Enhanced mindfulness-based stress reduction in episodic migraine: a randomized clinical trial with magnetic resonance imaging outcomes.

Autor:	Seminowicz DA; Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, United States.; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, United States., Burrowes SAB; Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, United States.; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, United States.; Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, United States., Kearson A; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States., Zhang J; Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, United States.; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, United States., Krimmel SR; Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, United States.; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, United States.; Program in Neuroscience, School of Medicine, University of Maryland Baltimore, Baltimore, MD, United States., Samawi L; Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, United States.; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, United States., Furman AJ; Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, United States.; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, United States.; Program in Neuroscience, School of Medicine, University of Maryland Baltimore, Baltimore, MD, United States., Keaser ML; Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, United States.; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, United States., Gould NF; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States., Magyari T; Private Mindfulness-based Psychotherapy Practice, Baltimore, MD, United States., White L; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States., Goloubeva O; University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland Baltimore, Baltimore, MD, United States., Goyal M; Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States., Peterlin BL; Neuroscience Institute, Penn Medicine Lancaster General Health, Lancaster, PA, United States., Haythornthwaite JA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Jazyk:	angličtina
Zdroj:	Pain [Pain] 2020 Aug; Vol. 161 (8), pp. 1837-1846. Date of Electronic Publication: 2020 Mar 13.
DOI:	10.1097/j.pain.0000000000001860
Abstrakt:	We aimed to evaluate the efficacy of an enhanced mindfulness-based stress reduction (MBSR+) vs stress management for headache (SMH). We performed a randomized, assessor-blind, clinical trial of 98 adults with episodic migraine recruited at a single academic center comparing MBSR+ (n = 50) with SMH (n = 48). MBSR+ and SMH were delivered weekly by group for 8 weeks, then biweekly for another 8 weeks. The primary clinical outcome was reduction in headache days from baseline to 20 weeks. Magnetic resonance imaging (MRI) outcomes included activity of left dorsolateral prefrontal cortex (DLPFC) and cognitive task network during cognitive challenge, resting state connectivity of right dorsal anterior insula to DLPFC and cognitive task network, and gray matter volume of DLPFC, dorsal anterior insula, and anterior midcingulate. Secondary outcomes were headache-related disability, pain severity, response to treatment, migraine days, and MRI whole-brain analyses. Reduction in headache days from baseline to 20 weeks was greater for MBSR+ (7.8 [95% CI, 6.9-8.8] to 4.6 [95% CI, 3.7-5.6]) than for SMH (7.7 [95% CI 6.7-8.7] to 6.0 [95% CI, 4.9-7.0]) (P = 0.04). Fifty-two percent of the MBSR+ group showed a response to treatment (50% reduction in headache days) compared with 23% in the SMH group (P = 0.004). Reduction in headache-related disability was greater for MBSR+ (59.6 [95% CI, 57.9-61.3] to 54.6 [95% CI, 52.9-56.4]) than SMH (59.6 [95% CI, 57.7-61.5] to 57.5 [95% CI, 55.5-59.4]) (P = 0.02). There were no differences in clinical outcomes at 52 weeks or MRI outcomes at 20 weeks, although changes related to cognitive networks with MBSR+ were observed. Enhanced mindfulness-based stress reduction is an effective treatment option for episodic migraine.
Databáze:	MEDLINE
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