Article by Nathan Wei
Today, arthritis patients are not only more receptive to complementary therapies- what has been called alternative therapy- but actually prefer it to conventional medicines.
There are many reasons for this. These reasons include the adverse publicity surrounding the side effects of medicines such as Vioxx and Bextra, cost of pharmaceutical agents, insurance restrictions that make it difficult for patients to get the types of medicines they need, and the widely held concept that “natural” implies safe.
As has been demonstrated on multiple occasions, a natural remedy is not necessarily safe, nor is it necessarily even effective.
However, there are natural therapies for which there is little evidence supporting their usefulness in conditions like arthritis, but also a paucity of data showing they are harmful.
Such is the case with meditation. Meditation not only is safe but has had beneficial applications in other rheumatic conditions such as fibromyalgia.
A recent study has demonstrated that meditation may also be useful as an adjunctive treatment for rheumatoid arthritis (RA).
A meditation training program, called Mindfulness-Based Stress Reduction (MBSR) was developed by Dr. Kabat-Zinn and other researchers at the University of Massachusetts Medical School. MBSR teaches participants to focus the mind in a special way. This technique is supposed to increase clarity and calmness.
Researchers at the University of Maryland School of Medicine assessed the effect of this meditation therapy on depressive symptoms, psychological distress, general well-being, and disease activity among RA patients. The results of the study indicates that there are potential benefits of MBSR and that it can be used with a conventional course of physical and pharmacological therapy.
Sixty-three adult RA patients were selected to participate in this novel pilot study. The subjects averaged 54 years in age and predominately women. All patients remained under their rheumatologist ‘s care and continued to take their routine medications throughout the study.
Thirty-one of the participants were randomized to receive MBSR therapy, starting with an 8-week training course followed by a 4-month maintenance program. The remaining 32 participants were assigned to a waiting list, agreeing to attend assessment sessions in exchange for free MBSR training at the study’s conclusion.
Both groups of participants underwent psychological and rheumatological examinations at baseline, and again at 2 months and 6 months into the study. Researchers used the Symptom Checklist-90-Revised, a self-report questionnaire, to evaluate depressive symptoms and psychological distress. Overall well-being was measured by the Psychological Well-Being Scales, made up of questions designed to evaluate positive outlook and approach to coping with difficulties. RA clinical factors were assessed by the Disease Activity Score in 28 joints (DAS-28).
Researchers compared scores of psychological and physical disease symptoms among MBSR participants with those of the control group. Patients receiving MBSR found the program to be enjoyable and continued throughout the follow-up period.
After 2 months, both groups showed improvements in depressive, psychological, and emotional symptoms, with no significant difference between the MBSR group and the control group. By 6 months, however, gains in the control group had largely disappeared, while MBSR participants maintained or improved further in psychological outcomes. By the end of the study, the MBSR group achieved a significant 35 percent reduction in psychological distress.
The meditation program had no impact on RA disease activity, measured by the DAS-28, which is a composite score derived from swollen joints, tender joints, and the erythrocyte sedimentation rate (ESR).
The studies flaws include its small sample size and the relative homogeneity of the control group.
The study showed that patients with RA may benefit from a meditation progra m such a s MBSR class. MBSR is also safe and appealing to participants. The lead investigator, Dr. Elizabeth Pradhan, also states, “For doctors wishing to offer patients a complement to medical management, mindfulness meditation may offer hope for improving psychological distress and strengthening well-being in patients with RA.”
(Pradhan EK, et al. Effect of Mindfulness-Based Stress Reduction in Rheumatoid Arthritis Patients. Arthritis Care & Research. October 2007).
About the Author
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment