Evaluating the Effectiveness of Mindfulness Meditation (iRest) for Chronic Musculoskeletal Pain in U.S. Veterans Using the Defense and Veterans Pain Rating Scale.

INTRODUCTION:

• This pilot study evaluated the effectiveness of mindfulness meditation (MM) for managing chronic pain in U.S. military veterans who have sustained a traumatic brain injury (TBI) during deployment to Afghanistan (OEF) or Iraq (OIF). Musculoskeletal pain conditions are the most frequently diagnosed health condition in this military cohort, exceeding any other medical or psychological concern (1, 2).
• Chronic pain is also highly comorbid in veterans who have sustained a TBI in theater, with up to 75% exhibiting both conditions concurrently (3). The prevalence of chronic pain and TBI supports the need to investigate effective treatments and assessment methods for patients with these two health conditions.
• Integrative Restoration Yoga Nidra (iRest®), a type of MM, is a Tier I intervention for managing pain in military and veteran populations (4) and is used clinically at VHA medical centers nationwide. Developed by Dr. Richard Miller, iRest promotes deep relaxation through breathing, guided imagery, and progressive relaxation techniques. This is the first study to research iRest as an intervention for chronic pain.
• Three metrics were used to assess self-reported pain: Visual Analogue Scale (VAS), Brief Pain Inventory (BPI) and Defense and Veterans Pain Rating Scale (DVPRS). The VAS exclusively measures pain intensity, whereas the BPI and DVPRS assess both pain intensity (referred to as “pain severity” for the BPI) and pain interference.
• The DVPRS was recently developed for use in military and veteran populations to provide more descriptive pain data than the commonly used numeric rating scale (NRS). The DVPRS measures pain intensity using an NRS enhanced by visual cues and verbal descriptors to improve interpretability of incremental pain intensity levels (Figure 1). The DVPRS also includes 4 supplemental questions to assess perceived interference of pain with general activity, sleep, mood and stress (Figure 2). Limited information exists regarding the validity of the DVPRS (5). To our knowledge this study represents the first use of the DVPRS in a research setting.
• This study examined whether iRest, as an adjunctive therapy to standard medical care, relieves chronic pain more effectively than standard care alone. Based on previous research supporting the benefits of MM on chronic pain (6, 7), we hypothesized that iRest practice would result in lowered pain intensity and pain interference as measured by the previously listed instruments.