Twenty minutes of mindful breathing, which focuses a person’s attention on their breath, seems to rapidly reduce the intensity and unpleasantness of cancer pain and relieve the associated anxiety, suggest findings from a small comparative study published by Tan et al in BMJ Supportive & Palliative Care.
Study Background
Mindful breathing complements traditional pain relief and broadens the repertoire of options available for patients with cancer, according to the study authors. Moderate-to-severe pain affects an estimated 30% to 40% of patients with cancer worldwide, and originates from a variety of causes, such as the tumor compressing or invading surrounding tissues, neuropathic mechanisms, and the side effects of treatment.
Despite advances in pain management and an evolving range of drugs and nerve blocks, inadequate pain control remains a substantial challenge for clinicians, the authors added. Among the array of complementary treatments, such as cognitive behavioral therapy, massage, acupuncture, and exercise, the value of mindfulness-based interventions is increasingly being recognized. But the research to date on the effectiveness of mindfulness for pain relief has primarily focused on programs lasting several weeks or for just 5 to 10 minutes, or have focused on people who don’t have cancer.
Study Methods
In light of previously published research indicating that periods longer than 10 minutes might effectively relieve pain, the researchers wanted to find out if a single session of mindfulness breathing lasting 20 minutes might do the same for patients with cancer.
To find out, they randomly assigned 40 inpatients with different types of cancer and a pain score of 4 or higher out of 10 (indicating moderate-to-severe pain) to one of two groups. One group (n = 21) participated in a mindful breathing session guided by a doctor who had been trained in mindfulness techniques. The session involved a brief explanation of mindfulness concepts and practices, followed by 20 minutes of mindful breathing. The session consisted of four steps, each lasting 5 minutes: identifying the in-breath and out-breath; following the entire length of the breath; bringing the mind back to the body; and relaxing the body, starting with the head all the way down to the feet. The other group (n = 19) received a 20-minute supportive listening session led by a doctor, during which they were asked about their experiences of illness using semistructured questions.
Before and after each intervention, the intensity and unpleasantness of every patient’s pain was measured using the validated Numeric Rating Scale (0-10), whereas the Hospital Anxiety and Depression Scale (HADS), consisting of 14 items rated on a 4-point scale, was used to assess their mood. Background information and pertinent clinical data, such as cancer types and stages and use of pain relief, including morphine, were retrieved from the hospital’s medical records.
The patients’ average age was 63 years, and although various cancer types were represented among them, one in three had colorectal cancer cancer. Twenty-nine patients had stage III or IV disease. Nearly two-thirds (65%) were using opioids to control their pain.
Findings
The results showed that the mindful breathing group experienced a much greater—and significant—reduction in pain intensity and pain unpleasantness than the comparison group. They also experienced a much greater reduction in HADS score.
The researchers acknowledge the relatively small size of the study and the fact that it was a single-center design. The nature of pain intensity/unpleasantness and psychological outcomes were also subjectively assessed. But patients with cancer often face practical constraints, so brief mindfulness interventions that can quickly reduce pain and complement traditional pharmacologic approaches are worth exploring, the study authors suggested.
“Additionally, the 100% response rate and the absence of adverse events underscore the feasibility and safety of the 20-minute mindful breathing intervention. The intervention can be quickly learnt and applied with beneficial effect,” they added.
“The findings suggest that this brief intervention holds promise in reducing pain intensity and unpleasantness, as well as alleviating anxiety among patients with cancer. While further research is needed to consolidate these findings, the study contributes valuable insights into a feasible and accessible nonpharmacological approach to enhance pain management in cancer care,” they concluded.
Disclosure: For full disclosures of the study authors, visit spcare.bmj.com.
