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It eases the depression that often accompanies the condition, study finds
Sep 28, 07
For rheumatoid arthritis sufferers whose painful illness prompts depression, relief may come from the practice of an age-old technique already embraced by millions around the world: meditation.
Researchers found that a half-year exposure to meditation techniques helped patients shave as much as one-third of their psychological distress.
The research team, led by Elizabeth K. Pradhan of the University of Maryland School of Medicine's Center for Integrative Medicine, based its conclusions on an analysis of a specific training course called "Mindfulness-Based Stress Reduction" (MBSR).
Pradhan and her colleagues said the MBSR concept of "mindfulness" is designed to guide patients to focus on the "here and now," while emphasizing the value of calmness, clarity, well-being, and a compassion for oneself and others.
The Arthritis Foundation has said that several so-called "mind-body practices" may help arthritis patients alleviate stress, pain, anxiety and depression.
In addition to meditation, the organization acknowledges the potential of electronic monitoring techniques such as biofeedback; the mental health benefits of guided imagery and hypnosis; and the ability of physical activities such as yoga and tai chi to both calm and energize patients.
The Maryland researchers noted that prior studies had already shown that the MBSR course, in particular, seems to have a positive impact on the psychological symptoms of patients with conditions such as anxiety disorders, chronic pain, fibromyalgia, cancer and multiple sclerosis. Patients recovering from organ transplant surgery also seem to derive some benefit, the researchers said.
For their study, published in the October issue of Arthritis Care & Research, Pradhan and her colleagues focused specifically on rheumatoid arthritis. It was the first-ever analysis of MBSR and its impact on depression, general well-being, and disease progression among rheumatoid arthritis patients, the researchers said.
Thirty-one patients were offered the mediation course over an eight-week period, followed by a four-month maintenance program. Another 32 patients did not participate but were told they would be offered free meditation training once the study was completed.
With an average age of 54, most of the patients were female, white, married, college-educated, middle-class, and all were free of either psychiatric illness or alcohol or drug addiction.
During the trial, all the patients continued to be treated by their regular doctor and to take whatever medication they'd been taking before the study began.
At the start of the study, and two and six months later, all the patients completed questionnaires to assess depressive symptoms and psychological distress. Also, blood measures of inflammation were taken and an assessment of tender and swollen joints was done to evaluate current RA status.
By the two-month mark, both the meditation and the non-meditation groups had shown equal levels of improvement in terms of depression and emotional symptoms.
But by six months, there was a "significant" difference in perceived psychological distress between the two groups -- those practicing mediation reported a 35 percent reduction in psychological distress.
The researchers emphasized, however, that the meditation had no impact on the progression and activity of RA disease itself.
Pradhan and her team concluded that the meditation technique offered rheumatoid arthritis patients a safe and appealing way to improve their sense of well-being, when offered alongside traditional medical care.
"There's a fair amount of emotional distress that accompanies RA in terms of stability, worrying about the future, worrying about the ability to take care of oneself, to keep a job, to say nothing about the daily pain," Pradhan said. "There's just a lot to deal with. So, I think this is a novel and innovative way to handle this emotional distress and one that hasn't been tried before, and we were happy to see that it did make a difference along those lines.
"It doesn't really change disease status. That didn't happen," she said. "But in terms of ability to cope with a chronic and debilitating condition, meditation did appear to be quite helpful. And there was really high satisfaction with the intervention. So, I think this bodes well for the future.
"The other thing I think is important to note about our study," Pradhan said, "is that mindfulness meditation can be combined with any rheumatological therapy. It is truly complementary medicine in that sense, done in addition to pharmacological or other intervention. So, for physicians and patients who wonder what they can do to improve well-being, beyond taking medications, this study offers evidence for a beneficial approach to dealing with the psychological distress of RA.
Dr. Stephen Lindsey, head of rheumatology at Ochsner Health Systems in Baton Rouge, La., applauded Pradhan and her team for managing to get a scientific handle on a phenomenon he has observed throughout his practice.
"If someone is having stress and trouble with their arthritis, if you can somehow decrease the stress, you might be able to increase their function," Lindsey said. "And when you're meditating, you're trying to relax your body and get rid of the tension. It doesn't necessarily have to be a meditation scheme. It could be yoga, or Pilates, or a self-help course. But I'm in favor of using everything possible to help people, and this would be just one more way to help patients improve their lives."
SOURCES: Elizabeth K. Pradhan, Ph.D., the Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore; Stephen Lindsey, M.D., head, rheumatology, Ochsner Health Systems, Baton Rouge, La.; October 2007, Arthritis Care & Research
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