Given that the aging population in the world is increasing [1], paying attention to this age group psychologically and physically is important to have a healthy society. Since the elderly may have cognitive problems and unrealistic thoughts and given that chronic pain disorder is very common among this age group and can affect their quality of life [2], pain perception and sleep quality [3, 4], it is necessary to seek treatment for them to increase their mental and physical health, and it is better to use treatments that do not have the side effects caused by taking drugs. In this regard, mindfulness therapy along with massage can be one of the useful treatment methods. Therefore, the present study aimed to determine the simultaneous effect of mindfulness training and aromatherapy massage on pain perception, sleep quality and quality of life in older women with chronic pain.

This is a quasi-experimental study with a pre-test, post-test, follow-up design using a control group. The study population consists of all women aged ≥60 years with chronic pain referred to clinics, hospitals and rehabilitation centers in the west of Tehran, Iran in 2017 to receive physiotherapy services. The sample size was calculated 15 for each group based on Cohen’s table considering effect size of 0.5, test power of 0.9 and error rate of 0.05 [5]. After obtaining the necessary permits from the university and receiving the code of ethics, a convenience sampling was conducted using inclusion criteria (being female, having old age and chronic pain, and no cognitive impairment measured by MMSE test) and exclusion criteria (use of psychiatric drugs, receiving other therapies simultaneously, absence from two or more sessions of intervention, unwillingness to cooperate, not signing the consent form to participate in the study, and not completing the questionnaires). Finally, 30 women were selected and randomly assigned to two matched groups. The groups were evaluated for in terms of pain perception, sleep quality and quality of life using the Short Form-McGill Pain Questionnaire-2 (SF-MPQ-2), the Pittsburgh Sleep Quality Inventory (PSQI) and the WHO Quality of Life Questionnaire, Brief Version (WHOQOL-BREF), respectively.
The intervention group underwent 10 sessions of 120 minutes of mindfulness group therapy plus aromatherapy massage according to Kabat-Zinn’s protocol [6] for 85 minutes and receiving aromatherapy massage training booklet prepared by Noavaran-e Salamat School and aromatic lavender essential oil for 35 minutes. The control group received no intervention. At the end of the intervention, the questionnaires were administered again to both groups. After 45 days, the questionnaires were completed again, and the collected data were analyzed by analysis of covariance (ANCOVA) in SPSS v. 19 software.

Before performing the multivariate analysis of covariance, its assumptions were examined. The results of Shapiro-Wilks test showed that the distribution of data in the two groups was normal for the three study variables (P>0.05). The results of Levene’s test were not significant (P>0.05) which confirmed the equality of variances. Hence, we were able to use parametric tests. The results of ANCOVA showed that the mean scores of post-test and follow-up were significantly different and the effect of group on sleep quality and quality of life was significant (P<0.05, η2=0.154-0.343). In the follow-up stage, the results showed that the effect of group on the pain perception was significant (P<0.05) while the effect was not significant on the sleep quality and quality of life (p>0.05). Regarding the dimensions of pain perception, post-test results were significant in all dimensions except for intermittent pain, and the effect of group on all four dimensions of neuropathic pain, affective pain, continuous pain, and intermittent pain was significant (P<0.05). However, the effect of group in the follow-up stage on dimensions of continuous pain and intermittent pain was not significant (P<0.05). Finally, results showed that mindfulness therapy combined with aromatherapy massage significantly improved the perception of pain and its components, as well as the quality of life and sleep quality in older women in the intervention group compared to the control group, and these effects remained stable on the pain perception variable in the follow-up phase in patients.

Simultaneous mindfulness therapy and aromatherapy massage reduce pain perception and improve sleep quality and quality of life in older women with chronic pain. Therefore, using massage techniques as a non-pharmacological strategy along with other treatment methods, along with teaching the patient to avoid negative thinking and pain-related rumination and have self-care skills through mindfulness reduce the severity of pain and cause relaxation in the elderly, limiting the possibility of complicated medical interventions and reducing the likelihood of functional disability. It is easy to use, safe, and cost-effective and is recommended in providing medical services to the elderly in the care centers.

All ethical principles were observed in this study. Informed consent was obtained from the participants after explaining the study method to them. They were assured of the confidentiality of their information and were free to leave the study at any time. This study obtained its ethical approval from the Islamic Azad University of Karaj Branch (Code: IR.IAU.K.REC.1397.51).

This study was extracted from the PhD. dissertation of the first author at the Department of Health Psychology, Karaj Branch, Islamic Azad University, Karaj.

All authors contributed equally in preparing this article 

The authors declare no conflict of interest.

The authors would like to thank all older adults participated in the study for their valuable cooperation as well as the Vice-Chancellor for Research of the Islamic Azad University of Karaj Branch

 

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