Pain is a common occurrence in the lives of adolescents, with one-third of youth reporting recurrent weekly pains (Stanford et al., 2008). Researchers have shown that a number of psychological variables impact the pain experience of young people including pain-related catastrophizing (Vervoort et al., 2007), anxiety (Pagé et al., 2010), and memories (Noel et al., 2010). In the adult literature, the construct of mindfulness has recently received attention for the role it may play in attenuating negative reactions to pain. Unfortunately, no research to date has examined the influence of trait or state mindfulness on the experience of pain in adolescents.

Mindfulness refers to a state of consciousness that involves purposefully paying attention to moment-to-moment experience in a nonjudgmental and accepting manner (Kabat-Zinn, 1996). Mindfulness can be viewed as a trait (the tendency to be mindful over time) or a state (how mindful one is at a given moment). It is believed that trait and state mindfulness can be enhanced through meditation practice (Carmody & Baer, 2007). Research with adults has generally found that higher levels of trait mindfulness are associated with more adaptive coping with chronic pain (Schūtze et al., 2010), and brief mindfulness interventions have been shown to reduce acute pain (Zeidan et al., 2010). Encouragingly, among adolescents trait mindfulness has been found to predict fewer symptoms of physical illness in healthy populations (Greco, Baer, & Smith, 2011), but no research has directly examined its influence on pain.

The purpose of this dissertation project is threefold. First, to examine the association between trait mindfulness, day-to-day pains and other pain-related variables (e.g., catastrophizing, anxiety). Second, to examine the effects of a brief mindfulness intervention on acute experimental pain. Finally, to examine the impact of the mindfulness intervention on memory for an acute pain experience.

Design and Methods

Using a randomized between-subjects design, 150 to 200 adolescents are being recruited to take part in this study. Efforts have been made to ensure that participants have a range of experiences with meditation through a local Shambhala Buddhist community in Halifax, Nova Scotia, as well as through the general population.

Participation takes place at the Centre for Pediatric Pain Research at the IWK Health Centre in Halifax, Nova Scotia, and involves three parts. Initially participants complete self-report measures of pain catastrophizing, pain anxiety, and trait mindfulness, followed by an interview to assess the frequency, duration, intensity, and functional disability related to day-to-day pains. It is hypothesized that trait mindfulness will be negatively associated with pain catastrophizing, pain anxiety, and pain-related disability.

In the second part of the study, participants will take part in an experimental pain task the cold pressor task (CPT). Before taking part in the CPT, participants will be randomly assigned to receive either a brief mindfulness intervention or a no-treatment control. The mindfulness intervention consists of instructions for the participant to become aware of the feelings of their body and the breath, to notice when awareness becomes distracted, and to bring awareness back to the body or breath. In addition, participants are instructed to bring a curious and accepting attitude to what is taking place. They are then instructed to bring this same awareness to the sensations they feel during the CPT.

In the no-treatment control condition participants are simply instructed to read quietly for 10 minutes, and then to use whatever strategies they would typically use during the CPT. The CPT involves placing the hand in a cooler of five degrees Celsius cold water for as long as tolerable. After removal of the limb, participants rate how intense their pain and pain-related anxiety was during the task. It is believed that the mindfulness intervention will increase pain tolerance, and reduce pain intensity and anxiety.

Finally, participants will be contacted two weeks later by phone and complete an interview on their memory of the pain task.

Research has shown that individuals who have exaggerated memories of painful experiences are at increased risk for subsequently painful experiences (Noel et al., 2010). It is hypothesized that individuals in the mindfulness condition will have less negatively exaggerated memories as this intervention is designed to bring non-judgmental attention to what is taking place during the pain task.

Potential Clinical/Research Implications

This study will be the first to examine the influence of trait mindfulness and a brief mindfulness intervention on the pain experience of adolescents. The results of this project may be used to inform the use and development of mindfulness-based interventions for use with adolescents for whom pain is a primary issue.

By examining how mindfulness affects other pain relevant variables it is expected that this study will make a significant contribution to our theoretical understanding of the processes by which mindfulness may alter the pain experience. This will also serve as one of the first investigations of the clinical use of a brief mindfulness intervention for acute pain in adolescents with and without meditation experience. We believe this project may also serve as an important first step in the development of mindfulness-based interventions for acute pain in this population.

References

Carmody, J., & Baer, R. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31, 23-33.

Greco, L. A., Baer, R. A., & Smith, G. T. (2011). Assessing mindfulness in children and adolescents: Development and validation of the child and adolescent mindfulness measure. Psychological Assessment, 23, 606-614.

Kabat-Zinn, J. (1996). Full catastrophe living : How to cope with stress, pain and illness using mindfulness meditation. London: Piatkus.

Noel, M., McMurtry, C. M., Chambers, C. T., & McGrath, P. J. (2010). Children’s memory for painful procedures: The relationship of pain intensity, anxiety, and adult behaviors to subsequent recall. Journal of Pediatric Psychology, 35, 626-636.

Pagé, M. G., Fuss, S., Martin, A. L., Escobar, E. M. R., & Katz, J. (2010). Development and preliminary validation of the child pain anxiety symptoms scale in a community sample. Journal of Pediatric Psychology, 35, 1071-1082.

Schütze, R., Rees, C., Preece, M., & Schütze, M. (2010). Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. Pain, 148, 120-127.

Stanford, E. A., Chambers, C. T., Biesanz, J. C., & Chen E. (2008). The frequency, trajectories and predictors of adolescent recurrent pain: A population-based approach. Pain, 138, 11-21.

Vervoort, T., Goubert, L., Eccleston, C., Bijttebier, P., & Crombez, G. (2006). Catastrophic thinking about pain is independently associated with pain severity, disability, and somatic complaints in schoolchildren and children with chronic pain. Journal of Pediatric Psychology, 31, 674-683.

Zeidan, F., Gordon, N. S., Merchant, J., & Goolkasian, P. (2010). The effects of brief mindfulness meditation training on experimentally induced pain. The Journal of Pain, 11, 199-209.