Comparison of the Efficacy and Mechanisms for MBCT and CT for Multiple Sclerosis (MS) Chronic Pain

Chronic pain is a pervasive, serious problem for many individuals with multiple sclerosis
(MS) that is typically inadequately treated by medications alone. There is a critical need
to develop and evaluate innovative psychosocial interventions that have the capacity to
effectively target the multidimensional nature of MS pain. Cognitive Therapy (CT) is one
psychosocial treatment that has been found to be a potentially beneficial treatment for
chronic MS pain. This approach teaches patients to identify and replace unhelpful thoughts
about pain with helpful, more adaptive thoughts. In addition, over the past decade there has
been a steady upsurge of research examining mindfulness meditation-based therapies for the
treatment of medical conditions, including symptoms associated with MS. Mindfulness
mediation involves training the mind to disengage from automatic thinking patterns to
mindfully perceive, in a non-judgmental manner, one's moment-to-moment experiences. This
meditation technique teaches patients to become aware of thoughts, emotions, and physical
sensations and to recognize that these are transient experiences that can be mindfully
perceived, accepted and let go. A promising, more recent trend in treatment development
research is the integration of tradition CT with mindfulness-based meditation, an approach
referred to as Mindfulness-Based Cognitive Therapy (MBCT). To date, we are the only research
group that has adapted and tested a manualized MBCT approach for the treatment of painful
medical conditions. Thus, the proposed pilot randomized controlled trial aims to utilize
state-of-the-art research methodology to evaluate traditional Cognitive Therapy (CT)
compared to an innovative, newly developed Mindfulness-Based Cognitive Therapy (MBCT)
protocol for the treatment of chronic pain in individuals with multiple sclerosis. This
study will answer three primary questions: (1) Do these treatments work to improve chronic
pain for individuals with MS and do these treatment also improve associated symptoms such as
depression, fatigue, and engagement in daily activities?; (2) How do these treatments work
in individuals with MS, i.e., what factors underlie improvement in outcomes during
treatment?; and (3) What are the individual person characteristics that best predict
outcome? This will be the first study to examine MBCT within an MS population. The results
will lead to the emergence of a novel, much needed additional psychosocial treatment option
for patients with chronic MS pain.