Chronic pain: ethno-cultural variation and the role of mindfulness

Chronic pain has been associated with significant distress and disability (Dahl, Wilson & Nilsson, 2004; McCracken, Eccleston & Vowles, 2005). Consequently, it has been the focus of much investigation in the search for evidence based clinical interventions. Recent empirical inquiry has identified the role of psychological and social factors in the prediction of these adverse effects (Green et al., 2003; Keefe et al., 2000; Severeijns, van der Hout, Vlaeyen & Picavet, 2002). This thesis explores two of these social and psychological spheres. Firstly, a literature review was conducted that systematically assessed ethno-cultural variation in physical and psychological functioning and related processes in people experiencing chronic pain. Studies were included where participants were differentiated into at least two ethnically or geographically defined cultural groups. Some evidence was provided for ethno-cultural variation in North America. Overall, however, research studies were limited by weak designs, sparse cultural groups and a failure to address process issues. Secondly, this thesis explored the concept of mindfulness which originates from Eastern traditions of Buddhist Vipassana philosophy and practice and involves moment-to-moment, non-judgmental and non-responsive attention and observation of thoughts, feelings and bodily sensations (Baer, 2003; Kabat-Zinn, 1982). A quantitative study examined the role of catastrophising and kinesiophobia for the operation of mindfulness benefits in people with chronic low back pain. Questionnaire assessments of mindfulness, pain intensity, disability, affect, pain catastrophising and kinesiophobia were collected from 116 adults embarking on a pain management programme. Longitudinal questionnaire data was also collected from 87 of these participants. Findings provided some support that mindfulness acts as a protective agent against catastrophising, kinesiophobia, disability and distress. As a result of these investigations, suggestions were identified for future research and effective chronic pain interventions. The critical appraisal encapsulates reflection on the processes and stages involved in the thesis and highlights avenues for chronic pain research linking ethno-cultural factors and mindfulness.