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만성통증에 대한 마음챙김의 뇌 생리학적 효과: 체계적 고찰

Brain physiological effects of mindfulness for chronic pain: A systematic review

고은미
한국건강심리학회 (Korean Health Psychological Association)|2023.11|한국심리학회지: 건강 (Korean Journal of Health Psychology)|제28권 제6호|pp. 1143-1163|DOI 10.17315/kjhp.2023.28.6.004

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마음챙김MindfulnessSystematic review체계적 고찰fMRI만성통증Neuroimaging기능성자기공명영상Chronic pain
주제분류심리과학

초록

마음챙김 훈련은 뇌 활성화를 조절함으로써 신체적 통증 감소에도 직접적인 영향을 미친다는 연구들이 지속적으로 증가하고 있다. 하지만 대부분의 연구들이 건강한 성인을 대상으로 의도적인 통증을 유발한 후 통증조절 효과를 확인하였다. 따라서 그 결과를 만성통증까지 일반화시킬 수 없다는 한계가 있다. 본 연구는 이러한 한계를 해결하기 위해 실제 만성통증으로 고통을 받고 있는 환자들을 대상으로 일정기간 마음챙김을 훈련시킨 후 그 효과를 뇌 생리학적으로 검증한 연구에 초점을 두었다. 이를 위해 PubMed와 Cochrane CENTRAL 데이터베이스를 이용하여 체계적 문헌고찰을 실시하였다. 포함기준에 충족된 연구는 총 4편이었고, 추가적으로 건강한 성인을 대상으로 한 4편의 연구와 비교하였다. 주관적 척도로 측정된 통증정도는 만성통증, 급성통증 모두 통제집단에 비해, 그리고 훈련 전에 비해 마음챙김 훈련 후 유의한 통증 감소를 보고하였다. 주관적 척도로 측정된 마음챙김 기술의 변화는 마음챙김 척도에 따라 차이를 보였다. 만성통증 연구에서는 2편의 연구가 CAMS-R과 KIMS로 마음챙김 변화정도를 측정하였고, 급성통증 연구에서는 2편의 연구가 FMI로 측정하였다. 그 결과, CAMS-R로 측정한 연구에서만 마음챙김 훈련 후 유의한 변화를 보이지 않았다. fMRI 측정 결과 만성통증, 급성통증 모두에서 마음챙김 훈련은 고차 뇌 작용인 하향통증조절경로를 활성화하여 통증의 감소를 가져왔다. 다만, 평균 10년 이상 훈련경험이 있는 경우 하향식 조절 대신 상향식 조절과 관련된 뇌 활성화를 보였다. 마음챙김의 수준에 따라 통증을 조절하는 뇌의 기제도 달라질 수 있음을 시사한다. 통증조절에 있어 마음챙김의 뇌 기제를 검증하는 연구는 아직 초기단계로 앞으로 더 많은 연구가 진행되어야 한다. 본 연구는 통증관리에 있어 마음챙김의 뇌 생리학적 효과를 만성통증과 급성통증으로 구분해서 비교한 첫 시도라는 점에서 의의가 있다. 본 연구 결과는 통증관리에 있어 마음챙김 훈련이 만성통증과 급성통증의 통증감소에 유의한 결과를 가져올 수 있음을 재확인하였다. 끝으로 향후 연구를 위한 제안을 논하였다.

Abstract

There is a continuous increase in the number of studies showing that mindfulness training has a direct effect on reducing physical pain by regulating brain activation. However, most of the studies have confirmed the effect of pain control after intentionally inducing pain in healthy adults. Therefore, the limitation is that the results cannot be generalized to chronic pain. In order to address this limitation, this study focused on works that verified the physiological effect of the brain after mindfulness training targeting patients with chronic pain. To this end, a systematic literature review was conducted using PubMed and the Cochrane CENTRAL database. A total of four studies met the inclusion criteria, and they were additionally compared with four studies in healthy adults. The degree of pain measured using a subjective scale showed a significant reduction in pain after mindfulness training compared to that in the control group and before training for both chronic pain and acute pain. Changes in mindfulness skills by using subjective scales showed differences according to the mindfulness scales. In the chronic pain study, two studies measured the degree of mindfulness change with the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) and Kentucky Inventory of Mindfulness Skills (KIMS), and in the acute pain study, two studies were assessed using the Freiburg Minfulness Inventory (FMI). Results showed that only the study assessed by CAMS-R showed no significant change after mindfulness training. Functional magnetic resonance imaging (fMRI) showed that mindfulness training in both chronic pain and acute pain reduced the pain by activating the descending pain modulatory pathways, which is a higher-order brain function. However, brain activation related to bottom-up regulation instead of top-down regulation was found in cases with a training experience of an average of 10 years or more. This suggests that the mechanism of the brain for controlling pain may also vary depending on the level of mindfulness. Studies verifying the brain mechanism of mindfulness in pain control is still in its infancy, and more research should be conducted in the future. This study is significant as it is the first attempt to compare the brain physiological effects of mindfulness in pain management by dividing them into chronic pain and acute pain. The results of this study reaffirmed that mindfulness training in pain management can cause significant pain reduction in chronic pain and acute pain. Moreover, suggestions for future research were discussed.

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