# Mindful Action for Pain: An Integrated Approach to Improve Chronic Pain Function

> **NIH VA IK2** · VA SAN DIEGO HEALTHCARE SYSTEM · 2022 · —

## Abstract

Chronic pain, defined as persistent or episodic pain that does not resolve with treatment, affects up to
50% of Veterans, costs the nation between $560 and $635 billion dollars annually, and is associated with high
rates of disability and low quality of life. According to the 2009 Veterans Health Administration (VHA) Directive,
the goal of pain treatment is to improve physical and psychosocial functioning, emphasizing non-
pharmacological approaches, such as psychosocial interventions, to target psychosocial factors that maintain
disability. Unfortunately, the gold standard psychosocial intervention for chronic pain, Cognitive Behavioral
Therapy (CBT), does not reliably produce meaningful increases in function. Veterans would greatly benefit
from innovative and theoretically-grounded alternative psychosocial interventions for chronic pain.
 An emerging scientific model that has been applied to chronic pain is the psychological flexibility (PF)
model. PF refers to the ability to behave consistently with one's values even in the face of unwanted thoughts,
feelings, and bodily sensations such as pain. Acceptance and Commitment Therapy (ACT) is the best known
treatment derived from the PF model and is as effective as the gold standard CBT, but still falls short on
achieving meaningful changes in functional improvement. Although ACT was designed to impact PF, methods
from different treatment approaches are also consistent with the model. An experiential strategy that holds
promise for enhancing PF is formal mindfulness meditation, a practice used to train non-judgmental awareness
and attention to present-moment experiences, which has never been tested within the PF model. There is
compelling theoretical and empirical rationale that the mechanisms underlying formal mindfulness meditation
will bolster PF processes and thereby can be applied to facilitate functional improvement. To test this, Dr.
Herbert, the principal investigator (PI), has developed a novel 8-week group-based intervention, Mindful Action
for Pain (MAP), which integrates formal mindfulness meditation with experiential methods from different
evidence-based treatment approaches in accordance with the PF model. MAP is designed such that daily
mindfulness meditation practice is used to develop the capacity to more completely utilize strategies to address
the key psychosocial barriers (e.g., pain catastrophizing) to optimal functioning.
 The proposed CDA-2 consists of two phases. Phase 1 (years 1 – 2) consists of using qualitative and
quantitative methods to iteratively develop and refine MAP (n = 20). Phase 2 (years 3 – 5) consists of a pilot
randomized trial (n = 86) of MAP vs. CBT for chronic pain (CBT-CP) in order to establish feasibility of a future
large-scale trial and estimate the preliminary impact of MAP. Functional improvement will be measured by
reductions in pain interference (primary clinical outcome). Further, meditation adherence will be assessed to
explore dose-response rela...

## Key facts

- **NIH application ID:** 10396993
- **Project number:** 5IK2RX002807-04
- **Recipient organization:** VA SAN DIEGO HEALTHCARE SYSTEM
- **Principal Investigator:** Matthew S Herbert
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-04-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10396993

## Citation

> US National Institutes of Health, RePORTER application 10396993, Mindful Action for Pain: An Integrated Approach to Improve Chronic Pain Function (5IK2RX002807-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10396993. Licensed CC0.

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