic Pain
controlled pilot study of MBSR for pediatric chronic pain. discussion of the session.8 Each wave’s MBSR group received treatment for 6 weeks. One participant identified as Latina.1 Given that chronic pain is complexly determined. Specifically. relaxation techniques such as diaphragmatic breathing.5 years (SD = 0. The study’s procedures were approved by the hospital’s Institutional Review Board (IRB). with the intention of identifying procedures that could be refined for larger trials.6 A primary goal of the present study was to identify methodological factors that might be hindering progress in this field and prescribe solutions. The final sample included six adolescents between the ages of 12 and 17 years. acceptability. VOL. as compared to clinically relevant alternative interventions. chronic pain condition of a 3-month or greater duration were eligible to participate in this study. participants did not know which group they would be randomly assigned to (wave one) or which group would be randomly chosen to begin (waves two and three) until approximately 1 week prior to the start of a treatment wave. range = 12-17 y). (2) were diagnosed with a cognitive disability. For the psychoeducational arm. youth. random-number generator. Sessions included a review of homework. and effectiveness of MBSR. A compact disc with the sitting and body-scan meditations was also provided. For the first wave. For all three waves. 6 9 .71. help alleviate symptoms associated with medical illnesses (eg. thus. would be associated with significant improvements in pain. multidisciplinary. 19.0 years (SD = 2. and pain catastrophizing. it was decided that only one group would be conducted during each wave. a MBSR group was selected. and one participant did not report ethnicity data. please visit copyright. participants (n = 2) were female with an average age of 12. health-related quality of life. Participants were asked to complete 30 minutes of homework 6 days per week to facilitate the use of meditation practice throughout the study. and social factors of pain. psychological.16. Youth between the ages of 12 and 18 years who were currently being treated for a pediatric. the present study sought to explore and describe the challenges of managing a randomized.3 It is thought that shifting attention to the present allows for the use of positive coping strategies.and parentreported anxiety. body-scan meditation. weekly MBSR group sessions were 90 minutes in length and followed a structured protocol that included instruction in body awareness and basic yoga. walking meditation. Participants (n = 4) in the mindfulness intervention were 75% female (n = 3) with an average Jastrowski—Pediatric Chronic Pain I age of 15. The selection of which group (MBSR or psychoeducation) to begin was determined by flipping a coin.com. To subscribe. All MBSR participants received a journal as an adjunct to the group sessions to reinforce the skills and topics discussed during each of the classes. chronic pain).4 A meta-analysis of mindfulness-based approaches to adult chronic pain has reported medium effect sizes for pain intensity. The primary goal was to examine the feasibility. The study aimed to use block randomization involving a total of five recruitment waves. an introduction to and practice of meditation. ALTERNATIVE THERAPIES. Following wave one. one participant identified as African American. Allocation to the groups was determined using a computerized. For both the second and third waves. Specifically. a biopsychosocial framework for pain management is necessary because treatments are inadequate when they fail to recognize the interactions among biological. visit alternative-therapies. MBSR Group The MBSR intervention was modeled on the work of Jon Kabat-Zinn et al7 and used the same adolescent-specific adaptations as described by Beigel et al.This article is protected by copyright. participation was offered to the clinic’s new and existing patients. but research on MBSR for youth remains scarce. For the second and third waves.5 The literature on MBSR for adults with chronic illness is growing. and quality of life. The current study conducted the first randomized. controlled trial of MBSR for pediatric chronic pain. one MBSR and one psychoeducation group were planned to start every 8 weeks. nonjudgmental observation of thoughts. appreciation of the self and respect for uniqueness. range = 12-13 y).3 Research has suggested that mindfulness can aid in reducing stress. increasing adaptive coping strategies and decreasing stress may be important in treatment. due to the previously mentioned challenges. To share or copy this article. adolescents were randomly assigned to one of two groups: MBSR or psychoeducation. Only three treatment waves were conducted because of difficulties with recruitment and attrition. Two of the participants were Caucasian. functional disability. The primary MBSR practitioner had studied with Kabat-Zinn and had 11 years of experience as a facilitator. and increase quality of life. The study excluded youth who (1) came from non-English speaking families. pediatric pain clinic.4 For medical illnesses. or (3) were presenting with current suicidality or a serious mental illness. and a review of the home practice assignment.com t is estimated that 1 in 5 children in the United States is affected by chronic pain. It was hypothesized that MBSR. and gratitude meditation. Procedure Recruitment for this study was conducted after families completed their intake evaluations in an outpatient. mood symptoms. All participants received standard medical care and continued with any pre-existing mental health services. METHOD Participants Adolescents were recruited from a multidisciplinary pain clinic at a large Midwestern children’s hospital in the course of approximately 18 months. Unique aspects of working with pediatric patients may make rigorous methodologies particularly challenging.2 Mindfulness-based stress reduction (MBSR) is the practice of teaching mindful attention to the present moment. NOV/DEC 2013. Use ISSN#1078-6791. Thompson and Gauntlett-Gilbert conducted a review on mindfulness in youth and reported an astonishing lack of rigorous methodologies. and one was multiracial.
participants used the same rating scale to report the degree of helpfulness for each of the treatment’s components. during.13 Children rate how fre10 ALTERNATIVE THERAPIES. emotional. and school). (2) decided that the group was too far away. 19. Some eligible youth were not approached due to the unavailability of staff who could describe the study and obtain consent/assent. (4) found they no longer were interested in the group or were uncomfortable with or nervous about a group intervention. Of the 31 participants. Thus. citing a high level of commitments. Prior to treatment. 80. participants rated the degree to which they expected various treatment components to be helpful (1 = not at all helpful.4% were excluded. and descriptive and frequency statistics were used to describe the variables under study. all participants were asked to complete measures at pre-treatment. 5 = completely helpful). or not calm). Specifically. Psychoeducation Group The psychoeducation group designed for this study consisted of six weekly group sessions. Measures Participants in the two groups completed outcome measures at the same time points. The Mindfulness Self-Efficacy Scale (MSES) consists of 35 items designed to measure changes in levels of self-efficacy before. Refer to Figure 1 for a detailed recruitment-flow diagram. Six patients were found to be ineligible after being approached. calm. please visit copyright. Specifically. The psychoeducation group’s facilitator was an experienced pediatric psychotherapist and clinical nurse specialist with expertise in pediatric chronic pain. range = 3).11 Participants reported their perception of self-efficacy on a 5-point scale (0 = not at all.com. Higher scores indicate greater functional disability. Group Attendance For the psychoeducation group. Due to the small sample size.00. Parents completed the Pain Catastrophizing Scale for Parents (PCS-P). The Pain Frequency-Severity-Duration scale (PFSD) was used to assess the frequency. the average number of sessions attended was 4 Jastrowski—Pediatric Chronic Pain . IL. Data Analyses Data analyses were performed using SPSS version 17 (SPSS Inc. A fourth wave was attempted but cancelled due to recruitment difficulties. parent-proxy-and-child version of the Child Activity Limitations Interview (CALI). whereas the Trait scale (20 items) assesses how the respondent generally feels (hardly ever. USA). 74. disinterest in the study. 10 = worst pain) and pain duration (h) for usual and worst pain.10 The State scale (20 items) asks how respondents feel at the moment (very calm. 5 of the 8 recruited participants withdrew before the start of the treatment wave. including pain intensity (0 = no pain. a parallel measure of parents’ thoughts and feelings in the context of their child’s pain. Based on a cognitive-behavioral model of pain. including the nature of chronic pain— anatomy/physiology and misconceptions about pain—and stress management.0 is a 23-item questionnaire that assesses health-related quality of life (HRQOL) on a variety of functional domains (physical. For the MBSR group. At posttreatment and follow-up. The psychoeducation group also covered general topics such as ways to improve communication skills with peers and parents. To subscribe. during which a second mindfulness practitioner with 10 years of MBSR experience discussed MBSR and the homework requirement and answered parents’ questions. posttreatment. Total scores were calculated by summing the 21 item ratings. the three remaining recruited participants were unable to participate in the study. Use ISSN#1078-6791. resulting in a recruitment rate of 49.This article is protected by copyright.7% (n = 25) withdrew before starting participation in the psychoeducation or mindfulness group.com Parents were asked to attend one session that ran concurrently with the first MBSR session. and one was ineligible because of missing information.0). the psychoeducation sessions covered various topics. Of the 63 youth whom were approached. Demographic data were used to describe the sample. The difficulty ratings range from 0 (not at all difficult) to 5 (extremely difficult). visit alternative-therapies. social. RESULTS Recruitment Of the 246 patients whom the research team could approach. Chicago. or (5) did not provide a reason.2%. VOL. severity. and after mindfulness-based therapy programs. A five-item. individual scores were plotted in exploratory analyses to determine the general trends within the data. and duration of pain episodes. or a preference for a different therapy. 31 of the 63 approached patients agreed to participate. The PedsQL 4.9 Youth reported the number of days with pain over the prior 2 weeks. The Child Activity Limitations Questionnaire (CALQ)9 is a written.12 The Pain Catastrophizing Scale for Children (PCS-C) consists of 13 items describing a thought or feeling that a child may experience when in pain. or often). Reasons for withdrawal included the following: Participants (1) could not be contacted. (3) concluded they were too busy to participate or were not available on the nights of the group. Thus.14 Respondents indicate how difficult a list of 21 activities has been for the child due to pain over the past 4 weeks. and 12-week follow-up. The State-Trait Anxiety Inventory for Children (STAI-C) was used as a measure of self-reported state and trait anxiety. 4 = extremely) they experience each of the thoughts and feelings. the average number of sessions attended was 3 out of 6 (SD = 0. 4 = completely). Both parents and adolescents completed the Pediatric Quality of Life Inventory (PedsQL 4. 6 quently (0 = not at all. youth-report measure was developed to assess participants’ expectations about the benefits of MBSR or psychoeducation. To share or copy this article. sometimes. 4-week follow-up. NOV/DEC 2013. 25 refused to participate.
and (4) back pain. VOL. referring clinics included (1) gastroenterology.52). Recruitment Flow Diagram Enrollment Refused Participation (n = 32) Reasons given: • Unsure about participation.7% reporting worst pain lasting 9 to 12 hours per day. no f/u with researcher (n = 8) • Too busy with other commitments (n = 9) • Not interested/prefer different therapy (n = 8) Ineligible (n = 6) Missing info (n = 1) Missing info (n = 1) Assessed for Eligibility (N = 246) Excluded/Ineligible (n = 183) • Left appt early (n = 4) • Cancelled/no-show (n = 8) • Lack of staff (n = 11) • Missing info (n = 12) • Age (n = 74) • Lived far from clinic (n = 41) • Other (n = 30) • Missing info (n = 3) Approached.02) with 66.33 out of 10 (SD = 2. with 66.com.7% reporting that usual pain lasted 19 to 24 hours per day. (3) headache pain.50 days (SD = 0. Usual pain was 5. To subscribe. No referral information was available for two participants. Use ISSN#1078-6791. please visit copyright. Pain In the psychoeducation group. Usual pain severity was 6 out of 10 (SD = 1. 19.com Figure 1. and (4) psychiatry.71. (2) primary care. with both youth reporting usual and worst pain episodes lasting 1 to 2 hours per day.71) in the previous 2-week period. the four participants’ primary pain complaints included (1) chest pain. visit alternative-therapies. range = 3-5).12). To share or copy this article. ALTERNATIVE THERAPIES. Average attendance was 62% when combining both groups. Three of the 4 youth in the MBSR group reported experiencing pain every day during the 2-week period before the intervention.This article is protected by copyright.41) and worst pain was 7.83 out of 10 (SD = 1. Contacted (n = 63) Agreed to Participate/Randomized (n = 31) Allocation Allocated to MBSR Group (n = 26) • Received allocated intervention (n = 4) • Did not receive allocated intervention (n = 22) 0 Wave 4 cancelled due to recruitment difficulties (n = 8) 0 Withdrew prior to first session (n = 5) 0 Withdrew after first session (n = 3) 0 Lost to follow-up/unknown (n = 6) Follow-up Completed 4-wk follow-up (n = 2) Completed 12-wk follow-up (n = 2) Lost to follow-up: n = 1 at 4 wks (unable to contact) n = 1 at 12 wks (unable to contact) Analysis Allocated to Psychoeducation (n = 6) • Received allocated intervention (n = 2) • Did not receive allocated intervention 0 Withdrew prior to first session (n = 3) 0 Too busy to complete (n = 1) Completed 4-wk follow-up (n = 0) Completed 12-wk follow-up (n = 0) Lost to follow-up: No response to contact (n = 2) Analyzed (n = 4) Excluded from analysis (n = 22) • Did not receive intervention (n = 22) Analyzed (n = 2) Excluded from analysis (n = 4) • Withdrew from intervention (n = 4) (SD = 0. (3) orthopedics. (2) extremity pain. Jastrowski—Pediatric Chronic Pain Adolescents in the psychoeducation group reported experiencing pain for an average of 6. Worst pain was 7. NOV/DEC 2013. For the MBSR group. the primary complaint of the two participants was abdominal pain. 6 11 .5 out of 10 (SD = 2. Overall.
please visit copyright. 19.” One participant reported that it would be “very helpful” to learn about stress management and both reported that it would be “somewhat helpful” to meet other youth their age who experienced pain. Jastrowski—Pediatric Chronic Pain .com Table 1. In comparing the participants who completed the MBSR treatment versus those who withdrew prior to treatment.89.57 54. Individual Analyses Given the small sample size.67.09 66.5 0 1 -7 4 B C D E F G Abbreviations: CALQ = Child Activity Limitations Questionnaire.com.43 39.” Both reported that the group was “somewhat” relaxing. Use ISSN#1078-6791. A similar trend emerged for pain catastrophizing and anxiety. regardless of group assignment. both participants in the psychoeducation group reported expecting that the treatment would be “a little helpful. One reported that MBSR was “completely helpful” while the other reported that it was “not at all helpful.64 52.25). expected helpfulness of relaxation training (Mwithdrew(n = 6) = 3. MSES = Mindfulness Self-Efficacy Scale. SD = 1.25.13 63.17 47. VOL. PedsQL = Pediatric Quality of Life Inventory. To subscribe.83 47. Three of the participants in the MBSR group reported expecting that MBSR would be “somewhat” to “completely helpful.” At 12 weeks postintervention. SD = 0.25. Treatment Expectations and Experiences Prior to the intervention.61 58. SD = 1. Mcompleted(n = 4) = 3. Two participants in the MBSR group completed the questionnaire. SD = 1. SD = 0.48 30. General trends suggest that activity limitations decreased for some participants (C and E).00.53).26).00. SD = 1. To share or copy this article. while increasing or staying roughly the same for other participants. Mcompleted(n = 4) = 3.30 67. individual scores were plotted for the variables under investigation (Table 1 and Figure 2). and expected helpfulness of training on concentration (Mwithdrew(n = 6) = 3. Individual Scores on Variables Across the Study Time Points Participant A Time Pre Post 4 wks 12 wks Pre Post 4 wks 12 wks Pre Post 4 wks 12 wks Pre Post 4 wks 12 wks Pre Post 4 wks 12 wks Pre Post 4 wks 12 wks Pre Post 4 wks 12 wks CALQ 31 ---7 41 50 0 44 60 50 47 29 44 38 39 40 PedsQL 126.96.36.199).50.35 76.33. Increased mindfulness-based self-efficacy was noted for all participants. Mcompleted(n = 4) = 3. Half of the participants reported an increase in HRQOL.70 43. participants reported similar treatment expectations.03. no psychoeducation participants returned the treatment experiences questionnaire.39 82.10. SD = 0.83 53. visit alternative-therapies. 6 reported similar values on the expected helpfulness of MBSR (Mwithdrew(n = 6) = 3.26 PCS 20 45 36 27 17 12 28 25 34 27 33 36 25 36 43 State Anxiety 32 30 38 34 22 20 35 33 54 53 31 37 41 30 48 Trait Anxiety 30 40 38 40 32 29 44 44 58 59 45 41 41 43 44 MSES -15 -8 -11 -2 12 15 -6 -6 -6 -6 -10. expected helpfulness of homework (Mwithdrew(n = 6) = 2. Participants who completed MBSR and those who withdrew 12 ALTERNATIVE THERAPIES. NOV/DEC 2013. PCS = Pain Catastrophizing Scale for Children. SD = 1. Mcompleted(n = 4) = 2.This article is protected by copyright.
This finding is important because pediatric chronic-pain patients frequently experience numerous stressors in the domains of school. completed) Preintervention Postintervention Preintervention Postintervention (e) Participant E (mindfulness intervention. and family. completed) Preintervention 4-wk follow-up Preintervention Postintervention (c) Participant C (psychoeducation. The reasons reported by youth varied greatly as to why they were not interested in participating or decided to withdraw. In doing so. 6 13 . suggestions and recommendations are proposed for researchers and clinicians. Use ISSN#1078-6791. completed) (d) Participant D (mindfulness intervention. the atmosphere of the study’s MBSR program may have triggered anxiety or apprehension in some participants. Individual Plots of Primary Outcome Measures (a) Participant A (mindfulness intervention. controlled pilot study of MBSR in adolescents with chronic pain. however. peer relationships. NOV/DEC 2013. it may be that unique concerns apply when working with this age group. completed) (f) Participant F (mindfulness intervention. Although it is sensible to focus on adolescents.com Figure 2. given the propensity of adolescents to have heightened concerns related to fitting in and feeling self-conscious. please visit copyright. To subscribe. It is not difficult to imagine ALTERNATIVE THERAPIES. given the challenges in recruitment and attrition. Developmental considerations may also prove to be important factors in determining for whom MBSR will be most suitable and effective. One common theme was feeling too busy or overextended to dedicate the amount of time required by a MBSR program.This article is protected by copyright. visit alternative-therapies.com. completed) Preintervention 4-wk follow-up 12-wk follow-up Preintervention 12-wk follow-up DISCUSSION In the current study. the research team has reported on the first randomized. Qualitative analyses suggested that participants had positive expectations of MBSR. VOL. For example. it is important to examine factors possibly contributing to those challenges. The psychosocial stress that likely exacerbates chronic pain symptoms is serving as an impediment to participating in a treatment program that may help to develop new ways of managing stress and pain more effectively. 19. To share or copy this article. completed) (b) Participant B (psychoeducation.15-17 Perhaps one challenge when trying to engage youth with Jastrowski—Pediatric Chronic Pain chronic pain in a MBSR program is that some may feel too overwhelmed by other facets of their daily lives to enroll in an intervention that requires a considerable time commitment and perhaps little perceived benefit.
13(3):209-216. 10. Hainsworth KR. Clin J Pain. Hainsworth KR. and the Children’s Hospital of Wisconsin Foundation. Mindfulness self-efficacy scale (MSES). 2009. Biegel GM. Results suggest that developing effective short-term interventions may be the next step in exploring the effectiveness of MBSR for adolescents with chronic pain. Davies WH. Clin Child Psychol Psychiatry. Psychotherapy Theory Res Pract. 16. Seid M. 1973. negative perceptions of the time commitment-benefit tradeoff. Sherry DD. 2008. Joseph JM. DiClemente CC.8(9):746-752. Glass B. To subscribe. Adolescent-parent relationships in the context of adolescent chronic pain conditions. Researchers who want to examine use of MBSR in treatment of individuals with pediatric chronic pain may also consider offering incentives for participation. J Spec Pediatr Nurs. Pain. Chronic pain and its impact on quality of life in adolescents and their families. painrelated stress).17(3):213-218. School avoidance: implications for school nurses.22(6):576-583. Rose JB. Sibinga EM. Mindfulness-based stress reduction for urban youth. Med Care. MiCBT Institute Web site. In summary. Johnson K.12(3):210-212. J Clin Psychol Med Settings.mindfulness. McGrath PA. Ladwig RJ. 2013. visit alternative-therapies.37(2):126-139.24(2):172174. Valenzuela D. Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: a randomized clinical trial. J Pediatr Psychol. Logan DE. Hunfeld JA. Edwards CD. et al. as this readiness has been shown to be related to treatment progress and outcomes. Medrano GR. Poster presented at: National Conference in Pediatric Psychology. Drotar DD. Bohlmeijer ET. 8. 11. 2011. State-Trait Anxiety Inventory for Children.26(3):145-153.au/mindfulness-based-self-efficacy-scale. Speilberger CD. Perquin CW. Shigaki CL. 12. Text messaging: an innovative method of data collection in medical research. Schubert CM. Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. Studies with participants from adolescent psychiatry8 and primary care sources18 have used MBSR programs that were largely adapted from the adult MBSR program. Br J Health Psychol. Magyari T. Sirriyeh R. Oskam MJ. Cayoun BA. Development and validation of the Child Activity Limitations interview: a measure of pain-related functional impairment in school-age children and adolescents. 19. as it likely influences their acceptance of MBSR and willingness to devote extensive time and effort toward meeting the expectations of the program.com how a teenager might find it challenging to learn new skills and discuss private thoughts and experiences in a group of peers with whom the adolescent has never interacted. Conquering Your Child’s Chronic Pain: A Pediatrician’s Guide for Reclaiming a Normal Childhood. Similar efforts should be made toward promoting adherence to the MBSR program during treatment.19.22 This finding suggests that clinicians may find it helpful to employ motivational interviewing techniques or otherwise determine patients’ readiness to change. 2004. condition-specific barriers (eg. 2003. Varela Research Grant to KJM). Schreurs KM. Accessed September 11. http://www.104(3):639-646. Ward J. Researchers may benefit from the use of incentives and the use of engaging technology.152(3):533-542. et al. Bijttebier P. 2006. Kew S. 6 busy family lives. Prochaska JO. USA. and developmental stage. 1999. The child version of the pain catastrophizing scale (PCS-C): a preliminary validation. Mindfulness with children and adolescents: effective clinical application. REFERENCES 1. 2. 15. Witherspoon D. WI. it may be important to involve adolescents with chronic pain from the ground up in the development of the intervention rather than at the time that the intervention is ready to be implemented. Khan KA. Readiness to change in adolescents presenting with complex chronic pain. prior to the introduction of a novel therapeutic approach.net. adolescents present to treatment with various expectations and degrees of readiness to change. CA: Mind Garden. 7. Menlo Park. Pain. 2005.com. Guite JW. Jastrowski—Pediatric Chronic Pain . the Jane B. 2009. 2011. April 14-16. Transtheoretical therapy: toward a more integrative model of change.3:342. 3. San Antonio. J Pain. 20.109(3):461-470. Recruitment and attrition challenges may be linked to 14 ALTERNATIVE THERAPIES. Although the purpose of the current study was to investigate the effectiveness of MBSR in circumstances approximating real.21 In pediatric chronic pain.This article is protected by copyright. please visit copyright. Kabat-Zinn J. 9. J Consult Clin Psychol. it may be important to determine the benefit of employing incentives to improve recruitment of participants. The clinical use of mindfulness meditation for the self-regulation of chronic pain. NOV/DEC 2013. It is recommended that focus groups be used to help shape the design of future MBSR interventions and materials. 2007. VOL. 13. Physical activity and adolescents: an exploratory randomized controlled trial investigating the influence of affective and instrumental text messages. 22. J Pediatr Psychol. Complement Health Pract Rev. Zeltzer LK. Future studies would benefit from conducting needs assessments with representative samples drawn from the target population prior to designing and implementing a MBSR program. 19.20 The challenges faced in the current study suggest that it may be necessary for clinicians to assess each individual’s readiness for behavioral change. Lushene R. and lower readiness in treatment-seeking adolescents has been found to correlate with greater rates of pain catastrophizing and lower quality of life. Using technology that is appealing to adolescents may also help to improve treatment adherence to MBSR. Lawton R. Mobilehealth (m-health) approaches using cellular phones and palmtop computers are becoming increasingly common in pediatric health research as it has been shown that mobile technology can improve symptom monitoring and treatment adherence and can reinforce healthy behaviors. Mindfulness-based stress reduction in medical settings. Kerrigan D. Weisman SJ. Varni JW. NY: HarperCollins Publishers. 1985. Eccleston C. et al. Milwaukee. Veehof MM. Duivenvoorden HJ. html. Freestun J.77(5):855-866. Montuori J. Commentary: psychological interventions for controlling children’s pain: challenges for evidence-based medicine. Mindfulness research update: 2008. 1982. This sense of uncertainty about participating in a group format was explicitly reported by a subset of youth who chose not to participate or withdrew.8(2):163-190. 4.15(pt 4):825-840.world clinical experiences. J Altern Complement Med. Brown KW. 2006. New York. Crombez G. 14. 2001. Use ISSN#1078-6791. Nov 2010. Pain. BMC Res Notes. Given the complexity of pediatric chronic pain. Benefits include trends toward increased mindfulness and reduced functional disability. 5. Palermo TM. Greeson JM. This work was supported by the Mind and Life Research Institute (2007 Francisco J. 21. Thompson M. 17. Lipworth L. Ellen JM. Clinicians and researchers may benefit from an assessment of readiness for behavioral change. TX. Development and preliminary validation of the child activity limitations questionnaire: flexible and efficient assessment of pain-related functional disability.13(3):395-407. Burney R. AUTHOR DISCLOSURE STATEMENT The research was conducted at the Children’s Hospital of Wisconsin. Schopp LH. Gauntlett-Gilbert J. Pettit Pain and Palliative Care Center’s Chair Fund. Khan KA. 18. Rode CA. J Behav Med. this study expands the current understanding of both the benefits and challenges associated with MBSR for adolescents with pediatric pain. 1999.19(3):276-288. Dec 2010. 2007. 2011.14(1):10-18. Shapiro SL. 6. To share or copy this article. Stewart M. The PedsQL™: measurement model for the pediatric quality of life inventory.