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Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: A systematic review and network meta-analysis
  1. Eve-Ling Khoo1,2,
  2. Rebecca Small1,3,
  3. Wei Cheng1,
  4. Taylor Hatchard4,
  5. Brittany Glynn1,
  6. Danielle B Rice1,5,
  7. Becky Skidmore6,
  8. Samantha Kenny1,7,
  9. Brian Hutton1,
  10. Patricia A Poulin1,8,9
  1. 1 Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  2. 2 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
  3. 3 Faculty of Medicine, Memorial University of Newfoundland, Newfoundland and Labrador, Canada
  4. 4 School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
  5. 5 Department of Psychology, McGill University, Montreal, Canada
  6. 6 Independent Information Specialist Consultant, Ottawa, Ontario, Canada
  7. 7 Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
  8. 8 Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
  9. 9 Department of Anesthesia and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr Patricia A Poulin, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; ppoulin{at}


Question This review compares mindfulness-based stress reduction (MBSR) to cognitive-behavioural therapy (CBT) in its ability to improve physical functioning and reduce pain intensity and distress in patients with chronic pain (CP), when evaluated against control conditions.

Study selection and analysis Ovid MEDLINE, EmbaseClassic+Embase, PsycINFO and the Cochrane Library were searched to identify randomised controlled trials. The primary outcome measure was physical functioning. Secondary outcomes were pain intensity and depression symptoms. We used random and fixed effects (RE and FE) network meta-analyses (NMA) to compare MBSR, CBT and control interventions on the standardised mean difference scale.

Findings Twenty-one studies were included: 13 CBT vs control (n=1095), 7 MBSR vs control (n=545) and 1 MBSR vs CBT vs control (n=341). Of the 21 articles, 12 were determined to be of fair or good quality. Findings from RE NMA for change in physical functioning, pain intensity and depression revealed clinically important advantages relative to control for MBSR and CBT, but no evidence of an important difference between MBSR and CBT was found.

Conclusions This review suggests that MBSR offers another potentially helpful intervention for CP management. Additional research using consistent measures is required to guide decisions about providing CBT or MBSR.

  • mindfulness-based stress reduction
  • cognitive-behavioral therapy
  • chronic pain; meta-analysis
  • randomized controlled trials

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  • Contributors E-LK reviewed the manuscript after the updated search. E-LK, DBR and SK completed data extraction and risk of bias assessments. DBR, PAP, E-LK, BG and SK completed updated review of full-text articles. E-LK and RS completed the initial review of full-text articles, data extraction, risk of bias assessments and wrote the manuscript. TH codeveloped the protocol for this review and oversaw abstract screening. WC and BH provided methodological expertise in the area of network meta-analysis, conducted all statistical analyses and prepared figures. BS wrote and performed the search strategy. BG reviewed the studies and contributed to the tables describing the characteristics of CBT and MBSR studies as well as assisting in the manuscript revisions and submission. BS provided expertise as an information specialist consultant in searching for articles to review. PAP codeveloped the review protocol and oversaw all aspect of the projects. All authors contributed to manuscript writing and review. All authors read and approved the final manuscript.

  • Funding BH is supported by a New Investigator award from the Canadian Institutes of Health Research and the Drug Safety and Effectiveness Network. No funding was received for this study.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Any additional unpublished data from this meta-analysis will be provided upon request by the corresponding author.

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